Blanche: a poem by Sophie Howard

It’s 11/11 or Remembrance Day, as it’s known throughout the Commonwealth. On this day, we commemorate those who fell in service to the Crown. No holiday or day of commemoration has spawned as much poetry as Remembrance Day. There’s the classic, For the Fallen by Laurence Binyon, Alan Seeger’s Rendezvous with Death, and, of course, In Flanders Fields by John McCrae, which established the poppy as the symbol of Remembrance Day. I’m glad there’s so much poetry around. Remembrance Day is a different subject for me to write about, so I get to resort to the wit and words of others.

This one is a little different. There’s plenty of poetry that deals with us, the protagonists of this struggle, very much at the expense of those who suffer most from war: the civilian population, especially children. A poetic reflection on a story about a young girl in World War II, this poem was written by my niece, Sophie Howard. It is her debut poem, and at the tender age of twelve no less. It’s rare for someone so young to understand something she has been so fortunate not to have to experience first-hand with such profundity and treat it with such tenderness and grace. Like her, this poem is pure amazingness, and an utter privilege to be let into this incredible young lady’s thinking about war from a child’s perspective.


by Sophie Howard

Men go off,
Down the street.
Like a parade,
To the beat.
They hope to win,
So they need food.
No one argues
Though there’s long queues
I go to school,
I go back home.
This cycle goes
For weeks unknown.
Trucks go through town
On cobblestone.

One got wedged
In the mud.
A boy jumped out
Lands with a thud.
Runs away
That he tries
Straight into
The mayor’s open arms.
He gets dragged back
to the truck,
Which is now unstuck.
Now I wonder
Why he’s there.
Out of the truck
More faces stare.

I shall follow,
I run along.
I run fast
And strong.
I follow it,
Past signs
That say

Through the trees
And bars I go.
The truck’s ahead,
But there’s a road.
The sticks and leaves
Scrape my face.
Like angry cats
I say.
When I feel
I cannot go on.
I reach a clearing
Before too long
I look around,
This is wrong.
Why are the men
Doing this?

Silent children from behind a fence,
Hardly took a breath.
Hungry eyes looking on,
Never taking rest.
Shouts and cries,
For food they long.
They are hungry,
But food I have none.
The cries go on,
Long and loud.
The noise reduced,
To distant sound.
Slowly I leave,
But will come back.
With the food
That they lack.

I go back,
Into the mist.
To the town,
Where I have lived.
Those children,
That is wrong.
They should live
A life that is long.
They should go
To school as well.
If they can read,
I cannot tell.
I reach my home
In not too long.
Behind the fence,
They are strong.
They live without
The things they need.
There are things,
they can achieve.

From my plate,
I take food.
More than I need
From the school.
I walk along,
With heavy bag.
To those that trapped,
Who are sad.
I learn their names,
Like Jess and John.
We are friends,
before too long.
Why they are there,
I do not know.
Conditions get worse.
It starts to snow.

It’s now cold,
Snow and ice.
Men come back,
Lost the fight.
I still go,
to the fence.
Every day
None of rest.
Once I come,
There is none,
Nothing there,
And no more sun.
I smell smoke.
It’s a scare.
Hard to see,
Misty air.

Crunch of sticks,
Behind me now.
There’s nothing there,
No more sound.
I see a man,
A silhouette.
With a gun,
I now fret
I hear a shot,
I hit the ground.
Now I feel nothing,
There is no sound.
Nothing more
No more snow.
Spring has come,
For all to know.

(C) Sophie Howard, 2018.

Miss Howard (*2006) was born and raised in Queensland, Australia.

An epitaph on a life of service

They say your first boss is your most memorable one – the one that shows you the ropes about what work means and how to do it. This is not about my first boss, but my most memorable one. She wasn’t even my boss for particularly long, but only for the few months of a summer internship at the European Parliament. But she passed on some lessons to me that I might not always have been able to live up to, but I sure as anything never forgot.

It was the summer after my first year at Oxford, and my time in Brussels seemed to start under an ill omen: the turbine cowling of the plane I flew in on detached during landing, leaving the travelers on the starboard side seated around the wing screaming like a class of schoolkids on a rollercoaster. For that reason, we had to land at a divert field, which was out in the middle of nowhere, and my escort, whose phone number I did not know, was waiting for me at the other airport. My entry passes weren’t ready. And, of course, not only was I late for my first day because I inherited my father’s inability to read a map, I also had a whole flock of butterflies in my stomach.

“You’ve… grown!”, I heard her say immediately as she saw me. I hastily tried to recall when we last met – it was, I eventually recollected, more than half decade earlier, at a state dinner during her tenure as ambassador to Vienna, to which my father let me tag along, that we last saw each other. Her husband, a keen yachtsman, quite enjoyed having someone to ‘talk shop’ with, something he certainly did not seem to have had much occasion to in Vienna. And there I was, so many years later, in an almost entirely different world – she was now an MEP,1 I finished my first year in Oxford a few weeks earlier. I have gone from a chubby four-foot-something to a muscular 6’2″, no doubt helped by my physically and mentally intense freshman year. And with that single sentence, she dispelled all my anxiety and apprehension.

In retrospect, it’s silly how something so irrelevant could put me at ease immediately. I would learn, eventually, that this was part of her superpower. She was not a career politician. She was not a career diplomat, though she could be plenty diplomatic. She was far from a career Eurocrat. But she had the skill to put everyone at ease, find a voice with a range of people and say the right thing every time. In my personal diary, I wrote this about her style: “she could talk to butterflies.2 And that included not merely her ability to talk to everyone of all ranks and stripes, but a character that earned a begrudging respect even from her fiercest rivals.

She was not a believer in equal opportunities, but in fairness to all and responsibility according to merit. With my area of responsibility focusing on the Single European Sky Air Traffic Management Research and the Galileo GPS network, not only did she not mind taking advice and asking questions from a barely twentysomething intern, she relished it. The same went for everyone else – she took pleasure in learning new things and she enjoyed how such occasions confirmed that she picked right people for her staff. I would run meetings with experts, talk to stakeholders, write draft legislation and be the last to leave the office. And we had a blast.

On the last day on the job, she took me for a stroll across Parc Léopold, sheltering in the shadow of the European Parliament’s Hémicycle and the Solvay library.3 Others, I suppose, did appraisals – she bought us some French fries from a nearby stall, sat me down on a bench and taught me one of the greatest lessons of my life. I remember every moment like it is seared into my mind, and I hope never to forget her words.

“Service,” she would say, “is not about doing a job for a paycheck. It’s not about doing a job for the money. It’s not doing a job for the perks. Many will wonder why you chose to serve rather than being served. Some will make you feel unappreciated. But if I thought you’re after the easy path or if I thought you couldn’t handle watching others have an easier time, we wouldn’t be having this conversation.”

“You see,” she said, tossing a few French fries to the hungry ducks, “service is about doing what is right, because it’s the right thing and because you’re the right person to do it, and damn the consequences. And more often than not, it will be hard, unpleasant and sometimes even painful. You need to remember why you’re doing what it is you’re doing.”

“Now, I don’t know what you’ll end up doing,” she continued, almost as if she had somehow sensed my incipient misgivings about a career in public office. “But I know that you want to serve. I know that you want to do well, at all costs. I know that you want to see the job through. I know you want to do it with courage and honour, whomever or whatever you serve – your family, your nation, your people, or even humanity. And I know you chose that life out of your own volition, knowing it won’t be easy. But I also know there’s nothing on God’s green Earth that could make you happy other than service.”

“So find where you’re needed, run towards the fire, and don’t ever forget why you’re doing what you do.”

“Don’t you ever forget.”

It’s been many long years since that talk, and much has changed. I’ve climbed mountains and dug my way out of holes to find my way to that service that will sustain me. Her words have echoed with every reveille and with every moment on the verge of falling asleep on the keyboard, with every mile run and with every triumph and every failure. And if I am ever blessed to have children, I hope I will have the chance to pass this simple yet deep wisdom on to them.

As I write this, a cold, chilly, clear February winter night’s winds howl outside. I can hear the soft breathing of my gorgeous wife next to me, and the tiny snores of our kitten at the foot of the bed, occasionally stirring. And tomorrow is another day, another challenges and another set of service.

Dr. Barsi Pataky Etelka ran the course, and ran it with courage, strength and a commitment to service I have not often witnessed. Born in 1941, she trained as an architect and engineer. In 1990, with the fall of the communist terror regime, she would enter the political arena, eventually spending a tenure in Parliament and serving as Hungary’s ambassador to Vienna. In 2003, she was among the first batch of MEPs elected from Hungary, and became responsible for Europe’s ATC research and the development of Galileo, the EU’s global geospatial positioning system. Since 2009, she has been President of the Hungarian Chamber of Engineering and since 2010, a Governmental Commissioner for the Danube Regional Strategy. Dr. Barsi Pataky passed away yesterday, at the age of 77.

She has been married to the love of her life, the engineer, merchant and life-long legendary yachtsman István Barsi, for 44 years, until his death in 2012. Theirs was a kind of love that young men aspire to for their older days; a love that carried both of them through stormy waters.

To those she allowed in her confidence and mentored, however briefly, she will never be gone. She will be there, in our consciences and our thoughts, encouraging us to find where we are supposed to be of service and do so. And as long as we try to do our duty, as the Lord and our skills and talents give us the light to see it, she will live on.

References   [ + ]

1.Member of the European Parliament
2.That’s not to be taken literally. It is from a Kipling poem called True Royalty:

There was never a Queen like Balkis,
From here to the wide world’s end;
But Balkis talked to a butterfly
As you would talk to a friend.

There was never a King like Solomon,
Not since the world began;
But Solomon talked to a butterfly
As a man would talk to a man.

She was Queen of Sabaea—
And he was Asia’s Lord
But they both of ’em talked to butterflies
When they took their walks abroad.

3.Famous for being the scene of the Solvay Conferences, including the Fifth Solvay Conference, commemorated in the immortal photo that has basically all luminaries of interbellum physics.

The cult of suffering

In a recent tweet, @NewWorldHominin – also known as Lindsay Shepherd and famous for her very public conflict with her employer, Wilfrid Laurier University of Waterloo, Ontario, over showing a video of Jordan Peterson – posted a curious excerpt from Angela Nagle’s book Kill All Normies (what a title!), a short history of the most recent skirmishes in the online culture wars.1 Nagle writes:

[Progressive political scientist, activist and UPenn professor] Adolph Reed Jr. has often said liberals don’t believe in actual politics any more [sic], just ‘bearing witness to suffering’. The cult of suffering, weakness and vulnerability has become central to contemporary liberal identity politics, as it is enacted in spaces like Tumblr. It is also common … to openly identify themselves as having disabilities and mental health issues that make them, by their own admission, extremely vulnerable and suffering.

I am largely unconcerned with the political aspects of his statement. I am not a political scientist, and the politics of this issue are of no interest or concern to me.2 At the same time, society’s relation to pain, and the historical development of vulnerability and suffering, has been a pervasive interest of mine for most of my life. It is not entirely a matter of detached academic interest, either. I don’t normally talk about my own experience with pain: not only do I believe we all experience pain very differently and the neurophysiological processes involving afferent C fibres and all that jazz are only part of what we cognitively conceive of pain, but I’m also the product of a ‘boys don’t cry’ upbringing that shunned even really talking about all that. I have removed 3″ metal splinters from my upper arm and stitched up the resulting wound and went about my way, because, well, it was so normal. I have spent most of my life in severe – some would say excruciating – pain. Unlike the relatively simple pain of a nasty headache or a paper cut, chronic pain is not merely pain that takes longer to resolve, but an entirely different animal. And I have also devoted much of my life to alleviating pain and suffering, in various ways. It’s my subtle revenge on the imperfections of my physiology. Suffering, of course, is a somewhat different animal from pain, but not unrelated. And so, when reading Nagle discuss this ‘cult of suffering’, I was thinking about it partly as an individual witness to the phenomenon of pain – but also a witness to what a ‘cult of suffering’ indeed means to us as a society.

It is important, at this point, to delineate certain terms. When I refer to a ‘cult’ in this context, I am not referring to the modern meaning of the word – as a fundamentalist, often secretive and usually destructive religious movement. Nor am I referring to particular religious practices pertaining to a single deity or demigod, such as the Cult of Dionysius, the Eleusian Mysteries, the cult of Zeus Lykaios in Arcadia or the drug-fueled orgies of the Orphic Mysteries. Actually, most of these mystery religions eventually devolved into drug-fueled orgies that would have made 1970s Los Angeles blush, but that’s not what made them cults – they were ‘cults’ in the sense that they involved secret, set-apart mysteries reserved to the initiated and were in worship of a particular deity. This is closer to what we’re dealing with here, but it is not the relevant interpretation here, either.

Rather, I’m using the concept of a ‘cult’ to describe a set of social practices and methodologies intended to process some overwhelming human experience and integrate it into the way humans understood the world. The Orphic narrative, for instance, which retells the story of the poet Orpheus descending into the Netherworld to bring back Persephone to the land of the living, was an attempt to conceptualise and explain the changing seasons. The same death-rebirth aspect befell Bacchus, God of Wine, because grapes don’t grow all year, either. The ‘cultic’ part I’m concerned with is not about worshipping Bacchus or Persephone/Orpheus, but the fact that a set of notions – conventions, practices, songs, plays, narratives, actions, prayers, etc. – existed through which something cognitively-intellectually inconceivable was enacted communally, and thus, in a sense understood communally.

In that sense, a cult of suffering is not an inherently negative phenomenon. In fact, it is an acknowledgement that when someone is suffering, everybody can – and should – share in that suffering so that everybody could – and should – share in the healing. And there are, in fact, serious moral costs to not sharing this suffering as a community, to leaving the sufferer alone. No single work of human creation has tapped into the hidden heart of the human mystery of pain as profoundly as Sophocles’ Philoctetes, which in a sense deals exactly with what happens when the cult of suffering is absent. It is through understanding the cost of leaving the sufferer alone that we understand the importance and meaning and contribution of a cult of suffering to communal human existence.

Wails from Lemnos (aka ‘oh God, not more Greek drama, please!’)

The Trojan War has been raging on for the best part of a decade. The siege has whittled away the best warriors of both sides. Patroclus is dead, and so is his friend Achilles. Hector is dead. Ajax has taken his life in shame. Everyone is weary of the war, and there seems to be no end in sight, just the tiresome, mindnumbing bloodshed of daily combat. Until one day, the seer Helenus, son of King Priam of Troy, was captured and forced to tell the Greek commanders that they will not be able to prevail against Troy unless and until they have the bow of Heracles.

The bow of Heracles was a legendary weapon, equipped with arrows dunked in the poison of the Hydra. They were awarded to the Greek warrior Philoctetes by a dying Heracles himself, for ending his suffering by lighting his funeral pyre.3 Years later, Philoctetes was part of the Greek host sailing to Troy to reclaim Helen. On the voyage to Troy, however, Philoctetes’s foot was bitten by a snake, causing a wound that continued to torment and fester but would not heal. For days, the Greeks were distressed by the stench of the wound, kept awake by the wails of Philoctetes and more than a little discomforted by the belief that such injuries were a sign of moral pollution – miasma – that would follow the Greek army and bring misfortune upon them. So, on the advice of Odysseus, the king of Ithaca and the Greek forces’ chief intelligence officer, one night they stranded Philoctetes on the unpopulated island of Lemnos – alone, with only his bow, and his suffering, his pain, his festering wound – and sailed on to Troy.

One can barely imagine Philoctetes’ anguish. For not only is he suffering physically, but also morally, wounded by the Greeks’ betrayal:4

Imagine my surprise when I awoke, the tears I shed, the sound of my sadness.

All of the ships in the fleet had vanished.
Alone with my infection, I knew only pain.
Time demanded that I scavenge for food with this sacred bow, which saved my life.

I would crawl through deep mud on stiff knees, scraping my rotten foot against rocks.
When water was scarce, I survived by collecting ice.
I spent cold winter nights without fire, but rubbing stones together for their spark, I saved myself from certain death.

The true tragedy of Philoctetes was not just his snakebite: it was his abandonment.5 And the Greeks’ betrayal, leaving a wounded comrade behind, echoes through the ages. Modern militaries often speak of ‘leaving no man behind’, because if there’s one way to compound pain, it is to do so by making the person suffer alone. It morally degrades the victim, but also the perpetrator.

Unlike most tragedies, Philoctetes does have something approaching a happy ending, or at least a resolution. Odysseus and Neoptolemus, the young and recently orphaned son of Achilles, sail to Lemnos to mend ties and restore the relationship between Philoctetes and the Greek army, although in a typical Odyssean underhanded manner. In the end, there is – with the divine intervention of Heracles himself – a reconciliation. That reconciliation is, importantly, communal: Philoctetes cannot heal unless he returns to his community, the Greek army at Troy, and the Greeks cannot ‘heal’ and prevail in battle unless they mend the ties with the suffering warrior they so disgracefully betrayed. The message here is that from certain wounds, we can only heal as a community: only through sharing what we have been through, through communal rituals of processing trauma, through the reintegration of the wounded or sick person into society can healing take place.

When Sophocles wrote Philoctetes, he was in his late 70s. He has served as a general at least twice, in a century of near-constant warfare. His actors were citizen-soldiers, and so was much of his audience – all of it in need of healing from the traumata of war, loss and grief. Theatre, as the Athenians practiced it, was not entertainment – it was social psychotherapy, a form of group psychodrama that allowed them to grieve and heal together. It was a cult of suffering in the best sense possible.

Sharing and processing

The reason why Athenian drama therapy was so extremely successful was that it began with a highly egalitarian premise: we have all suffered, albeit in different ways, and we all deserve to heal. The primary objective was to expose traumatic histories to allow re-integration into society. It is often witnessed, for instance, that once a victim of a traumatic experience can narrate what happened to them, they gain a degree of control over it: they can conceive of themselves no longer as mere victims but as survivors and of the traumatic past not as a secret locked away in a hidden box of shame but something that they now have control over. We are narrative beings, and our principal way of asserting control over our experiences is to shape them into a narrative. That is trauma processing.

It is a fearsome process, and a fairly difficult one. For the longest time after surviving HLH, I have not been able to talk about it at all. I would perhaps mention occasional flashes of the crazy, sad, tragic yet sometimes hilarious experience that going through a nearly always terminal illness was in my early 20s. Self-deprecating humour and silly jokes6 alternated with moments of intense wistfulness and grief – one defensive mechanism yielding to the next. It wasn’t until I was able to – at the very least internally – tell my story from the beginning to its end, that I felt I could put this experience behind myself. First, I tried to recount it to myself, then to my beloved wife, who did exactly what I needed at the time: to be someone who listens. Processing trauma by verbalising it is scary because – once again, being the narrative creatures we are – it makes things a kind of real. The truly scary part about telling someone what happened to us is not that someone else will hear it – but that we, too, will hear it and have to accept it as real. A long time ago, working pro bono with survivors of political torture, I encountered an extremely polite and well-adjusted young man – almost a little too well-adjusted for what he’s gone through. And while he gave detailed narratives of what was done to him (I’ll spare you the details, but it was all kinds of horrid), he never used the word ‘torture’. Eventually, the staff psychologist picked up on this. Once she got him to reluctantly admit that he was indeed the victim of intense torture – in those words -, he broke down in tears that looked like they would never stop. He has faced the partial reality of his experience, but not the conceptual reality. Now, he had to process and own that part of his experience and his self-understanding. He had to adjust his self-understanding to include not merely the acts he was victim to, but also the notion of being a ‘torture victim’, with all that entailed for his personality.7

Facebook dot com slash catharsis

The theatre of Dionysus Eleuthereus, where Sophocles’s celebrated plays were performed, where Athenians first heard the wails of Philoctetes and the mournful agony of Heracles in the Trachinae, could seat over 15,000 people. Around the 5th century BC, that would have amounted to 5% of the whole population of Attica and half to a third of the 30-50,000 or so free male citizens who had the right to vote. Just a stone’s throw from the theatre of Dionysus, on the slopes of the Acropolis, stood the asclepeion of Athens, a combination of a temple, hospital and hospice where the sick came to experience ‘katharsis’: purification through baths, purging, diets and even a predecessor of art therapy. It is no accident that the patients of the Athenian asclepeion were within earshot of the Theatre of Dionysus, where they experienced an entirely different kind of katharsis: the emotional katharsis of the theatre was seen as being as legitimately therapeutic as snakes and purgatives and poultices and salves. The 5th century BC Athenians might have accidentally invented psychodrama.

Now, with the growth of social networks, 15,000 members are hardly a number worth mentioning. People suffering from illnesses or social situations that hardly anyone in their vicinity would be likely to share could immediately find thousands, if not hundreds of thousands, of fellow sufferers. To many, this must be as liberating as Philoctetes escaping his captivity on Lemnos, where he was alone with his grief, sorrow and agony, and find instead literally thousands of fellow sufferers. For example, for a condition as relatively rare as Ehlers-Danlos Syndrome (total prevalence: around 1:5,000-40,000 live births depending on type)8, there is a major group with over 27,000 members and over a dozen groups with a membership exceeding 5,000 members. Even for relatively rare diseases, such as HLH (prevalence: 1:50,000 live births)9 groups with several thousand members exist. The purpose of these groups is only partially informative: since most of the members are subjective laypeople (patients or their relatives), better information is available on medical websites and open access journals. Rather, the principal purpose appears to be the creation of a community of sufferers (both those in the first degree, i.e. patients themselves, and those in the second degree, i.e. their caregivers, parents and relatives). Interactions typically focus less on discussing potential treatment options, but rather significantly more on inquiring whether others have experienced a particular side effect or reaction on one hand and validate people who are unsure about their symptoms and diagnoses. And while all this does have an informational aspect, the aspect of a community that subjectively understands is what motivates most people to participate in such discussions.

In many ways, this is an undoubtedly positive development. But while – especially for rare diseases10 – such communialisation of suffering can alleviate the tormenting isolation reminiscent of Philoctetes’ on Lemnos, there is a dark side to this phenomenon, too.

We’re all mad here

What happens when the communalisation of trauma, misfortune, disease or pain, from Sophoclean plays to Facebook support groups, becomes dysfunctional? It is worth mentioning three possible dysfunctions.

One, the Sophoclean way of communal processing of trauma took place among a heterogeneous population. Certainly, they shared some fundamental experiences, which made for a dramatic language intelligible to all. For instance, the majority of actors and most of the audience watching Ajax’s descent into madness have themselves served and recognized Ajax’s combat trauma – what we in our contemporary language would call PTSD. Certainly many of them knew enough about chronic illness to understand Philoctetes’s anguish. And when they heard the wails of the greatest hero of Greek mythology, the mighty Heracles himself, begging for death in Sophocles’ Trachinae, most could relate it to a similar experience with a dying loved one. But the essence of processing this experience was to do it communally. It was never meant to be an echo chamber. It was not a bunch of citizen-soldiers turned actors putting a play for themselves, but to the Athenian public at large. Unlike the Facebook groups that serve as the modern equivalents of publicly processing grief or anguish, the Ancient Greek drama was meant as a sort of silent dialogue. The audience might not have had anything to say, but they did have something to do. This was for their benefit, too, and their duty was to assist the communal processing of the dramatic experience. Their job was to be the very opposite of the Greek fleet that left Philoctetes suffering alone – their job was to show ‘compassion’, to suffer (‘passion’) with (‘com’) the protagonist. In a homogeneous population, the dynamics are vastly different. Not only is everybody a ‘victim’, those who are not are expressly excluded. There is no hope for reintegration – after all, there’s no interaction with the society to reintegrate with. There is beyond doubt much merit in victims and sufferers living and discovering an experience of community, where they themselves feel no longer alone. But that’s not the experience of katharsis, of healing and of reintegration that communal processing of trauma, between those who are suffering and those who are not, could offer.

Two, the narrative framework that facilitated this communal processing of trauma – that is, the play itself – was abstract for a good reason. The tales of woe that Greek drama shows are not every-day crises. They are irresolvably tragic like the situation of Antigone torn between divine or secular law, they’re almost grotesquely devastating as the fate of Oedipus or they involve, like Medea’s descent into madness, the loss of innocent, valuable lives for no good reason. No-one in Sophocles’ Athenian audience, however blighted by misfortune their lives, would be tempted to compete with the tragic heroes of Ancient Greece. Who would dare compare their fate to that of Ajax, Medea or Oedipus? And who could compete with Philoctetes’ decade-long solitude and agony? So final and devastating were these tragedies that they conveyed, through their absoluteness, the message that trauma is not a competition. The Greeks understood that each individual trauma is a little universe in and of itself, a little infinity, and there is no point in arguing whose corresponding experience was the worst. This allowed Greeks to maintain a sense of perspective: on one hand, quite likely none of them had it as bad as the tragic heroes, but at the same time, deep down, they shared the same struggles and pain and tragedies as the divine Heracles, the mighty Ajax and the great Philoctetes. There was no need for an Olympiad of suffering, because of the almost over-the-top nature of Greek tragic fates that were shocking even given the occasional bloodthirstiness of that civilization.11 Over-the-top tragedy allowed it to remain abstract, while at the same time elevating it to universality. Where traumatic processing becomes concrete, it loses the ability of its abstraction to provide meaning. It becomes a fragmented tale of individual, competing traumata.

Finally, communal processing of trauma was all about reintegration – it was about closing the door behind the traumatic experience in a sense, and in ‘coming home’ to society. Trauma – and by this, I also include adverse experiences that are not ordinarily thought of as traumatic: a severe illness, a difficult upbringing or a childhood spent on the wrong side of the tracks – alienates us from our host society. Many victims of trauma go so far as to perceive themselves as fundamentally ‘different’ from ordinary human society and experience trouble ‘fitting in’ among those who have not undergone the same experience. The purpose of Greek drama was not to rehash endlessly how broken and different the victims of severe trauma were, but to show them a way back to us, and us a way back to them. In the end, it was about what we had in common rather than about differences. When traumatic processing becomes dysfunctional, it becomes about remaining the ‘other’, the ‘traumatized person’, rather than the person who, with all their traumatic experiences, can no less be integrated into society. Communal processing of trauma does not encourage the development of a highly emphatetic ‘otherness’, a trauma-based self-identity, but advocates a way back to normal society.

On bearing witness to suffering

Reed accuses liberals of ‘just bearing witness to suffering’. In this, I think, there’s a risk of missing the operative word – just. I doubt Reed would object to ‘bearing witness to suffering’. One of the greatest accomplishments of Ancient Greek drama was the validation of the suffering many in those societies have gone through. When citizen-soldiers watched Ajax or Philoctetes, both written by a retired general who knew the cost of teaching and making men inflict violence on others first-hand, they understood they weren’t alone. They understood that unlike the abandoned Philoctetes, they weren’t suffering on a desolate island, but that their pain and anguish were witnessed in some way. And that may have made all the difference.

But just bearing witness to suffering is not enough. For starters, as Reed alleges, it creates this cult of suffering and weakness.

As we have noted earlier, the term ‘cult’ should not necessarily invoke Waco or Jonestown. More subtly, a cult may just be about a shared ritual process, coupled with a shared identity. For instance, those who were inducted into the Eleusinian Mysteries, a mystery religion that evolved from an old farming cult of supplication for good crops, were not only, in a sense, chosen and identified themselves as part of this secret circle of people who could enter the mystery: they also shared a range of ritual practices (much of which involved getting hammered on kykeon, which was basically the ancient Greek version of LSD). Cults develop their own language, their own rules, their own habits, their own moral compass. The cult that Nagle refers to – the cult of ‘suffering, weakness and vulnerability – is no exception.

In a sense, this cult of ‘suffering, weakness and vulnerability’ is a dysfunctional form of communal processing. It is dysfunctional for three reasons:

      • It’s self-enclosed and self-directed. It is not a publicly enacted interactive performance in which there is a dialogue with anyone. It is, at best, an echo chamber. Quite often, the language of ‘owned spaces’ and ‘safe spaces’ is used, to wit, the manifestations of these spaces – virtual or real – should be limited to those ‘initiated into the cult’. There are some legitimate scenarios in which this approach is encountered, e.g. when 12-step groups exclude non-addicts so as to afford addicts a chance to speak openly. But as a social performance, this is failing to build any bridges. Consider the recent trend among Tumblr users to explicitly bar other users from following them unless they, too, are ‘neuroatypical’, ‘disabled’ or some other minority. This creates a curious segregationism that ultimately impedes positive functional outcomes.
      • Processing is always concrete and individual. Elizabeth Martinez coined the term ‘oppression Olympics’ as early as 1993,12 to describe the controversies that ensue when oppressed minority groups ‘compare’ or ‘rank’ their level of suffering. The genius of Sophoclean tragedy was altogether avoiding this, in two ways. One, the tragedy enacted on stage was so over the top that the audience could not possibly really relate (even in Athens in the 5th century BC, blinding oneself with one’s belt buckle for having accidentally committed incest towards one’s mother was rare enough that Sophocles had not to worry about someone in the audience one-upping poor Oedipus Rex). Two, the overall message of the drama was quite universal. The dramatic heroes fight not against particular forces or power structures that are in some way unique to their station in the world, but against universal human flaws and universal human failings: hubris, fate, ignorance, passion, betrayal. Everybody and nobody at the same time is invited to relate.
      • Processing surpasses the emotional-cathartic and enters the political. The purpose of a Sophoclean drama was to help victims of trauma find their way back to society, and vice versa. It was, primarily, about reconciliation. It was not, at any point, about compensation, about change, about various political rights. The audience may have left with slightly shifted views about some moral issues through the emotional experience of the catharsis, but Sophocles was not Bertolt Brecht.

What Angela Nagle points out as a cult of suffering, weakness and vulnerability rests on two pillars. One of these is the rapid destigmatisation of illness, disability and in particular mental health issues over the last few decades. There is absolutely no doubt to me that this will be recalled as one of humanity’s greatest feats. Partly thanks to a better understanding of the neurobiology of mental illness and partly due to treatments that allow even those with severe mental illness to live productive and socially integrated lives, our outlook on mental vulnerability has changed. At the same time, thanks to various social media platforms such as Facebook, those affected by these issues could experience the ‘safe space’ of an echo chamber.

Love bombing and the cultists of suffering

Ultimately, what Nagle describes as a ‘cult of suffering, weakness and vulnerability’ comes from an inadequate communal way of coping with experiences of suffering, weakness and vulnerability. In most cases, even if the underlying organic or psychiatric disorder is permanent, its effects in terms of suffering, weakness and vulnerability tend to be transient. As time goes on, patients build coping mechanisms that help them function in daily life. But within the dysfunctional ‘support groups’ over the internet, diagnoses are seen as immutable fates that are as part of one’s identity as one’s name or eye colour. The initial experience of being ‘understood’, especially for those suffering from a rare or misunderstood condition, can be overwhelmingly positive – indeed, so positive as to be addictive, and patients will gladly pay the price of not improving as the cost of remaining in this sheltered cocoon where – perhaps, sadly, often for the first time – the efforts it takes to complete every-day tasks with their conditions are appreciated. There is a bigger reward, however.

There exists a pathology known as ‘factitious disorder’ or ‘factitious and/or induced illness’ (FII). In FII, patients are aware they do not have a particular condition, but intentionally induce signs and symptoms to procure treatment. You may have heard it referred to as Munchausen’s Syndrome. It is a very controversial diagnosis, because it is hard to unambiguously separate whether people with FII suffer from a disorder no different from, say, BPD or major depression, or are just exploitative social parasites with a decent streak of sociopathy. People with FII leave a trail of broken people in their wake, theirtrust betrayed and their humanity brutally exploited, and as a consequence of the resulting stigma, we know less about FII than about any psychiatric condition. I recall first hearing about FII in a forensic psychiatry class, and I couldn’t possibly imagine why anyone would even do this. By then, I have been through a few bouts with serious illness, and to intentionally make oneself sick just made no darn sense to me. So after class, I grabbed my professor and asked him why people intentionally assume the sick role, often actually harming their own health.

“That’s the mystery,” he said. “We don’t know. There are so few confirmed cases, and even fewer are willing to talk about it. Why don’t you go and see what you can find?”

I did. I found virtually nothing, save for a small number of females who have been in treatment for FII for some years and offered a valuable insight into their thought process. One point I remember to this day was that while they initially did seek the attention that came from the sick role, what they really, really craved was the role of the ‘fighter’, the strong and resilient person who faces disease and trauma with courage. They wanted to be called brave. They wanted to be called fighters. And more than anything, they wanted someone to acknowledge their actions, praise them and tell them they could be proud of it.13

Many of these people came from broken families, and many in today’s cult of weakness come from a broken society. In this broken society, we haven’t decided how to treat young people: we give out participation trophies, but we are afraid to acknowledge true accomplishments lest the less accomplished feel offended. We tell young people they’re the future and they’re going to run the world someday, but we do not expect them to behave like that – and every leader’s education should start with service. We encourage young people to feel ‘pride’, but do not challenge them to accomplish things in which they could feel real pride. We praise every child, then we’re surprised that their self-esteem is low. It is low because kids aren’t idiots. In fact, they’re emotionally more sensitive due to their incomplete maturation of the frontal cortex. They know it’s all bullshit. They know that participation trophies are worthless. They know that they’re fed empty praise by parents and teachers who are scared of them, who are scared of the consequences of emotionally offending any child.14

And so, as they see through what Browning called the “forced praise on our part/ the glimmer of twilight“, they hunger for the genuine thing. They hunger for the politically incorrect thing of a first prize medal, for the verboten accomplishment of something at which most people fail, for the absolutely off-limits pride in themselves that can come from a tough job well done. People are willing to risk getting blown up for ridiculously low pay and stupid administrative burdens for a taste of a society that expects, demands and ranks mercilessly,15 because these things have been expunged from virtually everywhere.

If the sole way young people can find an identity that gives them value and through which they can feel appreciation is by claiming, pretending or role-playing to have various disadvantages, so that they would be measured with the lenient yardstick under which genuine praise betokens even completely mundane, every-day acts (and I can attest as a person with a disability that sometimes getting dressed feels like climbing Everest and going down to the shops, a daunting challenge!), we – and our parents’ generation, who have laid the groundwork for this state of affairs – need to have a conversation. We need to have a conversation on accomplishments, and the need for accomplishments for pride. We need to have a conversation about the fact that everyone is capable of accomplishments worthy of pride and honour. We need to have a conversation about the fact that we have a duty to communally process suffering – not just to witness it and write long-winded 2,200 word heart-wrenchers in Comment is Free but to engage with the existence of suffering, and with those who are going through it, and allow them to reconnect to the society of the ‘healthy’. We need to create a society that has more ambitions for people with disabilities than a socially and economically sidelined existence on benefits.

But more importantly, we need to have a conversation about the truth behind the lies.

The truth in the lie

True to Nagle’s description, the temples of this cult of weakness – Facebook support groups, Tumblr, other networks – create an echo chamber of self-validating pain and vulnerability. This echo chamber is premised on an economy of reciprocity: because one would not want to be ‘invalidated,'16 it is only too logical that one would have to validate everyone. There’s an undercurrent of hatred and skepticism towards anyone who challenges these self-identifications, be it disability status reviews, rude bystanders asking often insensitive questions, or indeed the medical profession, who are seen as dismissive towards the ‘disabled’ and the ‘vulnerable’, a fortiori where those conditions are concerned that evidence-based medicine does not recognize or does not diagnose with a frequency that would satisfy the echo chamber of pain. In this ‘safe space’, they are safe from the greatest threat to their chosen identity: reality.

Ironically, this claimed vulnerability is often counterposited by superficial and frequently excessive expressions of self-assurance and ‘toughness’: whether expressed often through radical political activism relishing in a tone of over-the-top vulgarity, a personal appearance and self-expression seeking to stand apart from culture even more (consider e.g. the ‘cripple punk’ aesthetic a manifestation of this dynamic) and the rhetoric of war and violence to describe disability and illness (such as self-descriptions as ‘fighters’ and ‘warriors’ at war against their health issues), there is a paradoxical display of exaggerated and situation-inappropriately presented strength. It is as if within the echoing walls of the temples of this this cult, its adherents are not quite sure whether to whisper or to yell, uncertain of who and what they are: strong or weak, heroic or vulnerable, victims or warriors. This is, of course, not unusual – many people this pertains to are at the age or stage of psychosocial development where their self-identity is still in the process of coalescing, and ‘trying on’ identities, even quite contradictory ones in rapid succession, is a normal part of that. But this paradoxical attitude suggests that something deeper is at play, that however willingly the role of weakness and vulnerability is adopted, it is at odds with other fundamental underlying impulses.

Following those underlying impulses and the odd complexity of strength and frailty at the same time, it becomes apparent that the young people in these echo chambers that Nagle is talking about are definitely not lying or misguided about one thing: they are in distress. They are broken and vulnerable. They are broken and vulnerable products of a society and an educational system that left them in a state of anomie that in and of itself could and should merit a psychiatric diagnosis. They are desperately looking for roles in this society, and the cult of suffering is the only one that has openings for them. They are suffering from a lack of having the mere opportunity to build something to be proud of, to try themselves against the tallest mountains, to explore, to fight, to lose, to win, to get the odd bloody nose and yet come home grinning from ear to ear, with the pride that comes from accomplishment. They may not have the thirty-something psychiatric diagnoses and fifty-odd chronic conditions they claim (if you think those numbers are exaggerated, you should go on Tumblr!), but they are experiencing legitimate anguish, and claiming the roles of weakness and vulnerability is their idiom of distress; the distress of their betrayal by a society that never gave them the chance to be anything but the roles of weakness and vulnerability they ended up adopting.

And we need to help them in finding a more fulfilling part in a more rewarding play.

References   [ + ]

1.Nagle, A. (2017). Kill All Normies: Online culture wars from 4chan and Tumblr to Trump and the alt-right. Zero Books.
2.Note I am not calling these matters unworthy of scholarship, merely admitting it is outside my experience and understanding.
3.Sophocles deals with that story in Trachinae, a heart-rending tragedy in its own right, and one I hope to return to in a future post.
4.All translations are by Doerries, B. (2015). All That You’ve Seen Here Is God: New versions of four Greek tragedies. Random House.
5.And his abandonment in turn caused a sort of reversion to a primal hunter-gatherer existence. Sophocles shows Philoctetes, a once-proud warrior and a civilized man, degraded to the point of a barbarian’s existence. In a sense, Philoctetes the Greek is dead, and all that is left is a husk driven by the most primal of human needs – food and water -, existing apart from society, apart from his people, apart from the polity. There was a particular degree of disgrace that came with such an existence that was easier to understand for a Greek audience than it is today.
6.I have an inexhaustible supply of crude, horrid and extremely tasteless jokes about sickness, in particular cancer, that I entirely credit the old guys at the hospital with. Nothing makes chemo fun, but listening to some seventy-somethings make the kind of jokes that people only make if they’ve seen heaven and hell was definitely a unique experience. They were also all kinds of loopy on their fentanyl pumps, so that helped. Someday I might write a post about this, but suffice to say that even serious illness is not all doom and gloom if there are people to share it with.
7.He turned out ok. After a brief bout of anxiety, he continued to improve. He is now a postgraduate student, and we still keep in touch. He has explicitly consented to me telling his story.
8.Data from NIH Genetics Home Reference.
9.Henter, J.I. et al. (1991). Incidence in Sweden and clinical features of familial hemophagocytic lymphohistiocytosis. Acta Paediatr Scand. 80(4):428-435. Cf. also Janka, G.E. (2012). Familiar and acquired haemophagocytic lymphohistiocytosis. Annu Rev Med. 63:233-246.
10.Defined in the US as any disease affecting fewer than 200,000 people US-wide – or roughly 1:1,500 people, while in the EU, rare diseases are defined as those with an incidence of fewer than 1:2,000 cases that are also life-threatening, chronically debilitating or inadequately treatable
11.In Tragedy and Civilization, a volume focusing on an interpretation of Sophocles, the author, Charles Segal, points out this peculiar coexistence of bloodthirsty savagery and high civilization in Ancient Greece in the book’s first, striking paragraph:

“High on a mountainside in a rugged and lonely part of Arcadia stands a remote shrine to Zeus Lykaios, Wolf Zeus. Plato alludes to a legend that human sacrifice was regularly practiced there, and the celebrant who partook of the flesh turned into a wolf. Across the valley from this grim precinct, in a spot of wild and desolate beauty, in a place known as the “glens”, Bassai, a small Greek city erected an elaborate temple to the most civilized of its gods, Apollo Epikurious, theHelper. Approaching this temple at Bassae from the city of Phigaleia, as the ancients did, the visitor experiences a striking visual confrontation of civilization and savagery. Before the ancient spectator stood the ordered geometry of columns and pediment outlined against the jagged mountaintops which stretch far into the distance. Freestanding and unexpected in that desolate setting, the temple seems an arbitrary example of pure form and human design as an attic amphora or the rhythm of a tragic chorus. But prominent just beyond the temple is the mountain where a grisly and primitive cult violated one of the first laws of human civilization as the Greeks defined it, the taboo against cannibalism.

12.Martinez, E. (1993). Beyond Black/White: The racisms of our time. Social Justice, 20(51-52), 22-34.
13.Note, for clarity’s sake: I am not alleging that the people referred to as part of this ‘cult of suffering, weakness and vulnerability’ suffer from FII or any related trait. I mention FII as it also manifests as a desire not merely of compassion and the sick role but also of the overcomer role. I’m also not making any assertions about how many of these people are actually sick, how many have a different disorder from what they’re claiming, how many are somatising/suffering from conversion disorder and how many are perfectly healthy and suffering from FII or just making stuff up. That is a question for medics. I’m looking at the diagnosis of the civilisational illness involved here, and for that, that’s all irrelevant.
14.At this point, it’s important to note the difference between the negative obligation not to emotionally harm a child intentionally, and the positive obligation to always emotionally foster and support children. There is never any excuse, by anyone, teacher or parent or coach, to intentionally emotionally humiliate a child. I’ve been there, and I know what it feels like, and I know that it’s the product of an inability to deal with one’s own insecurities as an adult, but that doesn’t justify it. It’s never OK. At the same time, nobody is responsible for your emotional wellbeing, and the idea that the world owes children a sphere where their precious self-esteem is never questioned and always positively affirmed is the worst preparation we can give to a generation facing the kinds of challenges our children do.
15.Although just how merciless that is has changed over the years. Especially with regard to physical fitness scores.
16.The ultimate sin on Tumblr, and roughly corresponding to any conduct that is not 100% affirmative of what one person believes is true about themselves, no matter how (un)realistic. While often criticized or sharply parodied, the insistence on validation and fear of/aggressive responses to – real or perceived – invalidation is an important mythopoetic act: it primarily serves to delineate and defend the community and the space in which the community’s cult, or ‘rituals’, are carried out. In a sense, it is akin to the markings on the trees of the sacred grove, bidding outsiders to stay out, or the various features that delineate a ritual space – an altar, or even an entire church, synagogue or mosque – from common spaces.

“Yeah, but what is it you actually DO?” A friendly explainer.

People ask me what I do a lot. I used to say “I work with computers”, but I realized this would earn me an invite to check out broken routers or messed up Outlook installations. Sometimes, I told people I was an epidemiologist, and a few insisted on asking me about skin disorders (err no… that’s dermatology). And eventually, in my exasperation, I asked around on our computational epidemiology mailing list how others deal with this question.

What you can expect next time you’re flying if you’re too specific about your research interests. That, or a spot on the no-fly list.

Turns out there’s no good answer. And I mean that, to the point that some people would rather actually check on Aunt Velma’s busted router. “Public health worker” sounds like a social worker. “I’m a mathematician that’s interested in diseases” strikes people as weird at best. And “Oh… I’m into ebola and stuff” gets you on the no-fly list faster than you can say Elizabethkingia.

If we’re lucky, your audience will politely nod once told what you do, and if we’re super lucky, they might google it later on. That you’re looking at this website may mean one of four things:

  1. You might be that exceptional lady or gentleman who did meet a computational epidemiologist, who handed you this link. Yay! You keep good company.
  2. You may have heard of what we do – or that we even exist – for the first time. Excellent! The longest journey begins with a single step. Or so the fortune cookie from last night’s Mama Chang’s says.
  3. You’ve been told you’re going to work with one of us, and you’re like ‘a whut?’. Cool! We’re a rare and endangered species, so please don’t shoot us.
  4. You’ve been considering, or you’ve been voluntold,1 to go into the computational epidemiology field. That’s because you’re either an epidemiologist who is a bit of a geek or a geek who has a penchant for epidemiology. Welcome!

In the following, we’ll go over some of the basics of who we aren’t, what we do and how to care for your friendly neighbourhood computational epidemiologist, including some basic do’s and don’ts. With adequate care, your computational epidemiologist may live a long, happy life only occasionally punctuated by swearing at the command line. Let’s get started!

Who we aren’t

To get this out of the way: computational epidemiologists are NOT infectious disease doctors (in fact, despite the name, epidemiology deals with all sorts of illnesses, including non-infectious ones!), most don’t have an MD, and no, most of us never wanted to be doctors. It’s not where ‘doctors who couldn’t hack it go’. That’s naturopathic medicine you’re thinking of.

While statistically, ugly sweaters are more prevalent among computationalists, Kate Winslet’s character in Contagion (2011) is actually a regular field epidemiologist. We know that because she dies. Computational epidemiologists are presumably immortal.

We’re also, mostly, not field workers. Remember that movie where somebody brings home some zoonotic meningitis/flu hybrid from South East Asia and the whole world starts dying, and Kate Winslet plays an EIS officer? Well, while technically there are computationalists who do end up in the EIS, most of us prefer our subjects of study to be as far away from us as possible. Given that I study filoviridae in particular and their transmission dynamics in various simulated populations, I’m rather glad I can do so without ever having to see a filovirus. Not saying they’re not pretty (they do have their own kind of beauty), but I’d rather keep my distance from things that dissolve your cells, turn you into sludge and make you bleed out of orifices you didn’t know you could bleed out of.

This transmission network of tuberculosis was done on the basis of contact tracing data. We rely on field epidemiologists to get us that data so that we can then understand spread and risk factors better.
Source: Bjorn-Mortensen et al., 2017.

We do, however, depend on field workers quite a bit – all the nice graph models we look at began life as a bunch of scared graduate students in Tyvek suits sweating their butt off and in laboured French/English/Swahili/Igbo/other language tried to ascertain whom the sickly-looking gentleman in the corner of the room has been in contact with over the last few weeks (that’s called ‘contact tracing’, and is one of the most indispensable yet one of the most tiresome parts of field epidemiology).

We’re also not infectious disease biologists, although if you’re really interested in how to create one that will kill a lot of people, ask a computational epidemiologist. They won’t answer, because you look shifty and anyone who asks questions like that shouldn’t know anyway, but we’re the ones to know.

What we actually do

An early triumph of geospatial methods in epidemiology: John Snow’s cholera map.

We’re in a somewhat ill-defined field. At the margins, we touch mathematics, statistics, bioinformatics, computer science and computability theory, genomics, medicine, public health and probably a dozen other fields I forgot about. Ultimately, the core of what we do is using (and improving and developing) computational methods to answer complex questions about health and sickness.

One surprising aspect when I talk to people is that we’re actually not only working with infectious diseases. I was bitten by the epidemiology bug2 when working on a Britain-wide project on predictive factors of heart disease. Epidemiologists also deal with obesity, drug use, workplace accidents and toxic exposure, radiation leaks and pretty much anything that can make you sick.3

The name does suggest an association with epidemics, but its roots are actually worth considering. Epidemiology is the art/science (logos) of what is ‘on’ (epi) the people (demos) – that is, the study of what has befallen the people. And an epidemic, of course, is something that befalls enough people that it might be worth considering as a population level phenomenon. The Greeks knew their thing when it came to naming stuff, and in a sense, this is brilliant naming, for it points out exactly what the great strength and the great weakness of epidemiology is: epidemiology is ‘good’ at answering questions about what’s going on with an entire population. It is notoriously less good at answering questions about what’s going on with an individual.

And so, when you tell an epidemiologist you have a sore throat, enlarged lymph nodes and a fever, they’ll tell you that statistically, you probably have acute bacterial pharyngitis caused by group A beta-hemolytic Streptococcus, aka ‘strep throat’. But statistically, you may also have infectious mononucleosis or lymphoma. That’s because if you look at a million patients with a sore throat, enlarged lymph nodes and a fever, most will indeed have acute bacterial pharyngitis (and most of those where a cause can be identified will have GABHS bacterial pharyngitis),4 and the rest will have an odd smattering of cases. Because on a population level, every patient is a Schrödinger’s Cat: until they get conclusively diagnosed, they have 80% bacterial pharyngitis, 15% mono, 3% lymphoma and 2% some weird bug the lab sees once a decade.5

The power of this kind of analysis becomes apparent when we do need to deal with a population at large rather than a small number of individual patients. This is the domain of public health, and that’s why epidemiologists and public health physicians are best of buddies.

Consider the following scenario. Every once in a while, someone is unintentionally exposed to HIV, the pathogen that causes AIDS. In some cases, a regimen of antiviral drugs administered right after the exposure (known as post-exposure prophylaxis or PEP) can reduce the likelihood of HIV remaining in the system and developing AIDS. However, the antivirals in PEP are both expensive and, well, fairly nasty drugs, with their own side effect profile. Should PEP be routinely offered? And for how long?

Enter epidemiology to save the day and answer the question. Based on studies about the likelihood that PEP will prevent seroconversion (being infected by HIV), studies about the per-thousand-doses risk of the antivirals used for PEP, data about PEP’s effectiveness and so on, a more coherent statistical picture can be constructed. This allows for the quantification of risks vs benefits in light of effectiveness and efficiency. Epidemiology can answer questions that literally save lives every day. It factors into individual health and treatment decisions, into the guidelines that govern care and into public health policies, such as the availability of neuraminidase inhibitors6 in a flu epidemic. It governs emergency responses, such as whether to respond to an outbreak by mass vaccination, ring vaccination, antivirals, isolation, quarantine or other measures. Ultimately, epidemiology is the art and science of using data to help physicians, public health officials and clinicians make the right decisions based on the right data.

The computational part

There are lots of ways to categorise epidemiologists (and none of them will be encountered with much favour – we like being uncategorised, thanks!). Sometimes, epidemiologists are categorized by the disease area examined (e.g. oncoepidemiology or psychiatric epidemiology), by patient group (such as pediatric or perinatal epidemiology or geriatric epidemiology), disease type epidemiology (in particular, chronic illness epidemiology) and finally, categories that look at particular methods of epidemiological research. Molecular and genetic/genomic epidemiology, for instance, looks at the genetic correlates of sickness and health, and what genetic factors determine or predispose to particular conditions – or the lack thereof. Much of this is using association studies – studies in which medical histories and genotyping are correlated to determine what factors are most strongly associated with a particular outcome.7 Computational approaches are just another methodological category.

So what sets computationalists like me apart? We are concerned with using computational efficiency and mathematically efficient methods to deliver results. Our quest is no different from other epidemiologists, but our arsenal of tools is different. By using a combination of statistical, machine learning, geospatial, graph based and simulational tools (and whatever else we found in the kitchen sink), we can provide more accurate and detailed data to provide answers to questions that can prolong life, avoid side effects, alleviate suffering and help people live longer, healthier, more fulfilling lives.

Computational epidemiology grew out of the increasing digitization of health data – the volume of detailed health information in electronic medical records are a tremendous resource – and the rapid growth in high performance computational methods over the last few decades. The reason computational epidemiologists are trained in a uniquely interdisciplinary fashion, and are expected to be conversant with anything from linear algebra to graph theory, efficient tensor algorithm programming to computationally solving differential equations, from filoviridae to predicting zoonotic vectors, from modeling the spread of waterborne infections to mining Facebook – in short, just about anything and everything – is to be able to carry a toolbox as extensive as possible to tackle the widest range of challenges. Ultimately, we rarely encounter the same issue twice, and the ability to solve problems often has to do with combining the right tools in the right constellation for the job.

The future

Computational epidemiology is a new profession, and yet every now and then, I get asked whether new developments in technology will make us someday obsolete.

No doubt there have been a lot of new developments in various fields of computer science and mathematics has given us some new tools to tackle challenges faster and better:

  • Social networks provide a volume of data about individuals that together may predict disease trends, and web-scale databases can efficiently analyze it. An example of this is Google Flu, which uses search terms for flu-related concepts – things one with influenza-like illness would search for, such as ‘is it normal to use more than 250 tissues a day?’ – to gauge and estimate the expected disease severity in a particular region. The efficacy of Google Flu is controversial,8 but the approach is definitely one that has a future. Efficient web crawling is another aspect of this.
  • Natural language processing helps analysing and interpreting unstructured, verbal information and allow analyses from unstructured data, such as news items or social media comments. NLP needs a lot of work as it currently stands, including the ability to understand non-literal language – irony, metaphor, etc.9 -, but it has gone an enormous way over the last decades and has become a workhorse of analysing medical and social data.
  • Machine learning is a wide field, and it’s without doubt that the rising ML tide lifts our boats, too. Deep learning, for instance, has made levels of large genomic association studies (genome-wide association studies, GWASs) with thousands or even millions of dimensions possible10 that hitherto would have required vast computing power reserved only to a few major institutions.
  • GPU based processing, together with the liberalization of access to computing power (consider AWS’s EC2 or Microsoft Azure), has opened up computationally intensive tasks to millions, and reduced the barriers of entry immensely by allowing pay-by-use instead of a massive upfront investment. The effect of this on our work cannot be underestimated.
  • The recent developments in synthetic populations and large agent-based models have made simulations of massive numbers of people based on real population data possible. This is an incredible opportunity, as it allows simulations to be conducted with a statistically representative communication while safeguarding patient privacy. Agent-based models are enormously useful not only to predict but to test potential interventional scenarios.
  • Graph databases can ‘organically’ represent relationship data, such as traced contacts. The result is the ability to perform searches (known as traversal in graph analysis lingo) over large networks in less time.
  • Optimisation and algorithmic research, in particular trying to parallelise as many problems as possible, is accelerating what we do every day.

But in the end, most epidemiologists find their strength and resilience in the fact that they are helping other humans live better, healthier lives. Unlike clinicians and field epidemiologists, we may not meet individual patients too often. But at the end of the day, behind all the numbers is a shared endeavor by a massive web of interdependent professions, from clinicians through pharmacologists and lab techs to public health workers and us computational epidemiologists to help people, to make their lives healthier and to alleviate suffering. It’s why we pull the crazy hours. It’s why we spend long days away from those we love. It’s what keeps us going after failed simulation #889982984234. And I doubt any algorithm, AI or robot, however advanced, can find that in their hearts.

While a lot of what’s in this post is important and factually true, the tone is occasionally a little more tongue in cheek than you might be used to on this blog. This is a profession for the slightly insane. Talking about it without a degree of self-deprecating irony is as pointless as it’s impossible.

References   [ + ]

1.Volunteering a la 12 Monkeys: “you, you and you!”.
2.That’s a metaphor. Epidemiologists are not made by insect bite, that’s Spider-Man. Epidemiologists are made, usually in small batches (use non-stick baking parchment and keep temperature below 250ºF). The process of creating decent epidemiologists has been engraved on the handle of John Snow’s pump. It hasn’t been seen since the 1854 London Cholera outbreak, sadly, so most of us have been winging it. Don’t complain, you’re still alive, right?
3.Controversially, this includes gun violence. Not to get into this fray, but epidemiology has neither the right tools nor the right approach to approach the tragedy of accidental and avoidable gun deaths and even less so for intentional and non-avoidable gun deaths. At some point, I’ll rant a little about how a lot of this has to do with the fact that when research money is at stake, everything looks like the kind of nail eminently suited for smashing by the hammer your working group came up with. Until then, I’ll stay quiet and try not to piss off too many people.
4.Note that because we don’t really bother with pharyngitis if it does the polite thing and goes away eventually, the definite cause of about a third of all cases of pharyngitis is never discovered. To put it in perspective: as the most frequent single pathogen causing bacterial pharyngitis, GABHS accounts for about 20% of all cases where the cause is known – in other words, ‘no known cause’ is still almost three times as frequent as the most frequent known bacterial cause!
5.These are not the real numbers, but you get the point.
6.Such as oseltamivir (Tamiflu), zanamivir (Relenza) and laninamivir (Inavir), used in the treatment of symptomatic influenza A and B infections. Controversially, their effectiveness is somewhat limited – at most, they cut off a few days off the disease length and for normal healthy patients, they may not make much of a difference -, but have pronounced side effects, some of which long outlast administration. At this point, meta-analyses show that in otherwise healthy patients, neuraminidase inhibitors do not have a favourable risk/benefit ratio.
7.A famous example is the case of PCSK9, a gene coding for a protein involved in lipoprotein homeostasis, which in turn is strongly correlated with heart disease and cardiac mortality. In familial hypercholesterolaemia, a heritable condition where people present with high cholesterol levels largely regardless of diet, a gain-of-function mutation of the PCSK9 protein is present. It was found that reducing the levels of PCSK9, such as by a targeted antibody that binds PCSK9 (the monoclonal antibodies evolocumab and alirocumab, for example), would reduce LDL (low density lipoprotein or ‘bad cholesterol’) and thus have cardiac benefits. In the end, so far, the effect has been quite modest compared to the exorbitant price tag, considering the much lower cost of statins that accomplish, more or less, the same purpose.
8.For a good summary, see Lazer, D., Kennedy, R., King, G., & Vespignani, A. (2014). The parable of Google Flu: traps in big data analysis. Science, 343(6176), 1203-1205.
9.Reyes, A., Rosso, P., & Buscaldi, D. (2012). From humor recognition to irony detection: The figurative language of social media. Data & Knowledge Engineering, (74)1-12.
10.Szymczak, S., Biernacka, J. M., Cordell, H. J., González‐Recio, O., König, I. R., Zhang, H., & Sun, Y. V. (2009). Machine learning in genome‐wide association studies. Genetic epidemiology, 33(S1).

Boyd and Ajax walk into a cubicle farm: a few thoughts about Rebels at Work

I’m gauged to tolerate more or less one management book a year. That’s not because I don’t care (I do) or because I pretend to know everything about leadership (I don’t and I don’t) or because there aren’t enough of them around (there are). Rather, most of them have very little to add to conventional wisdom and an abundance were written from a narrow perspective, and so, precious few have managed to speak to me. In my Grecian snobbery, the only work on leadership and management worth its salt was written by an Athenian general around 5th century BC, and is called Ajax. About which, later.

However, a number of epidemiologists I follow and respect – in particular, @DrBalsamAhmad, @PWGTennant and @statsmethods – have tweeted (twoth?) with approval of Rebels at Work, a book by Lois Kelly @loiskelly and Carmen Medina @milouness published by O’Reilly:

It sparked some very interesting comments, especially about a matter close to my heart: managing ‘moral frustration’ at work:

So I quickly procured a Kindle copy of the book, and devoured it in a single sitting, with copious annotations. That’s always a good sign.

Ms Medina’s name, of course, was immediately familiar1 – a career intelligence officer with three decades of service under her belt, she has served as the CIA’s DDI in the mid-noughties and finished her career with the Agency as the director of CSI, the Agency’s think tank. Closer to home, I knew her as the lady who took the enormous political risk to be among the first backers of Intellipedia, the US intelligence community’s shared wiki (and, in my humble opinion, one of the best things the US IC has come up with in a long, long time).2 Lois Kelly, meanwhile, has been a corporate consultant throughout most of her career.3 You couldn’t have picked two authors with more different backgrounds to write a book about prevailing with new ideas in rigid systems, yet their experiences coincide in the fulcrum of their book, Rebels at Work: both faced the tough challenge of bringing new ideas into bureaucratically petrified, change-resistant organisations. Their book is a culmination of their experiences, written for ‘Rebels at Work’: a field manual, so to speak, for waging maneuver warfare (or sometimes even guerrila warfare) against a larger, better equipped and solidly entrenched corporate infrastructure. The result is a book that has some great lessons despite ample space for criticism,4 and one that I kept mulling over long after devouring it in a single sitting. Instead of a review (there are plenty of those around and I’m not a great book reviewer), I’d prefer to focus on three points that, in my view, are missing from Ms Medina and Ms Kelly’s book.

40 Second Boyd’s Rebel Alliance

Col. John Boyd, USAF (1927-1997): the biggest damn hero you’ve never heard of, and an object lesson in the cost of rebellion.

If there has ever been a rebel in a stolid, unbending institutional structure who paid a high price for being right the wrong way, it was Colonel John Boyd, affectionately known as the Mad Major, the Ghetto Colonel (he spent most of his money on books and the care of his son Stephen, who suffered from polio as a child) and 40 Second Boyd (for a standing bet that he could defeat any fighter pilot in simulated 1v1 air combat within forty seconds – a bet he never lost). There is much more to be told about Boyd than would fit into several blog posts, and fortunately, a better writer has taken it upon himself to write the seminal biography of the man who changed not just the art of air combat but of how we think about strategy.5 Boyd was a synthetic genius, one of the few people endowed with the talent to draw on fields as disparate as thermodynamics, genetics, the then-still-nascent field of neuroscience (he commented on neuronal plasticity in an 1987 presentation, despite having no formal education in the life sciences!), psychology and anthropology – and find connections that pass most of us by.6 His work on energy-maneuverability (E-M) theory informs fighter design to this day, and he made significant contributions to the development of the ‘left hook’ of Operation Desert Storm that left the Iraqi army demoralized, scattered and in vulnerable disarray.

And he was also what Scotsmen call crabbit. Boyd was devoted to flying, but not to the chain of command. His insubordinations are as legendary as his accomplishments. When his superiors refused to grant him the computer time he would require to prove by simulations his E-M theory, he and a civilian mathematician, Thomas Christie, ‘stole’ computer time on the Eglin AFB mainframe to build the models and prove that US fighter aircraft were inferior designs to Soviet aircraft. His reward for what would have saved thousands of pilots’ lives in the case of an actual air war between the superpowers was an investigation by the Inspector General.7 Boyd was irreverent, once referring to the Thunderbirds (the USAF’s demonstration squad) as ‘trained monkeys’, and was fiercely politically incorrect before political correctness was a thing.

At the same time, he had a fierce loyalty towards the men who served with him. Alongside Christie, he had his own ‘rebel alliance’, jocularly dubbed the Fighter Mafia by Italian-American test pilot Col. Everest Riccioni. And he knew very well the cost of being part of the rebel alliance: this we know from a speech he often gave to young officers he thought about inviting into his alliance. It is, at this point, worth repeating.8

[O]ne day you will come to a fork in the road,” [Boyd] said. “And you’re going to have to make a decision about which direction you want to go.” He raised his hand and pointed. “If you go that way you can be somebody. You will have to make compromises and you will have to turn your back on your friends. But you will be a member of the club and you will get promoted and you will get good assignments.” Then Boyd raised his other hand and pointed another direction. “Or you can go that way and you can do something – something for your country and for your Air Force and for yourself. If you decide you want to do something, you may not get promoted and you may not get the good assignments and you certainly will not be a favorite of your superiors. But you won’t have to compromise yourself. You will be true to your friends and to yourself. And your work might make a difference.” He paused and stared into the officer’s eyes and heart. “To be somebody or to do something. In life there is often a roll call. That’s when you will have to make a decision. To be or to do. Which way will you go?

The fact is that while we’d all like to be the rebels that eventually prevail, there’s no such guarantee. There most definitely is no guarantee that being a rebel, however well one plays the game, will be easy. A Rebel at Work is, quintessentially, an insurgent. Even a good, successful insurgency is a pain to carry out well. And that is provided you’re one of the few insurgencies that win.

And so, perhaps the idea of this ‘rebel alliance'9 lies uneasy with me because if things don’t turn out well – and however closely Ms Medina and Ms Kelly’s guidance is followed, success is never guaranteed! -, there’s more than one’s own welfare at stake. And like Boyd did, the honourable thing is to make sure that they know what the likely consequences of failure are.

Because not every rebellion wins. And if you’re drawing others into your rebellion, you’ll have to be able to live with what happens to them, too.

A few years ago, I had the singular pleasure to discuss Boyd with one of his last living collaborators and a few devotees of “Genghis John”, and one question came up repeatedly: how different would things have been had Boyd had a slightly more subtle sense of social interaction? How different would our world be if Boyd had somehow had Ms Medina and Ms Kelly’s book? As a scientist and an experimentalist, I am somewhat torn. On one hand, many of Boyd’s ideas could have been adopted earlier if he had cultivated a more positive personality. But at the same time, what if much of the substance of his ideas flowed directly from those negative features of his demeanor, the ones that made him a ‘bad rebel’: irascibility, a sizeable ego even for a fighter pilot, prone to outbursts of rage, the kind of obsessiveness that drove him to teach himself entire subjects from whatever books he could scrounge from the base library and, of course, his preternatural talent of alienating people. It is no accident that despite his illustrious track record and lasting developments, he never rose to general officer rank and in a final act of contempt, the DoD sent a single general officer to his funeral, despite his vast contribution to winning the first Gulf War mere six years earlier. Would a nicer Boyd have come up with E-M? Was his obsessiveness, a result of his socially alienating perspective and ensuing solitude, the fulcrum around which his genius leveraged? It is clear to me what Ms Medina and Ms Kelly would say – I’m just not sure as to the evidential basis. ‘Good’ rebels have an easier time (eventually), but I am not as willing to discount the ability of ‘bad rebel’ traits to produce worthwhile, yea crucially important, things as the authors are.

Ajax meets HR

The suicide of Ajax, depicted on a black-figure vase by Exekias, ca. 540 BC. If this sort of stuff goes down in your office, you might be having a leadership problem.

The greatest work on management and leadership was written and first performed at some point around 2,450 years ago. It was written by a general in his late 50s who, besides his military career, had a hold and an understanding of the human psyche few others since then have been able to even approach. It takes place towards the end of the Trojan War, immediately after the death of the Greek hero Achilles at the hands of the Trojan Paris. And over the years, I have often required my reports/subordinates to read it and often implored my superiors and COs, too, to (re)acquaint themselves with it.10 But what relevance is a two-and-a-half-millennia old play about warriors to modern corporate culture and Rebels at Work?

Early on in the book, Ms Medina and Ms Kelly identify traits of ‘good’ and ‘bad’ rebels at work. In particular, they associate anger, pessimism, obsessiveness and alienating others as traits of ‘bad’ rebels at works. And they’re right. Those traits will not get you particularly far. Nobody listens to angry voices and pessimism. You don’t want to be the departmental obsessive. And you most definitely don’t want to alienate the uncommitted – you’ll need that Rebel Alliance at some point.

But these points have particularly hit home because I’ve seen this tetrad too often, in history and in real life: anger, pessimism, hostility and a near-obsessive adherence to things that make sense to few others. They’re the hallmark symptoms of what psychiatrist Jonathan P. Shay called moral injury.11

The archetypal moral injury and betrayal of themis mentioned by Shay: during the Vietnam War, infantry units were often separated and felt alienated from their commanders, who directed them from their airborne command posts, with little awareness of the risks and situation on the ground.

Moral injury is what happens when what Shay referred to as themis is violated. Themis is one of those beautifully untranslatable Greek cultural artifacts – with a meaning of “order”, “moral rightness” and “the way things ought to be”. Or, as he most beautifully put it, it is the “social morality of what’s right”, “the normal adult’s cloak of safety”.12

Shay is, of course, speaking in the context of trauma, specifically combat PTSD. It is his thesis that combat PTSD happens when a traumatic experience is accompanied with moral injury. But moral injury doesn’t need a traumatic event to accompany it. It happens every day, in boardrooms, in offices, in cubicle farms, much as it happened on the sands of Troy’s shore, amidst the Greek camp, during the events that inspired Sophocles’ Ajax.

The quintessential moral injury Ajax suffers is betrayal of what he believes is themis. Rightly or wrongly, he believes that as not merely the strongest warrior of the Greeks after Achilles but also the warrior whose acts had a character of self-endangering altruism – he was referred to as the ‘shield’ of the Greeks as he protected other warriors behind him -, he would be due the armour of the fallen Achilles. Nor is he entirely wrong – it is clearly implied that this would have been the ordinary way of doing things. But instead, Odysseus convinces the Greek leadership to award Achilles’s gear based on a competition that clearly favours him, including one in rhetoric – not exactly Ajax’s forte. The tragedy that ensues is nothing short of heartbreaking. The altruistic warrior who sheltered other soldiers with his own body now slaughters the Greeks’ sheep and shepherds – a quintessentially antisocial act, not merely taking lives but also depriving the Greek army of valuable supplies. In the end, Ajax – despite the entreaties of his war-bride Tecmessa – commits suicide: once again an act not merely against himself but also against the Greeks, a final act of vengeance, depriving them of one of their most decorated warriors.

What Ms Medina and Ms Kelly call ‘bad rebels’ might not be ‘bad rebels’ – they might suffer from the moral injury of a chain of command, violating institutional, individual and communal themis. The risk of Ms Medina and Ms Kelly’s identification of bad vs good rebels is twofold: on one hand, it blames the victim of moral injury for its natural effects – on the other, it relieves a deeply flawed chain of command of responsibility. The effects may not be as bloody as Ajax’s end, but they may well be as morally, individually and personally devastating.

To be quite clear: the authors do get it. Or, in the words of Ms Medina:

With their experience, they no doubt are aware that some frustration is endogenous and some frustration is exogenous. My sole apprehension is that there are precious few tools and tactics to differentiate these situations – and this is not the book’s fault, but a consequence of the underlying problem’s sheer complexity. To perfectionists suffering in a work environment pervaded by ‘moral injury’, it may be impossible to consider that the true problem is outside one’s cranium, and having witnessed the torment of the ensuing frustration, it is crucial for rebels to learn when they’re in a situation that defies the normal approach.

Responsible rebellion: put on your oxygen mask first

Perhaps the greatest strength, besides the vastly differing perspectives Ms Medina and Ms Kelly that form a truly unique synthesis of viewpoints, is an inherent understanding throughout that ‘good rebels’ are not self-directed: they’re organizationally directed. Much like Boyd’s promise to his acolytes-to-be, what’s on offer is not glory and immediate satisfaction but hard work and, if all goes well, organizational level success. I’ve touched on the small-scale aspect of this earlier, when I considered that however indispensable a Rebel Alliance is, it also means we’re betting others’ careers, livelihoods and well-being on how we do our job. I’m sure that Ms Medina and Ms Kelly would agree with me: being a rebel at work is an exacting task with very little margin for error. But there’s a different scale of responsibility involved in rebellion: responsibility for self.

There’s a common concept in modern (post-WW I) military strategy known as Auftragstaktik or mission command in the English sphere of military education.13 Mission command is similar to what is known in software development as ‘declarative programming’: instead of providing a list of imperatives (orders, instructions), an end result is specified and the unit in question gets to figure out how to best accomplish it. This is often discussed in the context of decentralized command: instead of micromanaging units from a far-off regimental HQ, commanders can issue objectives and lower-level leadership, who are closer to the objective, can make the small-scale decisions with much better and much more accurate information straight from the vicinity of the objective. Instead of regimental HQ specifying from which side to assault a position, the platoon or company actually carrying out the mission can adapt to rapidly changing circumstances right there, on the ground.

The vulnerability of mission command is that if the leadership – or just a crucial element – of a unit gets incapacitated, all hell can break loose. This was witnessed quite often during the Vietnam War, where Viet Cong snipers targeted officers and radio operators to incapacitate command and control.14 On Twitter, discussing Rebels at Work and the fact that sometimes, cynicism is a legitimate idiom of distress to the kind of moral injury discussed in the previous section, Barney Hammond (@bhammond) hit the nail on its head:

And perhaps as far as being a rebel goes,15 that is a tough dilemma to resolve: when do we owe it to our Rebel Alliance to put the oxygen mask on ourselves first? Rebels at work, as the authors correctly identify, are organizationally-altruistically minded, sometimes even to the point of self-deprecation and putting themselves last. But it is exactly that attitude that needs to be tempered by what Barney so acutely pointed out: sometimes, we need to put the oxygen mask on first before helping others. To find this sensitive balance is not going to be easy – and I would not be surprised if most rebels at work would, once they have gathered their Rebel Alliance, struggle with finding the right balance between self-care and altruism.

In lieu of a conclusion

Reading Rebels at Work was a pleasant disappointment. It is a practical book, with actionable steps and things to think about – in that sense, it is a book that demands to be worked on. And the discerning reader can take a lot away – especially if years of struggling against corporate rigidity has left them wondering whether they’re even cut out for this role. Learning how to navigate some of the processes the authors describe has taken me long years and some restless nights and – I won’t lie – more than a few tears shed. In reality, Ms Medina and Ms Kelly’s book is not so much a handbook for rebels but a field manual for launching an insurgency – a sort of asymmetric warfare guide for waging 4th generation warfare (4GW) against slow-moving Prussian line infantry armed with muskets but vastly superior in numbers. And that perhaps is the most laudable feature of their book: it’s not about surviving as a NOC16 rebel in a hostile organisation, but about openly accomplishing ambitious goals by building a network of support (the Rebel Alliance), exploiting critical actors, tending to your assets (see the part about the oxygen mask) and integrating one’s own desired objectives with pre-existing organizational commitments.

It was somewhat surprising to me to see so many epidemiologists discuss this book on Twitter – I mean, surely most of us do not work in a rigid, corporate framework that would necessitate us putting on our Rambo headbands and jungle camo face paint and go full-on tactical. Until, of course, I realized that as public health workers, we’re passionate by nature. Apathy doesn’t sit well with a job that is ultimately intended to save lives. And there aren’t many books that are so even-keeled about keeping a balance between operating within the system while pursuing what is right, even in circumstances where the institutional structures aren’t supportive of those goals. And so, to epidemiologists, public health workers and all those in the wider field working to save lives, this book might just be the best three hours you’ll spend reading during the holidays.

Boyd himself often pointed out that nothing – not even his own presentations – should be taken as gospel truth. To me, Rebels at Work leaves three questions open, and they are indeed quite unsettling.

  1. How do we differentiate between a ‘bad rebel’ (for whom the adequate response is primarily corrective) and a ‘good rebel’ suffering the kind of moral injury Shay discussed in the paper op cit.?
  2. As scientists, we’re bound to ask: what if the features of being a ‘bad rebel’ are necessary for some products of the mind? Consider the example of Boyd.
  3. Finally, how do we know when to prioritize ourselves and when to prioritize our Rebel Alliance?

The collaboration between the authors having been so successful, I would not be surprised if we were to see some answers to these questions in a sequel. I, for one, will definitely be looking forward to it.

An afternote

A mere hour or so after I posted this on my Facebook page, Lois Kelly posted this poignant message and kindly gave permission for me to repeat it here:

Thanks for such a thoughtful analysis and good questions. In my experience and research with Rebels at Work, “bad” rebel behaviors are sometimes necessary and useful. (My outrage and anger has propelled me in such positive ways.) A school superintendent of a big city school system here in the US told me that to cram as much change through the bureaucracy before his contract ended he had to go fast and embrace the “bad” behaviors. He knew he would alienate people and be disliked and he knew the children, teachers and principals would benefit. Playing a short game differs from the long game, which is important to understand. As for prioritizing between ourselves and the cause: we have to always be practicing resiliency (and I do mean practice) to manage our energy, sense making abilities, and relationships. The saddest stories I’ve heard are from people who ruined their marriages and friendships because of their obsession with their work/cause — and then didn’t achieve what they wanted at work anyway. Self-compassion is especially invaluable.

Lois makes two fantastic points here, both worth some thinking. One of these is, of course, that what’s good or bad might be context-dependent, in the example she mentions, conditional on time: or to say it all in warfighteresque, some targets call for a careful, slow approach while others require a degree of violence of action. More important, however, is her point on ‘practicing resiliency’. I know this because I’ve been there myself, so caught up with what my mission was at the moment that I lost track of many other things in life, and I’m quite sure that if my wife weren’t the steadfast angelic presence she is in my life, it could all have ended badly. I have seen way too many people who sacrificed their home base for fleeting objectives that some of them can’t even really remember anymore. I saw a shocking number of these cases when I was briefly working in Big Law. It reinforces another important rule of land warfare: know your stronghold, protect it, defend it and do not risk it for fleeting advantages.

To us in fields where there’s something larger at stake – be it the wellbeing of one’s unit, the fate of a company employing thousands, the health of millions relying on us doing our job well or indeed the very security of our nation -, it’s easy to find a justification for neglecting our stronghold: our friendships, marriage and our relationship with ourselves as expressed through self-compassion. This is a particular risk to altruists, and most epidemiologists do have a core of pure altruistic concern for the well-being of others and for humanity at large. To practice resiliency – or, as @bhammond2011 put it, putting on one’s own oxygen mask first – is particularly important, however counter-intuitive it is to the altruistic instinct to put others first and oneself last. To quote a Regimental Sergeant Major I once knew who was as grizzled as he was wise: “I don’t know what use you’ll ever be to anyone, but I sure do know you ain’t no use to anyone dead.

Kelly, L., Medina, C., & Cameron, D. (2014). Rebels at Work: A Handbook for Leading Change from Within. O’Reilly, $19.04 (Kindle). The authors also have a great website definitely worth checking out.

Reader questions: How did you find Rebels at Work? Do you feel it applies to your position in life and work? I’m particularly interested in epidemiologists, public health workers and researchers who found they got a lot out of the book. Don’t be shy, leave a comment!

References   [ + ]

1.You can take the boy out of the intelligence business, and so on.
2.Whether Intellipedia has lived up to its potential, and what that potential actually is, is a different story. But it takes willful disregard of the facts to ignore just how off the wall the very idea was: to begin with, Intellipedia had to exist on three different communication systems with a highest level of classification each of these could transmit: JWICS for TS, SIPRNet for Secret and Intelink-U for SBU/FOUO. I was in no sense au fait with the top of the US intelligence apparatus around 2005-2007 when Intellipedia was first proposed, but extrapolating from its current state, I would have been surprised if there had been more than one or two people who were willing to stick their neck out for such an idea – and as one of them, Ms Medina has all the right and credibility in the world to speak about being a rebel at a rigid bureaucracy playing a high-stakes game. I may not agree with Ms Medina on many things, but I can’t think of her with anything but the deepest respect.
3.I mean no disrespect by the fact that compared to Ms Medina’s career, I have less to say about Ms Kelly’s – merely that there is less information I could find.
4.I found some parts bordering on pseudoscience, especially the use of MindTime, which is neither sufficiently validated with peer reviewed research nor is its application in the book well executed: we know little about the sample other than the sample size and the fact that there was almost definitely some degree of selection bias. The problem with using pseudoscience at any point is that it casts doubt on the entire corpus at large.
5.Coram, R. (2002). Boyd: The fighter pilot who changed the art of war. Little, Brown.
6.DNI-POGO has all of Boyd’s presentations in original and modernized formats, and you should read them. The deck that best displays his incredible synthetic genius is Strategic Game of ? And ?, available here in its original form.
7.Kane, T. (2012). Bleeding Talent: How the US military mismanages great leaders and why it’s time for a revolution, Macmillan.
8.This version is taken from Coram’s book, op. cit.. Several of Boyd’s acolytes whom he invited on his quest for change confirmed the content of his invitation.
9.I refuse to go along with the ‘Dumbledore’s Army’ analogy many have raised on Twitter. Dumbledore’s Army is an object lesson on how to mount a stupid insurgency that will get you killed.
10.There is a great translation by Bryan Doerries, which you can buy on Amazon together with his translations of Philoctetes, the Trachinae and Aeschylus’ Prometheus Bound. Doerries, like me, believes in the abiding power of the Classics to speak to us today, too, and has held readings of many of these plays in all kinds of venues, from military bases through prisons to hospitals and hospices.
11.Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182. Available online here.
12.Shay, J. (2010). Achilles in Vietnam: Combat trauma and the undoing of character. Simon and Schuster. An excerpt from the book is available here.
13.There are convoluted arguments as to whether the two terms do indeed cover the same ground, but for the present purposes, these are largely irrelevant.
14.In his seminal book on the battle of Ia Drang, then-Col. Hal Moore describes practicing exactly for this scenario by occasionally declaring platoon leaders ‘dead’ during training and have their sergeant take over command of the platoon. This would, as his memoir, We Were Soldiers Once And Young describes, often make all the difference between a decapitated unit being able to continue to operate or fall into disarray.
15.I share many of the traits Ms Medina and Ms Kelly would identify in a rebel, but I am not quite sure if I would neatly fit into that box without reservations. Nor, I’d wager, would most people.
16.Non-official cover.

Peace on Christmas

The ‘war on Christmas’ is a venerable tradition in America. Many blame the incipient atheism and secularism of American society starting with the 20th century, but in fact, 17th century Puritans – whom you can accuse of many things but definitely not of religious pluralism and secularist tendencies! – were all too keen to ban celebrations of Christmas in the New World.1 And to this day, the ‘war on Christmas’ remains one of those political signal flags, waved with more pride than wisdom, more enthusiasm than meaning.

But I don’t want to talk about the war on Christmas. I want to talk about the peace on Christmas.

Christmas miracles

Like most people who, by addiction or duty, are near constantly connected to the internet, I couldn’t possibly miss astrophysicist popular science narrator Neil deGrasse Tyson’s obligatory tweet to enlighten the masses about the sheer folly and insignificance of Christmas.

Now, if Mr Tyson does not want to find a religious miracle in what transpired two millennia ago somewhere near Bethlehem, that’s his right, and a right I volunteered to bleed and die for. But maybe he’ll have time for a secular miracle.

December, 1914

By Christmas 1914, the Great War has been raging on for less than half a year, but quite definitely longer than what was promised – a quick pacification of the Balkans and resolution of the Austro-Hungarian crisis before the leaves fell. After the initial frantic changes of control that form the first spasms of every armed conflict, the lines of combat solidified, and warfighting went from killing time to, well, just killing time. Nowhere was this more true than the blood-sodden fields of Ypres, where the First Battle of Flanders between late October and late November ended in the kind of frustrating, indecisive result that we now know is psychologically more distressing than combat itself.2 The troops on the Western Front were tired, bored and immensely fed up with a war during which nothing happened.

Until something happened that no-one would have thought. Something we might with no exaggeration call a miracle.

After five months of war and the attendant emotions – rage, grief, loss, nationalistic fervour and divine self-justification -, the diary for the 16th Queen’s Westminster Infantry Regiment for 25 December 1914 noted only curtly: “no war today”.3 A Rifleman Graham Williams of the 5th London Rifle Brigade, cited by Neil Hollander,4 described the situation thus:

Then suddenly lights began to appear along the German parapet, which were evidently make-shift Christmas trees, adorned with lighted candles, which burnt steadily in the frosty air!
First the Germans would sing one of their carols and then we would sing one of ours, until when we started up O Come, All Ye Faithful, the Germans immediately joined in singing the same hymn to the Latin words Adeste Fideles. And I thought, well, this is a most extraordinary thing — two nations singing the same carol in the middle of a war.
I think I have seen one of the most extraordinary sights today that anyone has ever seen. […]

In his letter to his mother, the naturalist and author Henry Williamson, then also with the London Rifle Brigade, wrote an extensive narrative of the Christmas Truce, too long to repeat here but worth excerpting a few parts:

On Xmas eve both armies sang carols and cheered & there was very little firing. The Germans (in some places 80 yds away) called to our men to come and fetch a cigar & our men told them to come to us. This went on for some time, neither fully trusting the other, until, after much promising to ‘play the game’ a bold Tommy crept out & stood between the trenches, & immediately a Saxon came to meet him. They shook hands & laughed & then 16 Germans came out.

Thus the ice was broken. Our men are speaking to them now.

They are landsturmers or landwehr,5 I think, & Saxons & Bavarians (no Prussians).6 Many are gentle looking men in goatee beards & spectacles, and some are very big and arrogant looking. I have some cigarettes which I shall keep, & a cigar I have smoked.

We had a burial service in the afternoon, over the dead Germans who perished in the ‘last attack that was repulsed’ against us. The Germans put ‘For Fatherland & Freedom’ on the cross.

Other accounts recount spontaneous games of football (remarkably, between the 2nd Battalion Royal Welsh Fusiliers and the Saxon Infantry Corps)7, exchanges of gifts, joint services and a fervent yet futile attempt by senior leadership on both sides to prevent the truce. But miracles don’t obey orders.

Of course, eventually, war resumed, and after the increasingly inhumane and embittered warfare of 1915, involving in particular widespread use of lethal war gases like chlorine – in an act of sad irony, deployed near Ypres, where one of the first Christmas truces took place – and wide scale deployment of non-lethal lachrymants like xylyl bromide (T-Stoff), whatever residual sympathies could have led to a similar truce have been extinguished. For the rest of the war, Christmas Eve was celebrated by artillery barrages from both sides, so as to preclude any foolhardy attempts by the men in the trenches to find that unity between humankind that war cruelly severed, severs and will sever as long as we have them.

But once, just one brief Christmas Day, “at some disputed barricade”, there was a brief moment in which men who grew up, or at the very least were inculcated, with the superiority of their own nation and the justice of their cause, could set all that aside and realize that what they shared was much more than what divided them.

And that, to me, is as close to a Christmas miracle as it gets.

For reasons complex and convoluted, we don’t know to how many of the men reaching hands across the barbed wire and the barricades were devout Christians, or what the nativity of Christ meant to them, whether they ever celebrated Christmas, or whether they lit the last candle of the Menorah mere three weeks earlier. We do know that those who were Christians came from a range of different branches, some with radically different interpretations of Christmas. We don’t know to how many of them worshipped the nativity of Christ and how many were largely inspired by the secular aspects of Victorian Christmas: carols, Christmas trees and presents.

But what we do know is that on that 25th December 1914, something happened that no-one would have predicted, that someone at one point risked their lives to reach out their hand to their sworn enemy for a single day’s relief from the stalemate, that for one day amidst a senseless bloodshed, Love, Mercy and a notion of a shared humanity prevailed over principalities, powers, rulers of darkness of that world and spiritual and moral wickedness in high places that sought to separate brother from brother.

And if that’s not a miracle, I don’t know what is. You don’t have to believe in any supernatural power to accept it. It’s enough to consider all it takes to overcome the hatred and the chauvinism and the supremacist ideologies and the blind, unquestioning loyalty and the all-ever-blinding propaganda to conclude that whatever happened on that day 103 years ago, it was something very special.

And that’s why it will forever be taboo to speak of the unifying power of this day, between believers and unbelievers, between those who worship Christ and those who worship any other deity or none, between those who were made brothers and sisters equally endowed with a shared humanity but separated by arbitrary divisions.

And that’s why, as long as we wish to heal this broken world, we must think and speak more of the peace on Christmas than whatever war on Christmas, real or imagined.

Personal note: Joyeux Noël, despite the odd historical inaccuracies and somewhat contrived plot, is a beautiful dramatization of this incredible event, and definitely worth watching over Christmastide. Merry Christmas!

References   [ + ]

1.L.C. Scott writes in Christmas – Philosophy for everyone: better than a lump of coal (Wiley, 2002): “Ironically, the earliest Christian settlers on both the [American] mainland and the islands of Hawaii forbade the celebration of Christmas as extra-biblical. […] On the mainland, seventeenth-century Puritan New England had laws forbidding the observance of Christmas. […] Those who still celebrated Christmas, such as Lutherans, Catholics, Dutch Reformed and Anglicans, did so in a ow-key manner, focusing on church or home. Well into the 1800s the celebration of Christmas was a local matter. The first state to make Christmas a legal holiday was Alabama in 1836.”
2.For an argument expounding on this, see the works of Jonathan Shay, who among the moral decay of the war also emphasised the deleterious consequence of ‘killing time, punctuated by killing time’, and the relation of the abrupt changes from one to another to the development of hyperarousal as a pathognomonic symptom of combat trauma.
3.Cited in Blom Crocker, T. (2015). The Christmas Truce: Myth, Memory and the First World War. University of Kentucky Press.
4.Hollander, N. (2013). Elusive Dove: The search for peace during World War I. McFarland.
5.Roughly equivalent to a militia in this context, Landsturm and Landwehr were last-ditch forces conscripted of everyone of military age, hastily trained, badly armed and, effectively, cannon fodder.
6.The importance of this may be that Prussians practiced a much harsher military discipline than central and southern forces.
7.A good summary of the event is in DeGroot, G. (2014). The truth about the Christmas Day football match. The Telegraph, 24 Dec 2014.

Quantifying herd immunity lower bounds

In my previous article on the seasonal flu vaccine’s effectiveness, I wrote:

For the flu, with an R0 of about 1.5, we would need at least a third of the population vaccinated for herd immunity to be effective, assuming a 100% effective vaccine – knowing that flu vaccines’ VE is less than that, we’re looking at closer to 60% for adequate herd immunity. That means you, too. It is vitally important that everybody does their part, even if they themselves don’t expect, or care about, getting the flu.

Since then, I have been approached by a few people, both here and on Facebook, about the maths underlying it. So since I’m officially spending a mandatorily (read: spousally) enforced weekend off work, I thought I’m going to lay out the reasoning behind the maths.

What is herd immunity?

The idea of herd immunity is that an infectious disease needs a given number of available hosts in order to be ‘sustainable’ (able to continue to infect people) within that population. Typically, for illnesses from which people tend to either die or recover as non-infectious cases, this has to do with something called R_0 (pron. arr-nought) or ‘reproduction number’ of the infectious disease in a population.1

R_0 describes, roughly, the number of cases produced by each case. Consider poliomyelitis, which has an R_0 of about 6 (unusually high, given its transmission route).2 That means that every case produces, on average, six new cases. It is obvious from this that unless the R_0 for an infectious disease is above 1, the infection will not be sustainable in the long run – it will burn through the infected and eventually die out. R_0 is determined empirically, and is specific to a naive population, i.e. one where there is no pre-existing immunity to the disease nor is there any significant infection. It is often enough derived from the average contact rate of the population (the number of times the transmission-relevant contact occurs between people, e.g. the number of sexual contacts per unit time for sexually transmitted infections or the number of sufficient vicinity contacts for droplet/airborne transmitted infections) and the inverse of the infectious period, i.e. the multiple of unit time for which a case remains infectious.

The idea of herd immunity relates to R_0 in a particular way. Consider, once again, polio with its R_0 of 6. Now assume that half of the population is vaccinated, and assume for the time being that the vaccine is 100% effective. In practice, that means that 6 successful transmissions will at best yield 3 new cases (the unvaccinated half), whereas there will be 3 guaranteed resisters (the vaccinated half). In effect, vaccinating n% of the population cuts n% off the theoretical R_0 in a naive population – or, in other words, for a population with \frac{1}{n} vaccinated, the adjusted effective R_0 is

R_{0_{post-vaccination}} = R_{0} (1 - \frac{1}{n})

Recall that we have earlier related R_0, and specific values of it, to the survival of an infectious disease – namely that if R_0 < 1, the disease will eventually die out. The point of herd immunity is to artificially whittle down R_0 to a sub-1 value. If vaccinating \frac{1}{n } of the population reduces effective R_0 to R_0 (1 - \frac{1}{n}), then to reduce R_0 to 1 requires us to vaccinate 1 - \frac{1}{R_0}. Thus for polio, with R_0 = 6, we need to vaccinate

1 - \frac{1}{R_0} = 1 - \frac{1}{6} = \frac{5}{6}

of the population to reach a point where, assuming the vaccine is 100% effective (which it never is – not many things in reality are 100% effective), the disease cannot subsist and spread in the population for long. At that level of vaccination, even unvaccinated people are significantly protected, almost as well as if they were to be vaccinated. In theory, anyway.

Herd immunity in practice

In practice, there are two problems with this. One is that herd immunity doesn’t help you if you, for whatever reason, do things that lead to catching the disease. In other words, it is not a ‘real’ immunity the way getting vaccinated is. It ensures that the likelihood of catching the disease is significantly reduced, and that outbreaks become self-contained, but it doesn’t give you as an unvaccinated individual any immunity per se. The other problem is that herd immunity calculations are premised on 100% vaccine efficacy (which is not the same as efficiency, see the previous post for difference!). The point is that the result of the above calculation is a theoretical minimum, premised on 100% effective vaccines, for herd immunity – reaching it, or even exceeding it, does not yet guarantee herd immunity. And with information about vaccine efficacy not being easy to come by (unlike information about vaccine efficiency, which is available in abundance), it’s hard to determine a correct rate. For these reasons, anyone who could get vaccinated, should get vaccinated.3 Especially for viral diseases, herd immunity is the best protection for those who genuinely cannot get vaccinated. It’s a goal worth striving for as a population – and it costs nothing to confer herd immunity above and beyond getting immunised, which already confers the benefits of individual immunity.

References   [ + ]

1.The situation is different for illnesses where a recovered case may remain infectious, indefinitely or for a given time, e.g. for Ebola virus disease (EVD), where recovered patients continue to have actively infectious virus in their seminal fluid and vitreous humour for several years. For a case study, consider William A Fischer II et al. Ebola Virus RNA Detection in Semen More than Two Years After Resolution of Acute Ebola Virus Infection. Open Forum Infectious Diseases, 2017. DOI: 10.1093/ofid/ofx155/4004818
2.In general, airborne infectious diseases tend to have a higher R_0 than other methods of transmission, such as those that require sexual contact, blood or, as in the case of polio, fecal-oral transmission to spread.
3.A recent meme is claiming or pretending to have the MTHFR mutation and arguing that this should lead to a medical exemption from vaccinations. Most doctors haven’t heard much of MTHFR, and it sounds scary, and when you google it, most of the documentation is on the extremely rare complete MTHFR deficiency, a very rare and very serious illness that has about 70 documented cases in all of medical history. Meanwhile, some degree of MTHFR mutation is present in a good deal – somewhere between 10 to 35% – of the normal population, and is indeed so frequent without any associated clinical syndrome that it’s seen as a harmless variation in genetics. MTHFR (methylenetetrahydrofolate reductase) is an enzyme that catalyses the reduction of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate, which is involved in the methylation of homocysteine, yielding methionine. There is some evidence, from an NIH study with ridiculously small sample sizes, that certain MTHFR SNPs, particularly rs1801133, are associated with adverse events in smallpox vaccination. There are two problems with this. One, I don’t know of this ever having been replicated with any sample size worthy of being drawn conclusions from. Two, given the frequency of MTHFR deficiency in the population, you would expect vast numbers of ‘vaccine injured’ people, much more than the cases in VAERS and definitely more than those that have a credible claim. It makes no epidemiological sense at all. MTHFR polymorphisms are, as the science stands at the moment, not a good reason not to vaccinate.

Is the flu vaccine really only 10% effective? A sojourn into immunization epidemiology

If you work in IT, you must be familiar with the instances of well-meaning family asking you to fix their computers – even if you develop enterprise Java apps and they have a broken video card, they expect you to be able to do something about it. For epidemiologists, the equivalent is the flu shot. Over the last few weeks, I have been asked by so many of my friends to explain why they should even consider getting the flu shot if it’s, reportedly, only 10% effective. Add to that, of course, the sheer amount of crazy on the internet on the subject (the flu shot will give you cancer/autism/cancertism, here, have these herbs, open your chakras, meditate on these crystals and drink some colloidal silver until you look like Stan Jones).

“I mean, how hard could it be? We have the flu every year,” my friend, a very intelligent and accomplished lady, pointed out to me the other day. “And surely something like the flu is pretty simple, right? You’d think that by now we would have figured out what works and what doesn’t.”

In fact, it’s pretty complicated – and the simplicity of the flu virus makes matters worse, not better.

Read more

Destiny and desolation

This is the story of how I lost my destiny and found a world without destinies. It’s a story of two viewpoints – the human and the institutional. It’s a story of desire, longing, loss and of new beginnings. It’s a story that perhaps is a little uplifting, but also, on the whole, fairly depressing. And that shall suffice by way of preamble.1


There are, to the best of my understanding, two ways of dealing with present adversity. One is to fight it in the here and now, and rage against it with all one’s might, and to hell with the consequences. Or, one might instead opt for a slower course, and bide one’s time. The present may be dark, one might say, but there will be a future that will no doubt vindicate oneself. Sometimes, facing overwhelming odds, where there is no chance of success of a fight in the present, biding one’s time might indeed be the only thing one can do.

Inevitably, it becomes an existential necessity to set one’s sights on a target, as much in the stars as one’s adversity-laden present is a gutter. That, that would be the final justification, the thing to set all things right, the just reward for not giving up hope and the well-earned prize of a steadfast hand.

Some people would call that pursuit an ‘ambition’. That, dear reader, is pure steaming bullshit coming from people who do not understand the depth of the emotion herein described. It’s not an ambition. It’s love. It’s infatuation. It’s a passionate desire, an intoxicating mixture of equal part love and madness, that does not admit to alternatives or silver medals. You, you’ve just got to have it.

And to a select few, that thing becomes a part of their identity, dwarfing much that others care about. From time to time, society encounters individuals thus obsessed (or perhaps possessed would be a more apt term?), and sees them at best as eccentrics and at worst as single-minded obsessives devoid of fundamental human equanimity, who have abstracted their human worth onto the single pinpoint pinnacle of reaching their goal, pouring everything into that goal in ways that might, to the so-called ‘sane’, seem strange to the point of insanity (indeed, a good number of history’s asylums were, and remain, filled with people of this mindset).

I’m not here to convince you that people who go through this emotion are sane. That would be, of course, partly false witness. And partly, it would be witnessing in my own case.


An ambition is something you follow (or not, depending on how you’re feeling at the time). A Destiny is more like a plant, something one nourishes, and when one is out of water, it is the way of things that one would willingly shed one’s own blood to sustain that frail little flower, and to hell with one’s own survival. And with every day, it grows into a sustaining force of its own, a symbiotic entity of sorts, in need to be nourished much as it also nourishes and protects.

And sometimes, its very existence can help one survive the unsurvivable.

I will dispense with sordid details of past atrocities. All that needs to be said is, there were plenty. All that needs to be understood is that for a long, long time, the sole thing that kept me alive, through the dark night of the decade from age 8 to 18, was my destiny. I know this because I know those who went through the same night, and few made it out sane, never mind at all. Much of the terror of that night was compounded by a bitter lack of companionship, understanding and respect. And so, my destiny would be the place where I would find all three.

I would be a Fellow of All Souls.

Now, in case you have no idea what I’m talking about, here’s the Cliffsnotes version. Every year, All Souls College, the most elite college of Oxford and Cambridge and admitting only graduate students, elects one, sometimes two Prize Fellows (now called Fellows by Election). You can only try in the first few years after your BA, and generally, you need a top 1st – a top of the tops degree in your subject – to try. You sit a written examination, which is as insane as it is fun: two general papers and two subject papers. Many sit. Few, at most five, are chosen to a viva, an oral examination of sorts where your soul – and mind – is weighed by all current Fellows, many distinguished in their field to the point of being household names. Two at most are chosen.

To be a Prize Fellow is the greatest acknowledgement a young academic can hope for. I could wax lyrical about it, but frankly, there’s no point. It doesn’t matter what it was. It matters what it was to me.

To me, it was acknowledgement that I was worthy – the only thing I craved all my life. A simple, plain recognition that I was worthy of respect, of attention, of fostering and perhaps even of love. And a damning verdict on a world that repaid these needs of mine with rejection and abuse.

And so, when I took my pen to paper on a Saturday morning, the air thick with the sausage and hash browns of a whole university town at brunch, I wrote with the force and fervour of every ounce and grain of pain amassed over fifteen years, every insult and atrocity taken with a straight face and saved for this moment, every single one of those blinding flashes of grief and humiliation that are one’s lot – fifteen years of pent-up rage and anger and hate and that ultimate of human fundamental forces: the desire to be understood, loved and respected. I’m surprised the paper did not catch fire.

And a few days later, I got an e-mail. I made it into the viva. I was within the Final Five. I could see it, just inches away. Here was my prize, and by All Souls’ Day, a few days after the viva, it would be mine.

I came in from the river early, and ran for my room at a breakneck pace on the day of election. It was, we of the final five knew, that afternoon that the results would be communicated to us by the Warden (the head of the College).

And just as sure, the phone rang a few minutes after I entered my room. I picked up the receiver. As soon as I heard the Warden’s tone, I knew what the message was going to be. I was passed over. For whatever reason, and reasons are not really given in this stupid game, I’ve been found wanting.

I don’t care much for seven years’ free food and board. But that day, I lost my destiny.


Losing your destiny is like permanently missing a body part. It’s not so much painful as it is an acute awareness of the fact that there ought to be something there, and it isn’t. The edges of the wound, from which a part of one’s soul was torn with the violence of a stellar explosion, are sore. They heal slowly. Five years on, they still are incredibly sore.

I don’t know to this day how I survived that day, and the following weeks. I fielded calls of sympathy and e-mails telling me how incredibly proud the college was of having me in the viva… well meant, but I frankly couldn’t have cared less. After two and a half decades of working through pain and fatigue and a non-specific sickness of the previous few years that would soon make its grand entrance; after all-nighters heaped upon all-nighters, after exceeding every single expectation, after sacrificing more than many will ever know, – and perhaps I ought to be ashamed of writing this, but I am not – I hung my head and wept for an hour.

I would never be the same.


Destinies are not like houses. You cannot build yourself a new one if the old one crumbles. You cannot buy a new one. They are crafted in fiery furnaces, and it’s exceptional enough to have one in a lifetime. You certainly don’t get a second one.

What’s left is to pick up the pieces and carry on. That’s indeed what I did. I made a moderate success of my BCL, but it was clear after this rejection that there was no way I could with any self-respect get a doctoral place in Oxford. That’s the cost of shooting your arrow to the sky: if you’re chastened, there’s a good chance you’ll be chastened with that arrow through your knee.

It’s been 1,825 days since the worst injustice of my entire life – worse than any other – the thing that could’ve made everything good. Or so I thought, anyway. I never said there was a trace of sanity in this. If you think I’m entitled, you are probably right – but then, that word also means ‘deserving of receiving something’. And were you not chastising me for just that?

Or, if you think I was insane to put so much into an abstract, not even objectively measurable process: once again, I did not give warranties of sanity.

A few months later, I would stop being able to eat, violently throwing up every bite of food. I carried on doing 20-hour days in utter physical agony. I would eventually come down with a disease so rare, it was the fifth haematologist to pick it up. Things looked pretty darn grim. Very little is known about HLH, but it was pretty well known that it does one thing pretty well: it kills most patients. 78%, according to some statistics. That, by the way, is with treatment. I did not exactly care a lot, but probably decided to do chemotherapy because it was the right thing to do, plus, I am constitutionally intolerant of not doing something about a problem.

In what struck me as utterly bizarre, I lived.

A lot of pieces have fallen into place since then. Towards the end of my chemotherapy, I met the girl who became my loving, devoted wife. If I can write about this experience with pain only, but no anger and resentment, that’s all due to her. I did not really need someone to explain to me how silly the whole thing was, but that does not make it any less real. My heart will never be whole, and I have no more choice in that than I have in having greenish-blue eyes. But whether I would let this poison the good in it or not, that was my choice. I doubt I would have recognised it without her.

She is everything to me. I don’t know if she is my destiny, and I don’t care. Destiny can kiss my ass.

Since then, I have made my own destiny. I married the girl I loved, and now, I can hear her soft breathing as she sleeps next to me, occasionally exuding a giggle from what must be a particularly amusing dream. We have a kitten, and she’s a joy, even if she decides to poop where she’s not supposed to. I’ve found my place in a new career in a new industry that I love, and perhaps I’m better off now. On more cogent days, I even realise I came closer to my dream than virtually everyone save the 1-2 people a year, and that in and of itself is an honour. Some put it on their CV, proudly. I’m not there yet.

I’ve had plenty of recognition, too, since, and I’ve found many like-minded people. And perhaps part of growth is understanding that dreams are just that. We have them and they get us through the night. But we can’t spend our days in dreams. Not unless we aim to have some Thorazine with our dinner, too.

I’m probably never going to have a destiny again, and most of the time, that’s fine with me. “Fine”, like an old injury is fine – painless most days, but makes itself felt every once in a while when moving funny or when the weather turns damp.

References   [ + ]

1.The title, as well as this sentence, is of course an act of unbridled linguistic thievery committed against one of my favourite papers in moral philosophy by Rae Langton, but maybe the reader will accept a more charitable construction of homage.

10 tips for passing the Neo4j Certified Professional examination

Everybody loves a good certification. Twice so when it’s for free and quadruply so if it’s in a cool new technology like Neo4j. In case you’re unfamiliar with Neo4j, it’s a graph database – a novel database concept that belongs to the NoSQL class of databases, i.e. it does not follow a relational model. Rather, it allows for the storage of, and computation on, graphs.

From a purely mathematical perspective, a graph G(V,E) is formally defined as an ordered pair of vertices V (called nodes in Neo4j) and edges E (known as relationships in Neo4j). In other words, the first class citizens of a graph are ‘things’ and ‘connections between things’. No doubt you can already think of a lot of problems that can be conceptualised as graph problems. Indeed, for a surprising number of things that don’t sound very graph-y at all, it is possible to make use of graph databases. Not that you should always do so (no single technology is a panacea to every problem and I would look very suspiciously at someone who would implement time series as a graph database), but that does not mean it’s not possible in most cases.

Which leads me to the appeal of Neo4j. In general, you had two approaches to graph operations until graph databases entered the scene. One was to write your own graph object model and have it persist in memory. That’s not bad, but a database it sure ain’t. Meanwhile, an alternative is to decompose the graph into a table of vertices and its properties and another table of connections between vertices (an adjacency matrix) and then store it in a regular RDBMS or, somewhat more efficiently, in a NoSQL key-value store. That’s a little better, but it still requires considerable reinvention of the wheel.

The strength of graph databases is that they facilitate more complex operations, way beyond storage and retrieval of graphs, such as searching for patterns, properties and paths. One done-to-death example would be the famous problem known as Six Degrees of Kevin Bacon, a pop culture version of Erdös numbers: for an actor A and a Kevin Bacon K within a graph G_{Actors} with A, K \in G_{Actors}, what is the shortest path (and is it below six jumps?) to get from A to K? Graph databases turn this into a simple query. Neo4j is one of the first industrial grade graph DBs, with an enterprise grade product that you can safely deploy in a production system without worrying too much about it. Written in Java, it’s stable, fast and has enough API wrappers to have some left over for the presents next Christmas. Alongside the more traditional APIs, it’s got a very friendly and very visual web-based interface that immediately plots your query results and a somewhat weird but ultimately not very counter-intuitive query language known as Cypher. As such, if graph problems are the kind of problem you deal with on a regular basis, taking Neo4j for a spin might be a very good idea.

Which in turn leads me to the Neo4j certification. For the unbeatable price of $0.00, you can now sit for the esteemed title of Neo4j Certified Professional – that is, if you pass the 80-question, 60-minute time-capped test with a score of 80% or above. Now, let not the fact that it’s offered for free deter you – the test is pretty ferocious. It takes a fairly in-depth knowledge of Neo4j to pass (I’ve been around Neo4j ever since it has been around, and while I’ve never tried it and passed at first try recently, it has been surprisingly hard even for me!), the time cap means that even if you do decide to refer to your notes (I am not sure if that’s not cheating – I personally did not, as it was just so time-intensive), you won’t be able to pass merely from notes. Worse, there are no test exams and preparation material is scarce outside (rather pricey!) trainings. As such, I’ve written up the ten things I wish I had known before embarking upon the exam. While I did pass at the first try, it was a lot harder than I expected and I would definitely have prepared for it differently, had I known what it would be like! Fortunately, you can attempt it as often as you would like for no cost, and as such it’s by no means an impossible task,1 but you’re in for a ride if you wish to pass with a good score. Fasten your seat belt, flip up the tray table and put your seat in a fully upright position – it’s time to get Neo4j’d!

1. This is not a user test… it’s a user and DBA test.

I haven’t heard of a single Neo4j shop that had a dedicated Neo4j DBA to support graph operations. Which is ok – compared to the relatively arcane art of (enterprise) RDBMS DBAs, Neo4j is a breeze to configure. At the same time, the model seems to expect users to know what they’re doing themselves and be confident with some close-to-the-metal database tweaking. Good.

The downside is that about a quarter or so of the questions have to do with the configuration of Neo4j, and they do get into the nitty-gritty. You’re expected, for instance, to know fairly detailed minutiae of Enterprise edition High Availability server settings.

2. Pay attention to Cypher queries. The devil’s in the details.

If you’ve done as many multiple choice tests as I have, you know you’ve learned one thing for sure: all of them follow the same pattern. Two answers are complete bunk and anyone who’s done their reading can spot that. The remaining two are deceptively similar, however, and both sound ‘correct enough’. In the Neo4j test, this is mainly in the realm of the Cypher queries. A number of questions involve a ‘problem’ being described and four possible Cypher queries. The candidate must then spot which of these, or which several of these, answer the problem description. Often the correct answer may be distinguished from the incorrect one by as little as a correctly placed colon or a bracket closed in the right order. When in doubt, have a very sharp look at the Cypher syntax.

Oh, incidentally? The test makes relatively liberal use of the ‘both directions match’ (a)-[:RELATION]-(b) query pattern. This catches (a)-[:RELATION]->(b) as well as (b)-[:RELATION]->(a). The lack of the little arrow is easy to overlook and can lead you down the wrong path…

3. Develop query equivalence to second nature.

Python was built so that there would be one, and exactly one, right way to do everything. Sort of. Cypher is the opposite – there are dozens of ways to express certain relations, largely owing to the equivalence of relationships. As such, be aware of two equivalences. One is the equivalence of inline parameters and WHERE parameters:

MATCH (a:Person {name: "John Smith"})-[:REL]->(b)
MATCH (a:Person)-[:REL]->(b)
WHERE = "John Smith"

Also, the following partials are equivalent, but not always:


When you see a Cypher statement, you should be able to see all of its forms. Recap question: when are the statements in the second pair NOT equivalent?

4. The test is designed on the basis of the Enterprise edition.

Neo4j comes in two ‘flavours’ – Community and Enterprise. The latter has a lot of cool features, such as an error-resilient, distributed ‘High Availability’ mode. The certification’s premise is that you are familiar – and familiar to a fairly high degree, actually! – with many of the Enterprise-only features of Neo4j. As such, unless you’re fortunate enough to be an enterprise user, it might repay itself to download the 30-day evaluation version of Neo4j Enterprise.

5. The test is generally well-written.

In other words, most things are fairly clear. By fairly clear, I mean that there is little ambiguity and it uses the same language as the reference (although comparing test questions to phrases that stuck in my head which I ended up checking after the test, just enough words are changed to deter would-be cheaters from Ctrl+F-ing through the manual! There are no trick questions – so try to understand the questions in their most ‘mundane’, ‘trivial’ way. Yes, sometimes it is that simple!


A lot of traditional SQL clauses (yes, TRUNCATE is one example – so is JOIN and its multifarious siblings, which describe a concept that simply does not exist in Neo4j) come up as red herrings in Cypher application questions. Try to force your brain to make a switch from SQL to Cypher – and don’t fall for the trap of instinctively thinking of the clauses in the SQL solution! Forget SQL. And most of all, forget its logic of selection – MATCHing is something rather different than SELECTing in SQL.

7. Have a 30,000ft overview of the subject

In particular, have an overview of what your options are to get particular things done. How can you access Neo4j? You might have spent 99% of your time on the web interface and/or interacting using the SDK, but there is actually a shell. How can you backup from Neo4j, and what does backup do? What are your options to monitor Neo4j? Once again, most users are more likely to think of one solution, perhaps two, when there are several more. The difficult thing about this test is that it requires you to be exhaustive – both in breadth and in depth.

8. Algorithms, statistics and aggregation

As far as I’m aware, everyone gets slightly different questions, but my test did not include anything about the graph algorithms inherent in Neo4j (good news for philistines people who want to get stuff done). It did, however, include quite a bit of detail about aggregation functions. You make of that what you will.

9. Practice on Northwind but know the Movie DB like the back of your hand.

Out of the box, if you install Neo4j Community on your computer, you have two sample databases that the Browser offers to load into your instance – Movie and Northwind. The latter should be highly familiar to you if you have a past in relational databases. Meanwhile, the former is a Neo4j favourite, not the least for the Kevin Bacon angle. If you did the self-paced Getting Started training (as you should have!), you’ll have used the Movie DB enough to get a good grip of it. Most of the questions on the text pertain or relate in some way to that graph, so a degree of familiarity can help you spot errors faster. At the same time, Northwind is both a better and bigger database, more fun to use and allows for more complex queries. Northwind should therefore be your educational tool, but you should know Movie rather well for that little plus of familiar feeling that can make the difference between passing and failing. Oh, by the way – while Getting Started is a great course, you will not stand a snowball’s chance in hell without the Production course. This is so even if you’ve done your fill of deployments and integrations – quite simply put, the breadth of the test is statistically very likely to be beyond your own experiences, even if you’ve done e.g. High Availability deployments yourself. In the real world, we specialise – for the test, however, you must be a generalist.

10. Refcards are your friends.

Start with the one for Cypher. Then build your own for High Availability. Laminate them and carry them around, if need be – or take the few functions or clauses that are your weak spots, put them on post-its and plaster them on your wall. Whatever helps – unless you’re writing Cypher code 24/7 (in which case, what are you doing here?), which I doubt happens a lot, there’s quite simply no substitute for seeing correct code and being able to get a feeling for good versus bad code. The test is incredibly fast paced – 80 questions over 60 minutes gives you 45 seconds for a turnkey execution. At least 15-20 of that is reading the question, if not more (it definitely was more for me – as noted, most questions repay a thorough reading!). Realistically, if you want to make that and have time to think about the more complex questions, you’ve got to be able to bang out simple Cypher questions (I’d say there were about 8-10 of them altogether, worth an average number of points, though I (and I do regret this now) didn’t count them.


While the Neo4j certification exam is far from easy, it is doable (hey, if I can do it, so can you!). As graph databases are becoming increasingly important due to the recognition that they have the potential to accelerate certain calculations on graph data, coupled with the understanding that a lot of natural processes are in reality closer to relationship-driven interactions than the static picture that traditional RDBMS logic seeks to convey, knowing Neo4j is a definite asset for you and your team. Regardless of your intent to get certified and/or view on certifications in general (mine, too, is in general more on the less complimentary side), what you learn can be an indispensable asset in research and operations as well. Of course, I’m happy to answer any questions about Neo4j and the certification exam, insofar as my subjective views can make a valid contribution to the matter.

Update 15.02.2016: Neo4j community caretaker Michael Hunger has been so kind as to leave a comment on this article, pointing out that the scant feedback is intentional – it prevents re-takers from simply banging in the correct answers from the feedback e-mail. That makes perfect sense – and is not something I thought of. Thanks, Michael. He is also encouraging recent test takers to propose questions for the test – to me, it’s an unprecedented amazingness for a certificate provider to actually ask the community what they believe to be to be the cornerstone and benchmarks of knowledge in a particular field. So do take him up on that offer – his e-mail is in his comment below.


Title image credits: Dr Tamás Nepusz, Reconstructing the structure of the world-wide music scene with

References   [ + ]

1.I’ve been told that feedback on failed tests is fairly terrible – there is no feedback to most questions, and you’re not given the correct answers.