I Used to Be a Human Being

An endless bombardment of news and gossip and images has rendered us manic information addicts. It broke me. It might break you, too.
By Andrew Sullivan

New York Magazine


Personal life

Andrew Sullivan was born in South Godstone, Surrey, into a Roman Catholic family of Irish descent,[5] and was brought up in the nearby town of East Grinstead, West Sussex. He was educated at Reigate Grammar School[6] and Magdalen College, Oxford, where he was awarded a first-class Bachelor of Arts in modern history and modern languages.[7] In his second year, he was elected President of the Oxford Union for Trinity term 1983.

Sullivan earned a Master of Public Administration in 1986 from the John F. Kennedy School of Government at Harvard University,[8] followed by a Doctor of Philosophy degree in government from Harvard in 1990. His dissertation was titled Intimations Pursued: The Voice of Practice in the Conversation of Michael Oakeshott.[9]

In 2001, it came to light that Sullivan had posted anonymous online advertisements for unprotected anal sex, preferably with “other HIV-positive men”. He was widely criticised in the media for this, with some critics noting that he had condemned President Bill Clinton‘s “incautious behavior”, though others wrote in his defence.[10][11][12][13] In 2003, Sullivan wrote a Salon article identifying himself as a member of the gay “bear community“.[14] On 27 August 2007, he married Aaron Tone in Provincetown, Massachusetts.[15][16][17]

Sullivan was barred for many years from applying for United States citizenship because of his HIV-positive status.[18][19] Following the statutory and administrative repeals of the HIV immigration ban in 2008 and 2009, respectively, he announced his intention to begin the process of becoming a permanent resident and citizen.[20][21] On The Chris Matthews Show on 16 April 2011, Sullivan confirmed that he had become a permanent resident, showing his green card.[22]

  • Wikipedia


 I first encountered the writing of Andrew Sullivan in 1986 when, at 23 years of age he joined the staff of The New Republic. I was not a regular reader of that liberal publication, but I soon found myself reading everything he wrote for National Review, which I did read regularly.  It was obvious that he was a brilliant writer, conservative and Catholic.  I tolerated his disclosure of his homosexuality but when he moved further into supporting the LGBT agenda I stopped reading him.  You should not let the fact that he has survived Aids and now lives in a same-sex marriage prevent you from recognizing that when he is not writing about an LGBT issue, he has something important to say.  This article by Sullivan is brilliant in its focus on the need for solitude and for freedom from enslavement by social media.  You will profit greatly if you read it slowly and reflect on your own relationship with the smartphone. 

  • Abyssum


I was sitting in a large meditation hall in a converted novitiate in central Massachusetts when I reached into my pocket for my iPhone. A woman in the front of the room gamely held a basket in front of her, beaming beneficently, like a priest with a collection plate. I duly surrendered my little device, only to feel a sudden pang of panic on my way back to my seat. If it hadn’t been for everyone staring at me, I might have turned around immediately and asked for it back. But I didn’t. I knew why I’d come here.

A year before, like many addicts, I had sensed a personal crash coming. For a decade and a half, I’d been a web obsessive, publishing blog posts multiple times a day, seven days a week, and ultimately corralling a team that curated the web every 20 minutes during peak hours. Each morning began with a full immersion in the stream of internet consciousness and news, jumping from site to site, tweet to tweet, breaking news story to hottest take, scanning countless images and videos, catching up with multiple memes. Throughout the day, I’d cough up an insight or an argument or a joke about what had just occurred or what was happening right now. And at times, as events took over, I’d spend weeks manically grabbing every tiny scrap of a developing story in order to fuse them into a narrative in real time. I was in an unending dialogue with readers who were caviling, praising, booing, correcting. My brain had never been so occupied so insistently by so many different subjects and in so public a way for so long.

I was, in other words, a very early adopter of what we might now call living-in-the-web. And as the years went by, I realized I was no longer alone. Facebook soon gave everyone the equivalent of their own blog and their own audience. More and more people got a smartphone — connecting them instantly to a deluge of febrile content, forcing them to cull and absorb and assimilate the online torrent as relentlessly as I had once. Twitter emerged as a form of instant blogging of microthoughts. Users were as addicted to the feedback as I had long been — and even more prolific. Then the apps descended, like the rain, to inundate what was left of our free time. It was ubiquitous now, this virtual living, this never-stopping, this always-updating. I remember when I decided to raise the ante on my blog in 2007 and update every half-hour or so, and my editor looked at me as if I were insane. But the insanity was now banality; the once-unimaginable pace of the professional blogger was now the default for everyone.

If the internet killed you, I used to joke, then I would be the first to find out. Years later, the joke was running thin. In the last year of my blogging life, my health began to give out. Four bronchial infections in 12 months had become progressively harder to kick. Vacations, such as they were, had become mere opportunities for sleep. My dreams were filled with the snippets of code I used each day to update the site. My friendships had atrophied as my time away from the web dwindled. My doctor, dispensing one more course of antibiotics, finally laid it on the line: “Did you really survive HIV to die of the web?”

But the rewards were many: an audience of up to 100,000 people a day; a new-media business that was actually profitable; a constant stream of things to annoy, enlighten, or infuriate me; a niche in the nerve center of the exploding global conversation; and a way to measure success — in big and beautiful data — that was a constant dopamine bath for the writerly ego. If you had to reinvent yourself as a writer in the internet age, I reassured myself, then I was ahead of the curve. The problem was that I hadn’t been able to reinvent myself as a human being.

I tried reading books, but that skill now began to elude me. After a couple of pages, my fingers twitched for a keyboard. I tried meditation, but my mind bucked and bridled as I tried to still it. I got a steady workout routine, and it gave me the only relief I could measure for an hour or so a day. But over time in this pervasive virtual world, the online clamor grew louder and louder. Although I spent hours each day, alone and silent, attached to a laptop, it felt as if I were in a constant cacophonous crowd of words and images, sounds and ideas, emotions and tirades — a wind tunnel of deafening, deadening noise. So much of it was irresistible, as I fully understood. So much of the technology was irreversible, as I also knew. But I’d begun to fear that this new way of living was actually becoming a way of not-living.

By the last few months, I realized I had been engaging — like most addicts — in a form of denial. I’d long treated my online life as a supplement to my real life, an add-on, as it were. Yes, I spent many hours communicating with others as a disembodied voice, but my real life and body were still here. But then I began to realize, as my health and happiness deteriorated, that this was not a both-and kind of situation. It was either-or. Every hour I spent online was not spent in the physical world. Every minute I was engrossed in a virtual interaction I was not involved in a human encounter. Every second absorbed in some trivia was a second less for any form of reflection, or calm, or spirituality. “Multitasking” was a mirage. This was a zero-sum question. I either lived as a voice online or I lived as a human being in the world that humans had lived in since the beginning of time.

And so I decided, after 15 years, to live in reality.
Since the invention of the printing press, every new revolution in information technology has prompted apocalyptic fears. From the panic that easy access to the vernacular English Bible would destroy Christian orthodoxy all the way to the revulsion, in the 1950s, at the barbaric young medium of television, cultural critics have moaned and wailed at every turn. Each shift represented a further fracturing of attention — continuing up to the previously unimaginable kaleidoscope of cable TV in the late-20th century and the now infinite, infinitely multiplying spaces of the web. And yet society has always managed to adapt and adjust, without obvious damage, and with some more-than-obvious progress. So it’s perhaps too easy to view this new era of mass distraction as something newly dystopian.

But it sure does represent a huge leap from even the very recent past. The data bewilder. Every single minute on the planet, YouTube users upload 400 hours of video and Tinder users swipe profiles over a million times. Each day, there are literally billions of Facebook “likes.” Online outlets now publish exponentially more material than they once did, churning out articles at a rapid-fire pace, adding new details to the news every few minutes. Blogs, Facebook feeds, Tumblr accounts, tweets, and propaganda outlets repurpose, borrow, and add topspin to the same output.

We absorb this “content” (as writing or video or photography is now called) no longer primarily by buying a magazine or paper, by bookmarking our favorite website, or by actively choosing to read or watch. We are instead guided to these info-nuggets by myriad little interruptions on social media, all cascading at us with individually tailored relevance and accuracy. Do not flatter yourself in thinking that you have much control over which temptations you click on. Silicon Valley’s technologists and their ever-perfecting algorithms have discovered the form of bait that will have you jumping like a witless minnow. No information technology ever had this depth of knowledge of its consumers — or greater capacity to tweak their synapses to keep them engaged.

And the engagement never ends. Not long ago, surfing the web, however addictive, was a stationary activity. At your desk at work, or at home on your laptop, you disappeared down a rabbit hole of links and resurfaced minutes (or hours) later to reencounter the world. But the smartphone then went and made the rabbit hole portable, inviting us to get lost in it anywhere, at any time, whatever else we might be doing. Information soon penetrated every waking moment of our lives.

And it did so with staggering swiftness. We almost forget that ten years ago, there were no smartphones, and as recently as 2011, only a third of Americans owned one. Now nearly two-thirds do. That figure reaches 85 percent when you’re only counting young adults. And 46 percent of Americans told Pew surveyors last year a simple but remarkable thing: They could not live without one. The device went from unknown to indispensable in less than a decade. The handful of spaces where it was once impossible to be connected — the airplane, the subway, the wilderness — are dwindling fast. Even hiker backpacks now come fitted with battery power for smartphones. Perhaps the only “safe space” that still exists is the shower.

Am I exaggerating? A small but detailed 2015 study of young adults found that participants were using their phones five hours a day, at 85 separate times. Most of these interactions were for less than 30 seconds, but they add up. Just as revealing: The users weren’t fully aware of how addicted they were. They thought they picked up their phones half as much as they actually did. But whether they were aware of it or not, a new technology had seized control of around one-third of these young adults’ waking hours.

The interruptions often feel pleasant, of course, because they are usually the work of your friends. Distractions arrive in your brain connected to people you know (or think you know), which is the genius of social, peer-to-peer media. Since our earliest evolution, humans have been unusually passionate about gossip, which some attribute to the need to stay abreast of news among friends and family as our social networks expanded. We were hooked on information as eagerly as sugar. And give us access to gossip the way modernity has given us access to sugar and we have an uncontrollable impulse to binge. A regular teen Snapchat user, as the Atlantic recently noted, can have exchanged anywhere between 10,000 and even as many as 400,000 snaps with friends. As the snaps accumulate, they generate publicly displayed scores that bestow the allure of popularity and social status. This, evolutionary psychologists will attest, is fatal. When provided a constant source of information and news and gossip about each other — routed through our social networks — we are close to helpless.

Just look around you — at the people crouched over their phones as they walk the streets, or drive their cars, or walk their dogs, or play with their children. Observe yourself in line for coffee, or in a quick work break, or driving, or even just going to the bathroom. Visit an airport and see the sea of craned necks and dead eyes. We have gone from looking up and around to constantly looking down.

If an alien had visited America just five years ago, then returned today, wouldn’t this be its immediate observation? That this species has developed an extraordinary new habit — and, everywhere you look, lives constantly in its thrall?

I arrived at the meditation retreat center a few months after I’d quit the web, throwing my life and career up in the air. I figured it would be the ultimate detox. And I wasn’t wrong. After a few hours of silence, you tend to expect some kind of disturbance, some flurry to catch your interest. And then it never comes. The quiet deepens into an enveloping default. No one spoke; no one even looked another person in the eye — what some Buddhists call “noble silence.” The day was scheduled down to the minute, so that almost all our time was spent in silent meditation with our eyes closed, or in slow-walking meditation on the marked trails of the forest, or in communal, unspeaking meals. The only words I heard or read for ten days were in three counseling sessions, two guided meditations, and nightly talks on mindfulness.

I’d spent the previous nine months honing my meditation practice, but, in this crowd, I was a novice and a tourist. (Everyone around me was attending six-week or three-month sessions.) The silence, it became apparent, was an integral part of these people’s lives — and their simple manner of movement, the way they glided rather than walked, the open expressions on their faces, all fascinated me. What were they experiencing, if not insane levels of boredom?

And how did their calm somehow magnify itself when I was surrounded by them every day? Usually, when you add people to a room, the noise grows; here, it was the silence that seemed to compound itself. Attached to my phone, I had been accompanied for so long by verbal and visual noise, by an endless bombardment of words and images, and yet I felt curiously isolated. Among these meditators, I was alone in silence and darkness, yet I felt almost at one with them. My breathing slowed. My brain settled. My body became much more available to me. I could feel it digesting and sniffing, itching and pulsating. It was if my brain were moving away from the abstract and the distant toward the tangible and the near.

Things that usually escaped me began to intrigue me. On a meditative walk through the forest on my second day, I began to notice not just the quality of the autumnal light through the leaves but the splotchy multicolors of the newly fallen, the texture of the lichen on the bark, the way in which tree roots had come to entangle and overcome old stone walls. The immediate impulse — to grab my phone and photograph it — was foiled by an empty pocket. So I simply looked. At one point, I got lost and had to rely on my sense of direction to find my way back. I heard birdsong for the first time in years. Well, of course, I had always heard it, but it had been so long since I listened.

My goal was to keep thought in its place. “Remember,” my friend Sam Harris, an atheist meditator, had told me before I left, “if you’re suffering, you’re thinking.” The task was not to silence everything within my addled brain, but to introduce it to quiet, to perspective, to the fallow spaces I had once known where the mind and soul replenish.

Soon enough, the world of “the news,” and the raging primary campaign, disappeared from my consciousness. My mind drifted to a trancelike documentary I had watched years before, Philip Gröning’s Into Great Silence, on an ancient Carthusian monastery and silent monastic order in the Alps. In one scene, a novice monk is tending his plot of garden. As he moves deliberately from one task to the next, he seems almost in another dimension. He is walking from one trench to another, but never appears focused on actually getting anywhere. He seems to float, or mindfully glide, from one place to the next.

He had escaped, it seemed to me, what we moderns understand by time. There was no race against it; no fear of wasting it; no avoidance of the tedium that most of us would recoil from. And as I watched my fellow meditators walk around, eyes open yet unavailable to me, I felt the slowing of the ticking clock, the unwinding of the pace that has all of us in modernity on a treadmill till death. I felt a trace of a freedom all humans used to know and that our culture seems intent, pell-mell, on forgetting.
Based on: Hotel Room, by Edward Hopper (1931). Photo: Kim Dong-kyu

We all understand the joys of our always-wired world — the connections, the validations, the laughs, the porn, the info. I don’t want to deny any of them here. But we are only beginning to get our minds around the costs, if we are even prepared to accept that there are costs. For the subtle snare of this new technology is that it lulls us into the belief that there are no downsides. It’s all just more of everything. Online life is simply layered on top of offline life. We can meet in person and text beforehand. We can eat together while checking our feeds. We can transform life into what the writer Sherry Turkle refers to as “life-mix.”

But of course, as I had discovered in my blogging years, the family that is eating together while simultaneously on their phones is not actually together. They are, in Turkle’s formulation, “alone together.” You are where your attention is. If you’re watching a football game with your son while also texting a friend, you’re not fully with your child — and he knows it. Truly being with another person means being experientially with them, picking up countless tiny signals from the eyes and voice and body language and context, and reacting, often unconsciously, to every nuance. These are our deepest social skills, which have been honed through the aeons. They are what make us distinctively human.

By rapidly substituting virtual reality for reality, we are diminishing the scope of this interaction even as we multiply the number of people with whom we interact. We remove or drastically filter all the information we might get by being with another person. We reduce them to some outlines — a Facebook “friend,” an Instagram photo, a text message — in a controlled and sequestered world that exists largely free of the sudden eruptions or encumbrances of actual human interaction. We become each other’s “contacts,” efficient shadows of ourselves.

Think of how rarely you now use the phone to speak to someone. A text is far easier, quicker, less burdensome. A phone call could take longer; it could force you to encounter that person’s idiosyncrasies or digressions or unexpected emotional needs. Remember when you left voice-mail messages — or actually listened to one? Emojis now suffice. Or take the difference between trying to seduce someone at a bar and flipping through Tinder profiles to find a better match. One is deeply inefficient and requires spending (possibly wasting) considerable time; the other turns dozens and dozens of humans into clothes on an endlessly extending rack.

No wonder we prefer the apps. An entire universe of intimate responses is flattened to a single, distant swipe. We hide our vulnerabilities, airbrushing our flaws and quirks; we project our fantasies onto the images before us. Rejection still stings — but less when a new virtual match beckons on the horizon. We have made sex even safer yet, having sapped it of serendipity and risk and often of physical beings altogether. The amount of time we spend cruising vastly outweighs the time we may ever get to spend with the objects of our desire.

Our oldest human skills atrophy. GPS, for example, is a godsend for finding our way around places we don’t know. But, as Nicholas Carr has noted, it has led to our not even seeing, let alone remembering, the details of our environment, to our not developing the accumulated memories that give us a sense of place and control over what we once called ordinary life. The writer Matthew Crawford has examined how automation and online living have sharply eroded the number of people physically making things, using their own hands and eyes and bodies to craft, say, a wooden chair or a piece of clothing or, in one of Crawford’s more engrossing case studies, a pipe organ. We became who we are as a species by mastering tools, making them a living, evolving extension of our whole bodies and minds. What first seems tedious and repetitive develops into a skill — and a skill is what gives us humans self-esteem and mutual respect.

Yes, online and automated life is more efficient, it makes more economic sense, it ends monotony and “wasted” time in the achievement of practical goals. But it denies us the deep satisfaction and pride of workmanship that comes with accomplishing daily tasks well, a denial perhaps felt most acutely by those for whom such tasks are also a livelihood — and an identity.

Indeed, the modest mastery of our practical lives is what fulfilled us for tens of thousands of years — until technology and capitalism decided it was entirely dispensable. If we are to figure out why despair has spread so rapidly in so many left-behind communities, the atrophying of the practical vocations of the past — and the meaning they gave to people’s lives — seems as useful a place to explore as economic indices.

So are the bonds we used to form in our everyday interactions — the nods and pleasantries of neighbors, the daily facial recognition in the mall or the street. Here too the allure of virtual interaction has helped decimate the space for actual community. When we enter a coffee shop in which everyone is engrossed in their private online worlds, we respond by creating one of our own. When someone next to you answers the phone and starts talking loudly as if you didn’t exist, you realize that, in her private zone, you don’t. And slowly, the whole concept of a public space — where we meet and engage and learn from our fellow citizens — evaporates. Turkle describes one of the many small consequences in an American city: “Kara, in her 50s, feels that life in her hometown of Portland, Maine, has emptied out: ‘Sometimes I walk down the street, and I’m the only person not plugged in … No one is where they are. They’re talking to someone miles away. I miss them.’ ”

Has our enslavement to dopamine — to the instant hits of validation that come with a well-crafted tweet or Snapchat streak — made us happier? I suspect it has simply made us less unhappy, or rather less aware of our unhappiness, and that our phones are merely new and powerful antidepressants of a non-pharmaceutical variety. In an essay on contemplation, the Christian writer Alan Jacobs recently commended the comedian Louis C.K. for withholding smartphones from his children. On the Conan O’Brien show, C.K. explained why: “You need to build an ability to just be yourself and not be doing something. That’s what the phones are taking away,” he said. “Underneath in your life there’s that thing … that forever empty … that knowledge that it’s all for nothing and you’re alone … That’s why we text and drive … because we don’t want to be alone for a second.”

He recalled a moment driving his car when a Bruce Springsteen song came on the radio. It triggered a sudden, unexpected surge of sadness. He instinctively went to pick up his phone and text as many friends as possible. Then he changed his mind, left his phone where it was, and pulled over to the side of the road to weep. He allowed himself for once to be alone with his feelings, to be overwhelmed by them, to experience them with no instant distraction, no digital assist. And then he was able to discover, in a manner now remote from most of us, the relief of crawling out of the hole of misery by himself. For if there is no dark night of the soul anymore that isn’t lit with the flicker of the screen, then there is no morning of hopefulness either. As he said of the distracted modern world we now live in: “You never feel completely sad or completely happy, you just feel … kinda satisfied with your products. And then you die. So that’s why I don’t want to get a phone for my kids.”

The early days of the retreat passed by, the novelty slowly ceding to a reckoning that my meditation skills were now being tested more aggressively. Thoughts began to bubble up; memories clouded the present; the silent sessions began to be edged by a little anxiety.

And then, unexpectedly, on the third day, as I was walking through the forest, I became overwhelmed. I’m still not sure what triggered it, but my best guess is that the shady, quiet woodlands, with brooks trickling their way down hillsides and birds flitting through the moist air, summoned memories of my childhood. I was a lonely boy who spent many hours outside in the copses and woodlands of my native Sussex, in England. I had explored this landscape with friends, but also alone — playing imaginary scenarios in my head, creating little nooks where I could hang and sometimes read, learning every little pathway through the woods and marking each flower or weed or fungus that I stumbled on. But I was also escaping a home where my mother had collapsed with bipolar disorder after the birth of my younger brother and had never really recovered. She was in and out of hospitals for much of my youth and adolescence, and her condition made it hard for her to hide her pain and suffering from her sensitive oldest son.

I absorbed a lot of her agony, I came to realize later, hearing her screams of frustration and misery in constant, terrifying fights with my father, and never knowing how to stop it or to help. I remember watching her dissolve in tears in the car picking me up from elementary school at the thought of returning to a home she clearly dreaded, or holding her as she poured her heart out to me, through sobs and whispers, about her dead-end life in a small town where she was utterly dependent on a spouse. She was taken away from me several times in my childhood, starting when I was 4, and even now I can recall the corridors and rooms of the institutions she was treated in when we went to visit.

I knew the scar tissue from this formative trauma was still in my soul. I had spent two decades in therapy, untangling and exploring it, learning how it had made intimacy with others so frightening, how it had made my own spasms of adolescent depression even more acute, how living with that kind of pain from the most powerful source of love in my life had made me the profoundly broken vessel I am. But I had never felt it so vividly since the very years it had first engulfed and defined me. It was as if, having slowly and progressively removed every distraction from my life, I was suddenly faced with what I had been distracting myself from. Resting for a moment against the trunk of a tree, I stopped, and suddenly found myself bent over, convulsed with the newly present pain, sobbing.

And this time, even as I eventually made it back to the meditation hall, there was no relief. I couldn’t call my husband or a friend and talk it over. I couldn’t check my email or refresh my Instagram or text someone who might share the pain. I couldn’t ask one of my fellows if they had experienced something similar. I waited for the mood to lift, but it deepened. Hours went by in silence as my heart beat anxiously and my mind reeled.

I decided I would get some distance by trying to describe what I was feeling. The two words “extreme suffering” won the naming contest in my head. And when I had my 15-minute counseling session with my assigned counselor a day later, the words just kept tumbling out. After my panicked, anguished confession, he looked at me, one eyebrow raised, with a beatific half-smile. “Oh, that’s perfectly normal,” he deadpanned warmly. “Don’t worry. Be patient. It will resolve itself.” And in time, it did. Over the next day, the feelings began to ebb, my meditation improved, the sadness shifted into a kind of calm and rest. I felt other things from my childhood — the beauty of the forests, the joy of friends, the support of my sister, the love of my maternal grandmother. Yes, I prayed, and prayed for relief. But this lifting did not feel like divine intervention, let alone a result of effort, but more like a natural process of revisiting and healing and recovering. It felt like an ancient, long-buried gift.

In his survey of how the modern West lost widespread religious practice, A Secular Age, the philosopher Charles Taylor used a term to describe the way we think of our societies. He called it a “social imaginary” — a set of interlocking beliefs and practices that can undermine or subtly marginalize other kinds of belief. We didn’t go from faith to secularism in one fell swoop, he argues. Certain ideas and practices made others not so much false as less vibrant or relevant. And so modernity slowly weakened spirituality, by design and accident, in favor of commerce; it downplayed silence and mere being in favor of noise and constant action. The reason we live in a culture increasingly without faith is not because science has somehow disproved the unprovable, but because the white noise of secularism has removed the very stillness in which it might endure or be reborn.

The English Reformation began, one recalls, with an assault on the monasteries, and what silence the Protestants didn’t banish the philosophers of the Enlightenment mocked. Gibbon and Voltaire defined the Enlightenment’s posture toward the monkish: from condescension to outright contempt. The roar and disruption of the Industrial Revolution violated what quiet still remained until modern capitalism made business central to our culture and the ever-more efficient meeting of needs and wants our primary collective goal. We became a civilization of getting things done — with the development of America, in some ways, as its crowning achievement. Silence in modernity became, over the centuries, an anachronism, even a symbol of the useless superstitions we had left behind. The smartphone revolution of the past decade can be seen in some ways simply as the final twist of this ratchet, in which those few remaining redoubts of quiet — the tiny cracks of inactivity in our lives — are being methodically filled with more stimulus and noise.

And yet our need for quiet has never fully gone away, because our practical achievements, however spectacular, never quite fulfill us. They are always giving way to new wants and needs, always requiring updating or repairing, always falling short. The mania of our online lives reveals this: We keep swiping and swiping because we are never fully satisfied. The late British philosopher Michael Oakeshott starkly called this truth “the deadliness of doing.” There seems no end to this paradox of practical life, and no way out, just an infinite succession of efforts, all doomed ultimately to fail.

Except, of course, there is the option of a spiritual reconciliation to this futility, an attempt to transcend the unending cycle of impermanent human achievement. There is a recognition that beyond mere doing, there is also being; that at the end of life, there is also the great silence of death with which we must eventually make our peace. From the moment I entered a church in my childhood, I understood that this place was different because it was so quiet. The Mass itself was full of silences — those liturgical pauses that would never do in a theater, those minutes of quiet after communion when we were encouraged to get lost in prayer, those liturgical spaces that seemed to insist that we are in no hurry here. And this silence demarcated what we once understood as the sacred, marking a space beyond the secular world of noise and business and shopping.

The only place like it was the library, and the silence there also pointed to something beyond it — to the learning that required time and patience, to the pursuit of truth that left practical life behind. Like the moment of silence we sometimes honor in the wake of a tragedy, the act of not speaking signals that we are responding to something deeper than the quotidian, something more profound than words can fully express. I vividly recall when the AIDS Memorial Quilt was first laid out on the Mall in Washington in 1987. A huge crowd had gathered, drifts of hundreds of chattering, animated people walking in waves onto the scene. But the closer they got, and the more they absorbed the landscape of unimaginably raw grief, their voices petered out, and a great emptiness filled the air. This is different, the silence seemed to say. This is not our ordinary life.

Most civilizations, including our own, have understood this in the past. Millennia ago, as the historian Diarmaid MacCulloch has argued, the unnameable, often inscrutably silent God of the Jewish Scriptures intersected with Plato’s concept of a divinity so beyond human understanding and imperfection that no words could accurately describe it. The hidden God of the Jewish and Christian Scriptures spoke often by not speaking. And Jesus, like the Buddha, revealed as much by his silences as by his words. He was a preacher who yet wandered for 40 days in the desert; a prisoner who refused to defend himself at his trial. At the converted novitiate at the retreat, they had left two stained-glass windows depicting Jesus. In one, he is in the Garden of Gethsemane, sweating blood in terror, alone before his execution. In the other, he is seated at the Last Supper, with the disciple John the Beloved resting his head on Jesus’s chest. He is speaking in neither.

That Judeo-Christian tradition recognized a critical distinction — and tension — between noise and silence, between getting through the day and getting a grip on one’s whole life. The Sabbath — the Jewish institution co-opted by Christianity — was a collective imposition of relative silence, a moment of calm to reflect on our lives under the light of eternity. It helped define much of Western public life once a week for centuries — only to dissipate, with scarcely a passing regret, into the commercial cacophony of the past couple of decades. It reflected a now-battered belief that a sustained spiritual life is simply unfeasible for most mortals without these refuges from noise and work to buffer us and remind us who we really are. But just as modern street lighting has slowly blotted the stars from the visible skies, so too have cars and planes and factories and flickering digital screens combined to rob us of a silence that was previously regarded as integral to the health of the human imagination.

This changes us. It slowly removes — without our even noticing it — the very spaces where we can gain a footing in our minds and souls that is not captive to constant pressures or desires or duties. And the smartphone has all but banished them. Thoreau issued his jeremiad against those pressures more than a century ago: “I went to the woods because I wished to live deliberately, to front only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived. I did not wish to live what was not life, living is so dear.”

When you enter the temporary Temple at Burning Man, the annual Labor Day retreat for the tech elite in the Nevada desert, there is hardly any speaking. Some hover at the edges; others hold hands and weep; a few pin notes to a wall of remembrances; the rest are kneeling or meditating or simply sitting. The usually ornate and vast wooden structure is rivaled only by the massive tower of a man that will be burned, like the Temple itself, as the festival reaches its climax, and tens of thousands of people watch an inferno.

They come here, these architects of our internet world, to escape the thing they unleashed on the rest of us. They come to a wilderness where no cellular signals penetrate. You leave your phone in your tent, deemed useless for a few, ecstatically authentic days. There is a spirit of radical self-reliance (you survive for seven days or so only on what you can bring into the vast temporary city) and an ethic of social equality. You are forced to interact only as a physical human being with other physical human beings — without hierarchy. You dance, and you experiment; you build community in various camps. And for many, this is the high point of their year — a separate world for fantasy and friendship, enhanced by drugs that elevate your sense of compassion or wonder or awe.

Like a medieval carnival, this new form of religion upends the conventions that otherwise rule our lives. Like a safety valve, it releases the pent-up pressures of our wired cacophony. Though easily mockable, it is trying to achieve what our culture once routinely provided, and it reveals, perhaps, that we are not completely helpless in this newly distracted era. We can, one senses, begin to balance it out, to relearn what we have so witlessly discarded, to manage our neuroses so they do not completely overwhelm us.

There are burgeoning signs of this more human correction. In 2012, there were, for example, around 20 million yoga practitioners in the U.S., according to a survey conducted by Ipsos Public Affairs. By 2016, the number had almost doubled. Mindfulness, at the same time, has become a corporate catchword for many and a new form of sanity for others. It’s also hard to explain, it seems to me, the sudden explosion of interest in and tolerance of cannabis in the past 15 years without factoring in the intensifying digital climate. Weed is a form of self-medication for an era of mass distraction, providing a quick and easy path to mellowed contemplation in a world where the ample space and time necessary for it are under siege.

If the churches came to understand that the greatest threat to faith today is not hedonism but distraction, perhaps they might begin to appeal anew to a frazzled digital generation. Christian leaders seem to think that they need more distraction to counter the distraction. Their services have degenerated into emotional spasms, their spaces drowned with light and noise and locked shut throughout the day, when their darkness and silence might actually draw those whose minds and souls have grown web-weary. But the mysticism of Catholic meditation — of the Rosary, of Benediction, or simple contemplative prayer — is a tradition in search of rediscovery. The monasteries — opened up to more lay visitors — could try to answer to the same needs that the booming yoga movement has increasingly met.

And imagine if more secular places responded in kind: restaurants where smartphones must be surrendered upon entering, or coffee shops that marketed their non-Wi-Fi safe space? Or, more practical: more meals where we agree to put our gadgets in a box while we talk to one another? Or lunch where the first person to use their phone pays the whole bill? We can, if we want, re-create a digital Sabbath each week — just one day in which we live for 24 hours without checking our phones. Or we can simply turn off our notifications. Humans are self-preserving in the long run. For every innovation there is a reaction, and even the starkest of analysts of our new culture, like Sherry Turkle, sees a potential for eventually rebalancing our lives.

And yet I wonder. The ubiquitous temptations of virtual living create a mental climate that is still maddeningly hard to manage. In the days, then weeks, then months after my retreat, my daily meditation sessions began to falter a little. There was an election campaign of such brooding menace it demanded attention, headlined by a walking human Snapchat app of incoherence. For a while, I had limited my news exposure to the New York Times’ daily briefings; then, slowly, I found myself scanning the click-bait headlines from countless sources that crowded the screen; after a while, I was back in my old rut, absorbing every nugget of campaign news, even as I understood each to be as ephemeral as the last, and even though I no longer needed to absorb them all for work.

Then there were the other snares: the allure of online porn, now blasting through the defenses of every teenager; the ease of replacing every conversation with a texting stream; the escape of living for a while in an online game where all the hazards of real human interaction are banished; the new video features on Instagram, and new friends to follow. It all slowly chipped away at my meditative composure. I cut my daily silences from one hour to 25 minutes; and then, almost a year later, to every other day. I knew this was fatal — that the key to gaining sustainable composure from meditation was rigorous discipline and practice, every day, whether you felt like it or not, whether it felt as if it were working or not. Like weekly Mass, it is the routine that gradually creates a space that lets your life breathe. But the world I rejoined seemed to conspire to take that space away from me. “I do what I hate,” as the oldest son says in Terrence Malick’s haunting Tree of Life.

I haven’t given up, even as, each day, at various moments, I find myself giving in. There are books to be read; landscapes to be walked; friends to be with; life to be fully lived. And I realize that this is, in some ways, just another tale in the vast book of human frailty. But this new epidemic of distraction is our civilization’s specific weakness. And its threat is not so much to our minds, even as they shape-shift under the pressure. The threat is to our souls. At this rate, if the noise does not relent, we might even forget we have any.

*This article appears in the September 19, 2016, issue of New York Magazine.
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St. Francis debating with the Muslim Iman in front of Saladin

With Bergoglio the “Spirit of Assisi” Triumphs. But Ratzinger Is Ruining the Party

Francis reruns the encounter with men of all religions inaugurated by John Paul II thirty years ago. But the objections of the cardinal prefect of doctrine back then are still alive. And even more radical

by Sandro Magister

ROME, September 18, 2016 – The memorable encounter in Assisi, thirty years ago, between John Paul II and men of all religions (see photo) was perhaps the only moment of disagreement between the holy Polish pope and his absolutely trusted chief of doctrine at the time, Cardinal Joseph Ratzinger, who didn’t even go.

Ratzinger himself recalls this in his book-length interview published in recent days: “He knew,” he says, “that I was following a different approach.”

But now that Pope Francis, the successor to both, is preparing to replicate that event in Assisi on September 20, the contrast is reemerging even stronger than before.

A dialogue among the religions on an equal footing – Ratzinger has in fact warned even after his resignation of the papacy – would be “lethal for the Christian faith.” Because every religion “would be reduced to an interchangeable symbol” of a God assumed to be equal for all:

> “Renunciation of the truth is lethal for the faith”

Naturally Jorge Mario Bergoglio does not identify with this kind of egalitarian dialogue, nor has he ever thought that the Catholic Church should give up preaching the Gospel to every creature.

 But some of his actions and words have effectively bolstered such tendencies, starting with his definition of proselytism as “solemn foolishness,” without ever saying how this is to be distinguished from genuine mission.e are no few missionaries on the frontiers, having spent a lifetime preaching and baptizing, who now feel betrayed in the name of a dialogue that makes almost any conversion useless.

Also with other Christians, Protestant and Orthodox, Francis moves at a different pace compared to his predecessors.

While for example Benedict XVI encouraged and facilitated the return to the Catholic Church of Anglicans in disagreement with the “liberal” pivot of their Church, Francis does not, he prefers that they keep to their own home, as revealed by two Anglican bishops who are his friends, Gregory Venables and Tony Palmer, whom he discouraged from becoming Catholic:

> Ecumenism Behind Closed Doors

But it has been above all a brief video from January of this year, released on a large scale in ten languages, that has most given the idea of a surrender to syncretism, to the equating of all the religions:

> “We are all children of God”

In it, Francis urges prayer together with men of every faith, for the love of peace. And along with him, in fact, appear a Buddhist, a Jew, a Muslim, with their respective symbols, all on equal terms. The pope says: “Many seek God and find God in different ways. In this broad spectrum of religions there is only one certainty for us: we are all children of God.”

Nice words, but in effect not in keeping with those of the New Testament and in particular of the Gospel of John, according to which all men are creatures of God, but the only ones who become his “children” are those who believe in Jesus Christ.

In Assisi, on September 20, Francis will again find himself beside Buddhists, Jews, Muslims, and still others. And it is likely that his speech will be more circumspect than in the video.

But there is an impact of the images that will be difficult to contain and rationalize. It is that which has been extolled by many since 1986 as the “spirit of Assisi,” a formula that Ratzinger always sought in vain to defuse, as cardinal and pope, so that it would be taken in a manner opposite to how so many understand it, meaning not in the “syncretistic” and “relativistic” sense:

> The “spirit of Assisi” that Benedict XVI doesn’t trust

So over Assisi there will again loom, in all its drama, the perfect storm that shook the Catholic Church in the summer of 2000, when the congregation for the doctrine of the faith, headed by Ratzinger, published the highly contested declaration “Dominus Iesus” precisely to contrast the idea that all religions are on a par and to reiterate instead that there is one way of salvation for all men, and it is Jesus:

> Dominus Iesus

In two millennia, never had the Church felt the need to recall this elementary truth of the Christian faith.

“The fact of needing to issue a reminder of this in our time tells us the extent of the gravity of the current situation,” warned a cardinal named Giacomo Biffi on the verge of the conclave of 2005, the one in which Ratzinger was elected pope:

> “What I Told the Future Pope”


This commentary was published in “L’Espresso” no. 38 of 2016 on newsstands September 18, on the opinion page entitled “Settimo cielo” entrusted to Sandro Magister.

Here is the index of all the previous commentaries:

> “L’Espresso” in seventh heaven


Pope Francis’s day in Assisi, September 20, 2016:

> Visit of the Holy Father to Assisi. Program


The guests at the encounter in Assisi on September 20 do not include the Dalai Lama, who however was present at the 1986 event with John Paul II.

The Holy See has said nothing in justification of this exclusion. But one indirect confirmation that this was dictated by the desire not to irritate the Chinese authorities is what happened in recent days following the invitation issued to the Dalai Lama by a political representative of Taiwan for a round of conferences on the island.

The spokesman of the Chinese office for external affairs, Ma Xiaoguang, reacted by threatening “the gravest consequences,” which he justified as follows:

“The Dalai Lama is a wolf dressed as a monk who, with his gang of independence activists and terrorists, is seeking to destabilize China and separate Tibet from it. But we will not stand by watching: anyone who supports him is an enemy of ours.”


English translation by Matthew Sherry, Ballwin, Missouri, U.S.A.


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Pope Francis and divorce

Originally published September 17, 2016 at 12:20 pm
The sin of a second marriage is not serious enough to justify excluding people of good intentions from the sacraments.
Ross Douthat


Syndicated columnist
Last weekend, Tim Kaine, the Democratic vice presidential nominee and a churchgoing Catholic, briefly escaped obscurity by telling an audience of LGBT activists that he expects his church to eventually bless and celebrate same-sex marriages.
In short order, his bishop, Francis X. DiLorenzo of Richmond, Virginia, had a statement out declaring that the Catholic understanding of marriage would remain “unchanged and resolute.”
In a normal moment, it would be the task of this conservative Catholic scribbler to explain why the governor is wrong and the bishop is right, why Scripture and tradition make it impossible for Catholicism to simply reinvent its sexual ethics.
But this is not a normal moment in the Catholic Church. As the governor was making his prediction, someone leaked a letter from Pope Francis to the Argentine bishops, praising their openness to allowing some divorced-and-remarried Catholics to receive Communion.
The “private” letter was the latest move in a papal dance that’s been going on since Francis was elected. The pope clearly wants to admit remarried Catholics to Communion, and he tried by hook and crook to get the world’s bishops to agree. But he faced intense resistance from conservatives, who pointed out that this reform risked evacuating the church’s teaching that sacramental marriages are indissoluble and second marriages adulterous.
The conservative resistance couldn’t be overcome directly without courting a true crisis. So Francis has proceeded indirectly, offering studied ambiguity in official publications combined with personal suggestions of where he really stands.
This dance has effectively left Catholicism with two teachings on marriage and the sacraments. The traditional rule is inscribed in the church’s magisterium, and no mere papal note can abrogate it.
But to the typical observer, it’s the Francis position that looks more like the church’s real teaching (he is the pope, after all), even if it’s delivered off the cuff or in footnotes or through surrogates.
That position, more or less, seems to be that second marriages may be technically adulterous, but it’s unreasonable to expect modern people to realize that, and even more unreasonable to expect them to leave those marriages or practice celibacy within them. So the sin involved in a second marriage is often venial, not mortal, and not serious enough to justify excluding people of good intentions from the sacraments.
Which brings us back to Kaine’s vision, because it is very easy to apply this modified position on remarriage to same-sex unions. If relationships the church once condemned as adultery are no longer a major, soul-threatening sin, then why should a committed same-sex relationship be any different? If the church makes post-sexual revolution allowances for straight couples, shouldn’t it make the same ones for people who aren’t even attracted to the opposite sex?
An allowance is not the same thing as a blessing. Under the Francis approach, the church would not celebrate second marriages, and were its logic extended to gay couples, there wouldn’t be the kind of active celebration Kaine envisions either.
Instead, the church would keep the traditional teaching on its books, and only marry couples who fit the traditional criteria. But it would also signal approval to any stable relationship (gay or straight, married or cohabiting), treating the letter of the law like the pirate’s code in the “Pirates of the Caribbean” movies: More what you’d call “guidelines” than actual rules.
The cleverness of this compromise, in theory, is that it leaves conservative Catholics with that letter to cling to, and with it the belief that the church’s teaching is supernaturally guaranteed. Thus, there is no crisis point and less risk of imitating Anglicanism’s recent schisms.
In the short run, this may indeed be clever. (Clearly, conservative bishops have no idea how to handle Francis’ maneuvers.) But how long will liberal Catholics be content with a settlement that still leaves same-sex relationships in a merely-tolerated limbo and that leaves open the possibility that a new pope — an African conservative, let’s say — might reassert the letter of the law and undo Francis’ work?
How long can conservative Catholics persist in waiting for such a pope, and in telling one another — as they’ve been doing, rather miserably, of late — to obey the church of 2,000 years rather than the current pontiff?
And how effectively can a church retain the lukewarm or uncertain if it keeps its most controversial teachings while constantly winking to say, “Don’t worry, we don’t actually believe all that?”
This instability makes it unlikely that Francis will be remembered as a great conciliator or unifier. It’s more likely now that his legacy will be either famous or infamous.
If liberal Catholics have read Providence’s intentions rightly, he will be the patron saint of all future reformers.
If not, he will join a group even more select than the communion of saints: The list of popes who came close — too close — to teaching something other than the Catholic faith.
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September 17, 2016, Saturday — The Bells of Rome, Last Conversations #4

Peter Seewald: When you left the Vatican in a helicopter, this also was part in some way of the entire screenplay, as it were, at least as seen from the outside. One could say that up until that moment no Pope had ascended into heaven while still living…

Emeritus Pope Benedict XVI: (The Pope laughs)

Peter Seewald: What were you thinking about?

Emeritus Pope Benedict XVI: I was deeply moved. The cordiality of the farewell, also the tears of my collaborators. (His voice breaks with emotion) On the roof of the Casa Bonus Pastor [a hotel for pilgrims just outside the Vatican walls] there was written in huge letters ‘Dio gliene renda merito‘ [“May God reward you”]. (The Pope weeps) I was really deeply moved. In any case, while I hovered overhead and began to hear the bells of Rome tolling, I knew that I could be thankful and my state of mind on the most profound level was gratitude.”

—The final questions and answers in Part One of Ultime Conversazioni (“Last Conversations”), Peter Seewald’s previously unpublished conversations with Emeritus Pope Benedict XVI (p. 49). Seewald in his introduction says the conversations occurred both before and after Benedict’s resignation from the papacy in February 2013. In his Introduction, he says the the last conversation occurred on May 23, 2016 — just four months ago. The book appeared in Rome in German and Italian editions on September 9, eight days ago. The English edition, to be entitled Last Testament, is expected in November




Correction: The date of the last interview between German writer Peter Seewald and Emeritus Pope Benedict was May 23, 2016, less than four months ago, not May 23, 2013, more than three years ago, as I wrote in several previous emails. I apologize to readers for this error.—Robert Moynihan








Correction: The date of the last interview between German writer Peter Seewald and Emeritus Pope Benedict was May 23, 2016, less than four months ago, not May 23, 2013, more than three years ago, as I wrote in several previous emails. I apologize to readers for this error.—Robert Moynihan




A Vatican official told me yesterday that the reflections of Emeritus Pope Benedict contained in the new book-length interview with German author Peter Seewald which came out on September 9, eight days ago, as Last Conversations (“Ultime Conversazioni” in Italian), were originally not intended to be published during Benedict’s lifetime.


Benedict granted the interviews — which Seewald tells us took place “just before, and after the resignation” (“poco prima, e dopo le demissioni” — as a help to Seewald, who is preparing a major biography of the Emeritus Pope, the official said.


So Benedict agreed to the interviews with the understanding that they would be used in the writing of the biography, which would come out after his death. How, then, did the book end up being published now, while Benedict is still alive?


In a new interview just given to the German magazine Christ un Welt (“Christ and the World”) Seewald explains what happened. The new interview is discussed by Luis Badilla, director of Il Sismografo (“The Seismograph”) — a very useful website for those who follow Vatican affairs, since it contains dozens of links daily to articles from the global press on Vatican and Church affairs — in an article posted today.


Seewald says Benedict’s words seemed so important to make clear the voluntary nature of his resignation for reasons of health that he, Seewald, decided to ask Benedict if he might not publish the interviews now, in this book, while Benedict was still alive.


Seewald notes that there have emerged many “legends and theories” of “a supposed conspiracy according to which Benedict’s renunciation of the papacy was not voluntary, that he was obliged to resign by scandals and even by blackmail.”


The publication of these interviews now was important “to put an end to such senseless tales,” Seewald says.


“So, after transcribing the tapes, I tried to convince Benedict to allow me to publish this material now,” Seewald says in the Christ und Welt interview.


“He, in the end, set one requirement: that Pope Francis would agree,” Seewald says. “There were no obstacles (from Francis).”


So Last Conversations was published now, with Benedict still living.


The Tolling Bells of Rome



I will never forget the day Pope Benedict left the Vatican by helicopter, bringing his papacy to an end.


It was a Thursday, February 28, in 2013. (February 28 also happens to be the day one of my sons was born in Rome — February 28, 1993, so February 28, 2013, was his 20th birthday, in addition to being the day Pope Benedict left the Vatican for the last time as Pope.)


As Benedict left the Vatican by helicopter, he sent his last Twitter message as Pope: “Thank you for your love and support. May you always experience the joy that comes from putting Christ at the center of your lives.”


To observe the helicopter flight, I decided to go to the highest point in Rome, to the top of the Janiculum Hill, to the piazza surrounding the statue of Giuseppe Garibaldi.


From there, by leaning over the top edge of the old wall of Rome, the Aurelian Wall, built by the Emperor Aurelian in 270 A.D., one can see the cupola of St. Peter’s clearly, and then, by running to the other side of the piazza, look out over Rome and see Castel Gandolfo in the distance, to the east of the city, the Pope’s destination that day.


It was about 5 p.m. in the evening.


The sky still blue though a chilly February evening was about to descend.


And then it happened.


The white helicopter lifted off from the heliport at the top of Vatican City, near to the Vatican walls at the end of the Vatican gardens, and began to circle the dome of St. Peter’s, as if the Pope wanted to look down at Vatican City one last time.


I shook my head.


“It is really happening,” I thought, with wonder and perplexity.


With wonder, because the imagery was so striking: a Pope, the Vicar of Christ on earth, dressed in white, riding in a white helicopter, its blades churning through the air, with the dome of St. Peter’s Basilica rising starkly above the surrounding buildings. It was like watching the scene of a man making a marvelous, daring escape from a prison — Pope Benedict as James Bond, getting away at the last moment, riding a white helicopter into freedom…


Perplexity because I did not understand at all why this was happening, or what it meant. Despite the Pope’s words that he was resigning from the papacy because he felt he no longer had the strength to carry out the duties of the Successor of Peter in an effective, dignified, fitting way, in my heart I still wondered whether he might not have continued. I, like some of his closest assistants, including Archbishop Georg Gaenswein, his personal secretary — who wept openly as he walked with Benedict down the stairs of the Apostolic Palace for the last time, before the Pope got into a car and drove from the Cortile San Damaso through the Vatican gardens and up to the heliport — wondered if it might not have been possible to make things a little easier for Benedict, so that he might have been able to feel strong enough to remain Pope for at least a little longer.



Bells rang out from St Peter’s Basilica and churches all over Rome as the helicopter circled Vatican City and flew over the Colosseum to give the pontiff one last view of the city where he had been bishop.


I felt disoriented and confused by the departure from the Vatican of a Pope I had met, talked with in his offices and in his private apartment, walked with in Borgo Pio and St. Peter’s Square, interviewed many times, and written about in Inside the Vatican for nearly 25 years.


The helicopter left the dome of St. Peter’s behind, and headed out over the center of the old city of Rome. I ran from one side of the piazza to the other.


Leaning over the wall, all of Rome stretched out below me. My eyes fixed on the white helicopter, I saw Benedict pass over the Tiber, cross over the Roman Forum and the Colosseum, cross over the cathedral of the city of Rome, St. John in Lateran, cross over over the countryside that stretches out toward the Alban Hills, and then set down in the gardens at Castel Gandolfo, about 15 miles away.


From the balcony of the castle, he told the crowd in the piazza below, many of whom were crying, that he would “simply be a pilgrim” and that he was now “starting the last phase of his pilgrimage on this earth.”

He then turned and went inside the villa, never to be seen again as Pope.


So it was official: Benedict was no longer Pope.


I did not know at the time that, as he took off from the Vatican, Pope Benedict was able to look down on the roof of the Casa Pastor Bonus [the “House of the Good Shepherd], a pilgrim’s residence just outside and in back of the Vatican’s walls, and see placards lined up with the words “Dio gliene renda merito” [“May God reward you”].


Now we know that he saw those signs, and was moved nearly to tears.


We know because, in his new book of conversations with Emeritus Pope Benedict XVI, Ultime Conversazioni (“Last Conversations”), Seewald includes this little fact, previously unknown because up until now the former Pope has said nothing publicly about his feelings and experiences after leaving the papacy in February of 2013.


Seewald asked the former Pope what he was thinking about as that helicopter took off.


“I was deeply moved,” Benedict tells him. “The cordiality of the farewell, also the tears of my collaborators. (His voice breaks with emotion) On the roof of the Casa Bonus Pastor [a hotel for pilgrims just outside the Vatican walls] there was written in huge letters ‘Dio gliene renda merito‘ [“May God reward you”].”


And at precisely this point, Seewald tells us that, recalling that moment, Emeritus Pope Benedict began to weep (“il papa piange,” meaning “the Pope  weeps”].


It is the only time in the entire book where Benedict displays such emotion.


“I was really deeply moved,” Benedict continues. “In any case, while I hovered overhead and began to hear the bells of Rome tolling, I knew that I could be thankful and my state of mind on the most profound level was gratitude.”


And with those words, with the tolling of the bells of Rome in the background, this section of the book comes to an end.


But what had happened in the weeks and months before that had led Benedict to this decision?


Through Seewald’s questioning, Benedict for the first time in this book gives us some answers and some deeper insights regarding his reasons for resigning the papac

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September 16, 2016, Friday — Adieu, Padre Amorth

“I, afraid of that beast? It is he who should be afraid of me: I work in the name of the Lord of the world. He is just the monkey of God.”

Father Gabriele Amorth, the famous Italian exorcist who was the exorcist for the diocese of Rome for the last 30 years, since 1986, referring to the devil. Father Amorth died today in Rome at the age of 91


Stefano Maria Paci: Father Amorth, Satanism is increasingly widespread. The new exorcism ritual makes it difficult to do exorcisms. Exorcists are prevented from attending an audience with the Pope in St. Peter’s Square. Tell me honestly: what is happening?
Father Gabriele Amorth: The smoke of Satan enters everywhere. Everywhere! Maybe we were excluded from the papal audience because they were afraid  so many exorcists would be able to chase out the legions of demons that have taken up residence in the Vatican.
Paci: You’re kidding, right?
Amorth: It may seem a joke, but I think it is no joke. I have no doubt that the devil tempts especially the leaders of the Church, as he tempts all leaders…
Paci: Are you saying that here, as in any war, Satan wants to conquer the opposing generals?
Amorth: It is a winning strategy. One always tries to implement it. Especially when the defenses of one’s opponents are weak. Satan also tries. But thankfully there is the Holy Spirit who governs the Church: ‘The gates of hell shall not prevail.’ Despite the defections. And despite the betrayals. Which should cause us no surprise. The first traitor was one of the apostles closest to Jesus, Judas Iscariot. But despite this, the Church continues on her way. She is held up by the Holy Spirit and therefore all the efforts of Satan can have only partial results. Of course, the devil can win some battles. Even important ones. But never the war.”
—from a 2001 interview between Italian journalist Stefano Maria Paci and Father Gabriele Amorth, published in the June 2001 issue of 30 Giorni magazine



In September 2006, 10 years ago, I received several letters from readers asking me if the new, post-Vatican II ritual of exorcism was as valid and effective as the old, pre-Vatican II ritual. I replied that I knew little about the matter, but would try to talk about the issue with Father Gabriele Amorth, the exorcist of the city of Rome since 1986. Two of these readers flew to Rome to accompany me for the conversation.


We drove over to a section of Rome near the via Cristoforo Colombo and parked the car. As we walked up to the address, located on a city block filled with residential apartment buildings, the music to the song “YMCA” was blasting out over the street from one of the open windows.


Father Amorth (photo below) greeted us warmly and ushered us into his office, which had the appearance of a kitchen, with a sink and stove at one end of the room.


But, since he did not know who we were, having never met us before, he asked if we would agree to answer three questions, and then to allow him to pray over us, one by one, before we began our interview. We agreed.


I was the first to sit down on a chair at the end of the room.


He moved his stole so that half of it was over my neck and shoulder while half remained over his neck and shoulder. Then he asked me the questions.


“Do you attend Sunday Mass regularly, every Sunday?” he asked. “Do you pray the Rosary? Do you go regularly to confession?”


After I gave him my answers, he began to pray over me, reciting a series of prayers, while I sat there. After a time, my eyes slowly closed. He then tapped on my head and then, with his fingers, raised my eyelids to look deeply into my eyes. I still remember the intensity of his gaze, just a few inches from my face. Then he continued to pray and at a certain moment, he finished, and said to me: “I declare you free of any evil spirits.”


He asked the same questions and prayed the same prayers over my two companions, each of whom heard him say the same final words, declaring them free of evil spirits.


Only then did we begin a long conversation about the Church today, about his work as an exorcist, and related matters, that continued for almost two hours.


I asked him how the new rite compares to the old rite, and whether concerns about the new rite are legitimate.


He said the new rite is legitimate, but that its prayers are less precise and powerful against the devil than the prayers of the old rite, so he prefers to do exorcisms in the old rite, and does so.


He also said that when he and one other exorcist went to the Vatican to try to gain a hearing for their concerns about the revisions in the rite, only one cardinal came to their assistance: Cardinal Joseph Ratzinger, who defended their continued use of the old rite.


Though now he has passed away, I would like to express thanks to him for the hospitality he showed to me that day, and for the prayers that he prayed over us.




Gabriele Amorth was born in Modena, in northern Italy, on May 1, 1925. He died today in Rome at the age of 91.


He was a Catholic partisan soldier at the end of the Second World War, and active after the war in Catholic Action, the youth movement of the Christian Democratic Party


He was ordained a priest in 1954 at the age of 29. An excellent writer, he published many articles in Italy’s leading Catholic magazine, Famiglia Cristiana.
Passionate about Mariology, he became the editor of the Catholic monthly magazine Madre di Dio (“Mother of God”). He was a member of the Pontifical International Marian Academy.

In 1986, the Pope’s cardinal vicar for the diocese of Rome, Cardinal Ugo Poletti, named Amorth the exorcist for the diocese.


He was a student of Father Candido Amantini, who for many years was the exorcist at the Scala Santa (the Holy Stairs) in Rome (the stairs believed to be those which Christ walked up to his trial before Pontius Pilate in Jerusalem, brought to Rome by St. Helena in the early 4th century, in about the year 326 A.D.). Today, many pilgrims go to those steps and walk up them on their knees, praying.

In various interviews, Amorth said he had carried out more than 50,000 exorcisms over the years, some taking him just a few minutes, others taking many hours of prayer.


Amorth also said that he had only been faced with about 100 cases of real demonic possession in all those tens of thousands of cases.


Most of the cases, he said, were either “disturbances” caused by the devil, or simple mental illnesses.


In an interview with Stefano Maria Paci of 30 Giorni in 2001, Amorth sharply criticized the post-Vatican II revision of the rite of exorcism.


“The old Ritual should have been amended, not entirely redone,” Amorth said. “There were prayers used for 12 centuries. Before canceling prayers so old which for centuries had proven effective, we should hesitate. But instead, no. All of us exorcists, using the prayers of the new interim Ritual, have experienced that they are totally ineffective… The new Book of Blessings has painstakingly removed any reference to the fact that the Lord must protect us from Satan, that the angels protect us from the assaults of the devil. They removed all the prayers that there were for the blessing of homes and schools. Everything should be blessed and protected, but today the protection from the devil does not exist anymore. There are no more defenses or even prayers against him. Jesus himself taught us a prayer of liberation, in the Our Father: ‘Deliver us from the Evil One. Deliver us from Satan.’ In Italian it has been translated incorrectly, and today we say: ‘Deliver us from evil.’ We speak of a generic evil, which we do not know the origin of, but the evil which our Lord Jesus Christ taught us to fight is a concrete person: Satan.”


Amorth tells Paci that the “greatest victory” of the devil is to persuade us that he does not exist.


In another interview (link), Amorth once said that he believed the consecration of Russia to the Immaculate Heart of Mary, as requested by Our Lady of Fatima in her apparitions to Sister Lucy, had not been done fully.


“The Consecration has not yet been made,” he said. “I was there on March 25 (1984) in St. Peter’s Square, I was in the front row, practically within touching distance of the Holy Father. John Paul II wanted to consecrate Russia, but his entourage did not, fearing that the Orthodox would be antagonized, and they almost thwarted him. Therefore, when His Holiness consecrated the world on his knees, he added a sentence, not included in the distributed version, that instead said to consecrate “especially those nations of which you yourself have asked for their consecration.” So, indirectly, this included Russia. However, a specific consecration has not yet been made. You can always do it. Indeed, it will certainly be done…”
Amorth died today in Rome after several days in the hospital of Santa Lucia.


May he rest in peace, and may eternal light shine upon him.

What is the glory of God?


“The glory of God is man alive; but the life of man is the vision of God.” —St. Irenaeus of Lyons, in the territory of France, in his great work Against All Heresies, written c. 180 A.D.

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The United States of America is not a pure democracy where every vote in a presidential election counts toward the election of a candidate.

Our Constitution wisely provides that in order to keep the big states from always determining the winner of a presidential election, the 50 states will choose Electors, the number based on the population of the state and in December of a presidential election year the Electors of a state will meet and cast their ballots for the nominee the voters in their COUNTY have selected.  It takes 270 electoral college votes for a person to be elected president of the United States (POTUS).

POLITICO.COM has analyzed past election results state by state and each week has averaged in this election cycle the results of five of the best opinion polls and has published on its website the results of its analysis.   Currently has determined that there are SEVEN SWING STATES containing TWENTY-FIVE SWING COUNTIES the voters of which will PROBABLY determine who the next POTUS will be.



In all the other states and counties, the dominance of either the Democrat Party (e.g. California) or the Republican Party (e.g Texas) means that it is almost certain that the majority of electoral votes will almost certainly go either for Hillary Clinton or for Donald Trump.  Therefore, the few voters who read this blog will not make any difference in the outcome of the election in those two states and that is why I have advised my readers in those, and similar states, to not vote for either Hillary Clinton or Donald Trump.  Why?  Because in my opinion both of them, while being ontologically good persons, have subjectively through a lifetime of bad choices made themselves morally evil persons.

Voting is a human act and it is an important human act.  As such it necessarily has a moral character.  Voting consists in CHOOSING between two or more candidates.  A Christian formed by the Gospel of Jesus Christ knows that he/she can never choose evil in the absence of necessity.  A voter living in a non-swing state does not cast a vote that can determine the outcome of the election and therefore does not have A MORAL IMPERATIVE TO CAST A VOTE FOR POTUS if the choice involves choosing between two evils.

It is a different situation for a voter living in a SWING STATE AND SWING COUNTY.  The vote of a voter in one of those swing counties very well might cast the deciding vote that will elect an ELECTOR who will vote for either Hillary Clinton or Donald Trump in the Electoral College meeting in December.  It is my opinion that there is sufficient necessity in such a case to justify the voter to choose the lesser of the two moral evils and to vote for Donald Trump.

All other voters, not voting in a SWING STATE AND SWING COUNTY, should not vote for either Hillary Clinton or Donald Trump but should vote for someone else whom they consider to be a morally good person and who has manifested opinions and beliefs that are not in conflict with the Gospel of Jesus Christ.  If the name of such a person does not appear on the ballot where you vote, write a name in.

My only purpose in offering this advice is to enable you to stand before God now and on your judgment day with a clear conscience knowing that you, at least in the election of 2016, did not choose evil.

God bless you and give you the grace to keep a clear conscience always.






























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James Madison

The Electoral College Still Makes Sense Because We’re Not A Democracy

What appears to deprive the populace of its power to decide a president is the very mechanism that preserves its power. The Electoral College works that way because the United States isn’t a pure democracy.
Donna Carol Voss


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The Electoral College has been on life support since a chad—specifically a “hanging” chad—tipped the White House to George W. Bush in 2000. The painful reality of how our Constitution works was never more apparent. The Gore/Lieberman ticket won the popular vote 50,994,086 to 50,461,092 but lost the electoral vote 266 to 271.

There was a lot more to it, but the punchline is that the U.S. Supreme Court ruled Bush the winner because he won the electoral vote. It’s a tribute to the American national character that we weathered that cataclysm without civil war, but it left a bad taste in the electorate’s mouth.

During the 2016 Republican primary, when it looked as if Donald Trump would win the popular vote but still not reach the delegate threshold for nomination, that bad taste turned sour. Riding high on populism and “throw the bums out,” Trump complained that the election was rigged because the people wanted him, and whomever the people wanted, they should get. Fortunately for the country, Trump reached the delegate threshold, and we were spared a debacle that would have made 2000’s cataclysm look like a lemonade stand.

Cue the national election. No controversy, scandal, “info dump,” lie, corruption, defection, or dirty trick has been left unturned. Why would election night go smoothly? Frankly, the plane is going down no matter who wins; it’s only a question of water or land and how many survivors there will be. Chances aren’t looking good for the Electoral College.

“This is a democracy,” the people cry. “It should be one person-one vote, and that stupid Electoral College needs to go!” Poor Electoral College. So misunderstood. If the Electoral College has to go, it has to go, but we should at least buy it dinner first. While we’re at it, we might as well get to know it better.

Trust History: You Don’t Want Mob Rule

The sad lot of the Electoral College is that what you see isn’t what you get. Like the counter-intuitive fact that a tire blowout on the right requires a steering wheel correction to the left, the EC works backwards. What appears to deprive the populace of its power to decide a president is the very mechanism that preserves its power. It works that way because this isn’t a democracy; not a pure one.

“Pure democracy” is just another phrase for “mob rule.” Dictatorship of the majority means 51 percent of the citizenry rule the other 49 percent. That minority has no rights except those the condescending majority grants. It works well for those in the 51 percent, not so much for those in the 49. Plato knew it, and James Madison, who knew his Plato, did too. Plato and Madison both recognized that justice and liberty for the minority is possible only when power is shared between groups in society.

Plato’s “Republic” heavily influenced Madison and the other framers to devise a Constitution that protected the minority. Plato held that the ideal, i.e., just, form of government was one in which power was shared correctly between workers, warriors, and rulers. Madison held that the ideal, i.e., American, form of government was one in which power was shared correctly between judges, lawmakers, and rulers.

Inspired as it is, our Constitution protects the minority while preserving the best of democracy: we the people elect representatives to run the government (republic) and we do so by majority vote (democracy). Ergo, this is a democratic republic. Ergo, an Electoral College.

The Electoral College Balances Voting Power

The purpose of the Electoral College is to balance voting power across states so no one region of the country can gain too much control. If a president is elected by a simple majority of votes, a candidate who is wildly popular in one region (e.g., Ted Cruz in Texas, Mitt Romney in Utah) can ignore smaller regions and campaign only where large majorities are possible. Or a candidate who kills in California and New York can write off “flyover country” completely.

If, however, the Electoral College elects a president, a candidate who is wildly popular in one region must also prevail in a number of sub-elections to win. The Electoral College ensures a better result for the country as a whole than the democratic power play wherein 51 percent of us matter and 49 percent of us don’t.

Think of the Electoral College like the World Series. One person-one vote equates to the World Series Champions being determined by total number of runs scored {in the series}. If the Dodgers win the first game 10-0, and the Yankees win the next four games 1-0, the Dodgers win the series. Even though the Yankees bested the Dodgers in four games, it doesn’t matter because the Dodgers scored 10 runs to their 4. One anomalous game decides the whole series. Without the Electoral College, a few heavily populated states {would always} decide the whole election.  {This would be the “tyranny of the majority” that Madison and the Founding Fathers sought to prevent.}

{ Without the Electoral College California would probably always choose the president of the United States because of its large voter population and the fact that it is an overwhelmingly Democratic State. }

So, the poor Electoral College sits condemned before its last meal because its power is misunderstood. How ironic—and tragic if no stay-of-execution arrives—that those who clamor for “one person-one vote” are seeking more power at the expense of power they already have.


Donna Carol Voss is a Berkeley grad, a stay-at-home mom, a former pagan, and a devout Mormon. She is the author of the memoir “One of Everything” and blogs at
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How Ratzinger Sees Francis: “He Is the Man of Practical Reform”

The reigning pope as described by his predecessor: “So different from how I had known him.” And also very different from him

by Sandro Magister

ROME, September 14, 2016 – There are few references to Pope Francis in the book-length interview that Joseph Ratzinger published in recent days. But all of them are significant.

To begin with, Ratzinger says that he had never imagined Jorge Mario Bergoglio as his successor.

He knew him, of course,” thanks to ‘ad limina’ visits and to correspondence.” But he believed him to be different from how he saw him later, after his election as pope:

“I knew him as a very decisive man, one who in Argentina spoke with great resoluteness: this is to be done, and this is not to be done. His cordiality, his attention to others in encounter are aspects of him that were not known to me.”

Ratzinger dismisses the rumor according to which Francis consults him often. “There’s no reason for it,” he says.

Bergoglio – he notes, for example – did not send him an advance copy of his agenda-setting apostolic exhortation “Evangelii Gaudium”:

“But he wrote me a personal letter. . . very affectionate, because of which I nevertheless received the apostolic exhortation in a particular form. And also bound in white, which is normally done only for the pope. I am reading it. It is by no means a brief text, but it is beautiful and compelling. Of course it is not entirely his own, but there is much that is personal.”

However – he says – “on some things he has sent me questions, including for the interview that he granted to ‘La Civiltà Cattolica’. In these cases I express my opinion.”

And in any case he concludes, emphasizing the separation:

“Overall I am very content not be consulted.”

Ratzinger also denies seeing a rupture between the pontificate of Francis and his own, but he clarifies:

“Naturally some points can be misunderstood so that afterward it is said that now things are going an entirely different way. If individual episodes are taken and isolated, disagreements can be manufactured, but this does not happen when one considers the whole picture. The accent may be placed on certain aspects, but there is no disagreement.”

If there is one innovation with Pope Francis, it is of this kind:

“Yes, there is a new freshness in the bosom of the Church, a new gladness, a new charism that is offered to men, this is indeed a beautiful thing.”

Further on Ratzinger presents the difference between him and his successor like this:

“Everyone has his own charism. Francis is the man of practical reform. He was an archbishop for a long time, he understands the task, he was superior of the Jesuits and also has the mindset to rollup his sleeves for actions of an organizational nature. I knew that this was not my strong suit.”

But he insists that the priority of the current pontificate must continue to be the same as that of the previous pontificate:

“The important thing is to preserve the faith today. I consider this to be our central task. Everything else is administrative questions.”

In any case, he avoids saying that with Francis a new era has begun:

“Temporal divisions have always been decided a posteriori. That is why I would not hazard to make this statement now. . . . I no longer belong to the old world, but in reality the new one has not yet begun.”


That’s all. There is no more on Pope Francis in the book. And the little that is there, as has been seen, focuses – intentionally? – only on a practical role, as promoter of organizational change, not doctrinal and perhaps not even “pastoral,” except within the limits of an empathetic engagement with persons.

On any disagreements that might be found between him and his successor, Ratzinger cautions against misunderstanding individual phrases and seizing upon isolated episodes.

Perhaps because he sees in the Jesuit Bergoglio a trait shared with another famous Jesuit, the German theologian Karl Rahner, one of whose works from the 1970’s Ratzinger describes as follows, in a passage from the book:

“It was so tortuous, as is the case with the texts by Rahner, who on the one hand represented a defense of celibacy, and on the other sought to leave the problem open for further reflection. . . It was a typical text à la Rahner, formulated through a tangle of affirmative and negative phrases that could be interpreted both in one sense and in the other.”

But it would be too much to read here an allusion to the current interpretive controversy “both in one sense and in the other” over the postsynodal exhortation “Amoris Laetitia.”

In any case there is not the slightest reference in the book to comparisons with Pope Francis on the terrain of doctrine and dogma.

But there are a couple of observations concerning Ratzinger’s current sensitivity to certain theological issues, which bring to light a substantial distance with respect to Bergoglio’s sensibilities:

“I now find many words of the Gospel, because of their greatness and gravity, more difficult than in the past. . . We realize that the Word [of God] is never fathomed in all its meanings. And precisely some words that express the wrath, the reproof, the threat of judgment become more disquieting, more striking, and greater than before.”

And concerning the ultimate realities, death and eternal life, which constituted a central part of his theological production and on which Ratzinger says he continues to reflect:

“Of course. Precisely my reflections on Purgatory, on the nature of pain, its meaning, and then on the communal character of happiness, on the fact that we are immersed in the great ocean of joy and love, for me are very important.”


There is also a passage from the book-length interview in which Ratzinger comments critically on the highly contested encyclical of Paul VI “Humanae Vitae,” without retracting his objections at the time:

“In the context of theological thought back then, ‘Humanae Vitae’ was a difficult text. It was clear that what it said was valid in substance, but the way in which it was reasoned out for us at the time, for me as well, was not satisfying. I was seeking a broader anthropological approach. And in effect, Pope John Paul II later combined the natural law angle of the encyclical with a personalistic vision.”

Curiously, therefore, on “Humanae Vitae” Bergoglio appears more “conservative” than Ratzinger, according to the comments of pure praise that the current pope has repeatedly dedicated to that encyclical so far, for example in the March 5, 2015 interview with the director of “Corriere della Sera” at the time, Ferruccio de Bortoli:

“Everything depends on how ‘Humanae Vitae’ is interpreted. Paul VI himself, in the end, urged confessors to be very merciful and attentive to concrete situations. But his brilliance was prophetic, he had the courage to stand against the majority, to defend moral discipline, to exercise cultural restraint, to oppose present and future neo-Malthusianism.”


One last observation concerning the address on Islam by Benedict XVI in Regensburg, an address that effectively cannot be imagined as coming from the mouth of Pope Bergoglio.

Asked if he had struck by accident upon that citation of the Byzantine emperor Manuel II Palaiologos which, extrapolated from the address, unleashed the violent reactions of many Muslims, Ratzinger responds:

“I had read this dialogue of Palaiologos because I was interested in the dialogue between Christianity and Islam. So it was not an accident. It was truly a matter of a dialogue. The emperor at that time was already a vassal of the Muslims, and yet he had the freedom to say things one could no longer say today. So I simply found it interesting to bring the discussion to bear upon this conversation of five hundred years ago.”

Well said: “The freedom to say things one could no longer say today.”


English translation by Matthew Sherry, Ballwin, Missouri, U.S.A.


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hillary_clinton_coughing_fitHillary Clinton has a coughing fit in the middle of a speech !

Defective Motor Control of Coughing in Parkinson’s Disease


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The high incidence of serious chest infections in patients with Parkinson’s disease is unexplained, but an impairment in cough reflex may have a role. Maximal voluntary cough (MVC) and reflex cough (RC) to inhalation of ultrasonically nebulized distilled water were analyzed in patients with Parkinson’s disease and age-matched control subjects by monitoring the integrated electromyographic activity (IEMG) of abdominal muscles. The peak amplitude of IEMG activity (IEMGP) was expressed as a fraction of the highest IEMGP value observed during MVC corrected to account for possible losses in abdominal muscle force due to reduced central muscle activation. Cough intensity was indexed in terms of both the IEMGP and the ratio of IEMGP to the duration of the expiratory ramp (Tec), i.e., the rate of rise of IEMG activity. Cough threshold was slightly higher in patients than in control subjects, but the difference failed to reach statistical significance. Compared with control subjects, patients displayed a lower IEMGP during maximal expiratory pressure maneuvers (Pe max), MVC, and RC (p always < 0.01); Tec during RC was longer (p < 0.01) than in controls. Consequently, the rate of rise of IEMG activity during cough was always lower in patients (p < 0.01), especially during RC. Finally, Pe max, and both the peak and rate of rise of IEMG activity during RC were inversely related to the level of clinical disability (Spearman rank correlation coefficient, rs = − 0.88, − 0.86, and − 0.85, respectively, p always < 0.01). The results indicate that the central neural mechanisms subserving the recruitment of motor units and/or the increase in their frequency of discharge during voluntary and, even more markedly, RC are impaired in patients with Parkinson’s disease.

Parkinson’s disease is a clinical syndrome dominated by a disorder of movement consisting of tremor, rigidity, slowness of movements (bradykinesia), and postural abnormalities associated with distinctive pathology consisting of degeneration of pigmentated brainstem nuclei, including the dopaminergic substantia nigra pars compacta (1, 2). One of the most prominent features contributing to bradykinesia is a failure to energize muscles up to the level necessary to perform fast or ballistic movements (1, 3, 4).

Respiratory problems are a common feature of the disease and respiratory complications, particularly aspiration pneumonia, are the most common cause of death (5). Respiratory alterations include disturbances of ventilation and breathing pattern (6), electromyographic abnormalities of laryngeal muscles (7), respiratory disrhythmias whether associated or not with levodopa therapy (8), respiratory muscle weakness (9, 10), chronic or recurrent airflow obstruction (11, 12). Recent lines of evidence have favored upper airway muscle dysfunction as the major cause of airflow limitation in these patients (13). However, the motor disorder of Parkinson’s disease may involve not only the muscles of the limb and upper airway, but also the inspiratory muscles of the rib cage and neck (14).

The high incidence of aspiration pneumonia in the late stages of Parkinson’s disease has been partly ascribed to an impairment in the control of the epiglottic, laryngeal, and pharyngeal musculature leading to a disordered volitional oral as well as reflex pharyngeal phase of swallowing (15), suggesting that these patients are “silent aspirators” with lack of awareness of aspiration. Indirect lines of evidence (10, 15) seem to indicate that not only swallowing disturbances, but also a defective cough reflex, may contribute to predisposing patients with Parkinson’s disease to chest infection; however, no specific attempt has been made to investigate if coughing is actually impaired in these patients. This study was therefore carried out to evaluate cough threshold and the intensity of voluntary and reflex cough efforts, both in patients with Parkinson’s disease and in age-matched control subjects. Cough was evoked by inhalation of ultrasonically nebulized distilled water (fog), and its intensity analyzed in terms of electromyographic activity of the abdominal muscles.

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SubjectsTwenty-three patients with idiopathic Parkinson’s disease (16 males, 7 females) age 55 to 79 yr (mean 64) characterized by different types of clinical expression of the disease and by different levels of clinical disability (16) were recruited (Table 1). Fifteen patients denied a previous smoking history; four patients (3 males, 1 female) had not smoked over the last 10 yr. None of them had a previous history of respiratory disease, and all were on levodopa-carbidopa substitution therapy at the time of the study. Twenty-three healthy, age-matched, nonsmoker volunteers (17 males, 6 females) age 47 to 78 yr (mean 65.7) who coughed in response to preliminary fog inhalation challenges served as a control group. None of the participants had suffered from respiratory tract infections in the preceding 6 wk. The experimental protocol adhered to the Recommendations of the Declaration of Helsinki for Human Experimentation. Individual informed consent was obtained after detailed explanations of the procedures, but not of the purposes, of the study.

Table 1Data table

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Routine pulmonary function tests were performed in both patients and control subjects; they included spirometry and functional residual capacity measurements (gas dilution method). Reference values were taken from Morris and Koski (17). Respiratory function data of patients and control subjects are summarized in Table 2.

Table 2Data table

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Experimental Procedures and ProtocolExperiments were carried out according to procedures previously described (18). Reflex cough (RC) was induced by inhalation of fog produced by a MIST-O2-GEN EN143A ultrasonic nebulizer (MIST-O2-GEN Equipment Company, Oakland, CA) whose output could be progressively increased in steps corresponding to 5% of the maximal attainable output level. The range of nebulizer outputs employed in the present study was from 0.08 to 4.45 ml/min (18). Maximal voluntary cough (MVC) efforts were obtained by repeatedly encouraging each participant to cough as forcefully as possible. The force of expiratory muscles was measured, by using standard equipment and techniques, as the maximal expiratory pressure (Pe max), i.e., the highest pressure generated by a subject against a closed airway and sustained for at least 1 s after a full inhalation to near total lung capacity. During these measurements the cheeks and the floor of the mouth were supported with the palm of the hands by an investigator; participants were also vigorously urged to exhale as hard as possible for the entire maneuver which lasted at least 4 s. During all these experimental maneuvers, the electromyographic (EMG) activity was recorded from the abdominal muscles using surface Ag-AgCl electrodes positioned 3 cm apart along the line of right obliquus externus fibers, with the lower medial electrode 10 to 20 mm lateral to the edge of the rectus sheath and just above the level of the umbilicus. The EMG activity recorded with these electrodes during cough was considered to reflect the activation of the obliquus externus muscle, as well as the activity of deeper abdominal muscles with minimal contamination of the EMG signal by the rectus abdominis electrical activity (19). The EMG signals were differentially amplified (×2,000), bandpass filtered (50 to 1,000 Hz), full wave rectified, and passed through a “leaky” integrator (low-pass resistance-capacitance filter, time constant 50 ms) to obtain the so-called “integrated” EMG activity (IEMG). The IEMG activity was fed to a DC amplifier whose gain could be adjusted to obtain, for each subject, paper recordings of such an amplitude to allow accurate measurements. Before each challenge, subjects were asked to change their posture (trunk flexion) and simulate events such as exhalation of a long, audible breath and throat-clearing; the IEMG wave forms evoked by these maneuvers were compared with those recorded during voluntary coughing for differentiation.

Participants were comfortably seated on a dentist’s chair provided with head and arm rests and were repeatedly reminded to relax and breathe normally with as constant a pattern as possible. To facilitate electrodes positioning and to prevent the development of EMG activity of postural origin in the abdominal muscles (20), the back of the chair was tilted backward by approximately 30 degrees. In these conditions, abdominal muscles displayed no obvious rhythmic or tonic activity. Then, patients were requested to cough as forcefully as possible to record IEMG activity from abdominal muscles during MVC. Given the high variability of IEMG amplitudes observed during MVC, each participant was asked to perform 15 to 20 MVC maneuvers separated by a 5 to 10-s interval. No attempt was made to control the lung volume at which maximal expiratory thrusts were started. Three to five Pe max maneuvers were also performed. No abdominal muscle activation was observed during the inspiratory phase that preceded expiratory efforts, both during MVC and Pe max. Following a 10-min recovery period, each subject was connected to the nebulizer via a mouthpiece and inhaled during resting tidal breathing increasing fog concentrations obtained by adjusting the nebulizer output. To avoid rebreathing, an outlet proximal to the patient port of the apparatus was provided. In all instances, the fog inhalation time was standardized at 1 min for each nebulizer output; 2 to 3 min of rest were scheduled between steps. On appearance of cough, the test was discontinued and subjects were allowed to recover for at least 30 min to avoid tachyphylaxis. Then, the challenge was restarted with inhalation of the fog produced at the output step immediately below the first cough threshold. If cough could be elicited again at the same level that had previously been shown to evoke cough, the challenge was discontinued and that level taken as the subject’s cough threshold. Conversely, if no cough response could be obtained, the challenge was resumed and continued until cough could be elicited twice at the same nebulizer output. In only four experiments (three patients, one control subject) we found a difference between cough threshold observed on the first and second occasion. Thus, cough threshold was taken as the lowest fog output capable of evoking at least one cough during two distinct challenges separated by a time interval of approximately 30 min. This procedure ensured that the cough recorded was a reflex response to the challenge rather than a random event (18). During the assessment of cough threshold, the number of expiratory thrusts varied from to 2 to 6 in each participant.

Recordings of the studied variables were performed by means of an eight-channel chart recorder (HP 7758A, Hewlett and Packard, Palo Alto, CA; paper speed from 5 to 25 mm/s); the signals of the variables recorded during coughing were also fed to a FM tape recorder (HP 3960) for later analysis.

Data Collection and AnalysisAs fully described elsewhere (18), we measured on paper recordings at relatively high speed (25 mm/s) the peak of IEMG activity (IEMGP) in arbitrary units (AU) during Pe max maneuvers, MVC, and during each of the two fog inhalation periods required to assess cough threshold.

Measurements of IEMG amplitudes recorded in different experimental sessions cannot reliably be used for within- and between-subject comparisons without adequate processing because they are affected by several factors. These factors, which are related to subjects’ and recording conditions, include muscle size (which may vary considerably with the gender and age of the subject), the efficiency of skin-electrode coupling, skin resistance, electrode position, distance between electrodes, and adjustment of signal amplification. Thus, when expressed in AU, IEMGP is a valid measurement only within a given subject and within the same experimental session; when considering different subjects or sessions, similar IEMGP may actually correspond to markedly different levels of muscle activation and, hence, muscle forces. The conventional method to overcome this problem consists of normalization of IEMG amplitudes by assigning an arbitrary value, usually 1 or 100, to the highest achievable amplitude (absolute maximum), and to scale all other IEMG amplitudes accordingly, i.e., expressing them as a fraction or percentage of the absolute maximum. In our experiments, the highest IEMGP was consistently attained during MVC. Thus, all IEMGP values recorded in each participant during Pe max maneuvers, MVC, and RC should have been expressed in relative units (RU), i.e., as a fraction of the highest IEMGP recorded during MVC which can be confidently considered as the absolute maximum in our experimental conditions. This normalization would be adequate to compare IEMGP values recorded in normal subjects, but it cannot be used to compare IEMGP values between normal subjects and Parkinson’s disease patients.

In fact, due to the well-established relationship between IEMG activity and muscle force (18, 21), subjects who develop muscle weakness due to a central deficit in muscle activation and, therefore, in motor unit recruitment, should also display a correspondingly reduced IEMG activity. Indeed, expiratory muscle force is reduced in Parkinson’s disease patients (10), as confirmed by their lower Pe max (see Results); if this reduction in expiratory muscle force is disregarded and IEMG data normalized as described previously, then the normalized IEMGP values observed in patients and control subjects during Pe max, MVC, and RC would not significantly differ. This is in sharp contrast with the finding that expiratory muscle force is reduced in our patients.

Therefore, due to the previously mentioned relationship between force and IEMG activity, the amplitude of the abdominal IEMG activity also should be accordingly reduced. In other words, while the maximal recorded IEMGP activity can be confidently assumed to closely approach their absolute maximum in normal subjects and used for normalization, the maximal IEMGP recorded in patients with a central deficit in motor activation is not their absolute maximum and cannot be used for normalization. In fact, the maximal IEMGP recorded in Parkinson’s disease patients is the maximal IEMGP they can attain in their present clinical condition, and it represents only a fraction of their absolute maximum. Therefore, to appropriately compare IEMGP values in patients and control subjects, we need to obtain a reliable estimate of the absolute maximum IEMGP in the patients. Given the well-known relationship between IEMG activity and muscle force, we can estimate patients’ absolute maximum IEMGP by considering the extent of the reduction in their expiratory muscle force. At variance with other muscle groups, the maximal force that can be developed by the expiratory muscles has been determined in a wide number of subjects and the corresponding predicted values, which take into account differences in age and gender, are also available (22). Thus, the ratio of measured-to-predicted Pe max can be taken as a reliable quantification of changes in expiratory muscle force and, hence, in the corresponding IEMGP values. In fact, assuming that in each subject the proportionality between IEMG activity and force is maintained, it follows that:

measured PEmax(cm H2O)predicted PEmax (cm H2O)=maximal recorded IEMGP (AU)absolute maximum IEMGP (AU)

Equation 1


absolute maximum IEMGP (AU)=maximal recorded IEMGP×predicted PEmax (cm H2O)measured PEmax (cm H2O)

Equation 2

With this procedure, we first obtain a close approximation to the absolute maximum IEMGP in AU, i.e., the IEMG amplitude one would record in the absence of a central deficit in muscle activation; then, this value is taken as 1 and all recorded IEMGP values are scaled accordingly, that is, expressed as a fraction of the absolute maximum in RU. The procedure was extended to normal subjects for homogeneity of data manipulation and analysis. On the other hand, this procedure bears little impact on data obtained from control subjects in which the ratio of predicted-to-measured Pe max is close to 1, while it significantly affects data from Parkinson’s disease patients in which the ratio is considerably higher than 1. In consequence, all IEMGP in AU are disregarded because they are affected by subjects’ and recording conditions (as described earlier); rather, we rely on IEMGP values expressed as a fraction of the absolute maximum (in RU). This allows pooling of data within each group and enables one to compare normal and diseased subjects by considering both time and amplitude components of IEMG bursts.

The duration of the rising phase of the abdominal IEMG activity during both MVC and RC was measured as the time elapsed between the onset of IEMG activity and the peak level of that activity. The onset of IEMG activity was arbitrarily considered as the time at which the activity just exceeded the 10% of its peak amplitude above the mean level of ongoing baseline activity. The 10% level was chosen to avoid uncertainties in the measurements, especially when slow drifts in IEMG activity were present. This time duration, i.e., the time duration of the expiratory IEMG ramp during cough, was termed Tec. When considering phrenic or diaphragmatic activity, an important measure of drive intensity is the ratio of peak amplitude of inspiratory activity to the duration of the inspiratory ramp. In the present study, the intensity of the neural drive to the expiratory musculature during coughing was measured by using similar criteria. Thus, the rate of rise or slope of IEMG activity, i.e., the ratio of IEMGP to Tec (IEMGP/ Tec), was subsequently calculated for all considered cough efforts. Due to the proportionality between force and IEMGP and, as a consequence, between the rate of rise of the force generated by the contracting muscles and their IEMGP/Tec, these IEMG-related variables were confidently used as indices of cough intensity (18). In each subject, the static expiratory maneuver showing the highest Pe max value was selected for analysis. The selected Pe max consistently displayed, compared with all other static expiratory efforts, also the highest IEMGP value. In the results, maximal static expiratory pressure was expressed as a percentage of subject’s predicted value (22). With regard to the MVC, the three maneuvers with the highest IEMGP were considered in each subject. Differences in these IEMGP values during MVC were always less than 10% of the maximum. With regard to RC, all efforts recorded during cough threshold assessment were analyzed. Owing to the small variations in IEMG variables during both MVC and RC in each subject, average values were taken as single measurements for purpose of analysis. Other methods for assessing cough intensity such as using, for instance, expiratory flow rates were discarded. Measurements of expiratory flows require the use of a pneumotachograph and a respiratory valve. Because any device interposed between the nebulizer and the airways may potentially affect the size and penetration of inhaled particles (23), we preferred to avoid this complicating factor that could influence cough threshold assessment (18).

Comparisons between baseline lung function data as well as between cough threshold values in patients and control subjects have been performed by the nonparametric unpaired Wilcoxon test. Paired and unpaired Wilcoxon tests were also employed to compare data related to IEMG variables during Pe max maneuvers, as well as during reflex and maximal voluntary cough efforts. Spearman nonparametric correlation coefficient was used to investigate the relationship between Pe max and the level of patient’s clinical disability. Relationships between patients’ IEMG variables (IEMGP and IEMGP/Tec) recorded during RC and the level of clinical disability were investigated with the same statistical procedure. Reported data are means ± SD, unless otherwise stated. In all instances, p < 0.05 was taken as significant.

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All but one of the 23 patients tested coughed in response to fog inhalation. Cough threshold values ranged from 0.4 to 3.36 (median 0.87) ml/min in control subjects, and from 0.4 to 4.0 (median 1.31) ml/min in patients (Figure 1). The corresponding first and third quartiles were 0.4 and 1.31 ml/min in patients and 0.77 and 1.77 ml/min in control subjects, with interquartile ranges of 0.91 and 1.04 ml/min, respectively. Comparison between cough threshold values in the two study groups failed to show any significant difference.



Comparison between cough threshold values in control subjects and patients with Parkinson’s disease. [More]

Patients’ Pe max, expressed as a percentage of predicted values, was 66.88 ± 11.95 (Figure 2); this value was significantly lower (p < 0.01) than in control subjects (98.01 ± 8.10). As shown in Figure 3A, there was a negative correlation (rs = −0.88, p < 0.01) between Pe max and the level of clinical disability.



Comparison between maximal expiratory mouth pressure (Pe max) values in control subjects and patients with Parkinson’s disease. [More]


Correlations of maximal expiratory mouth pressure (Pe max), peak (IEMGP), and slope (IEMGP/Tec) of the integrated electromyographic activity of abdominal muscles during reflex cough versus the level of clinical disability. [More]

In control subjects, IEMGP values during MVC slightly but significantly (p < 0.05) exceeded those recorded during Pe max, and RC (Table 3); in contrast, patients’ IEMGP values observed during Pe max maneuvers, MVC, and RC did not significantly differ, but were significantly lower than the corresponding values recorded in control subjects (p always < 0.01). In patients, the duration of Tec during RC turned out to be significantly longer (p < 0.01) not only than that observed during MVC, but also than that recorded in control subjects during both RC and MVC. On the other hand, Tec values recorded in control subjects during MVC and RC were similar. As a consequence, both in patients and controls, the rate of rise of IEMG activity (IEMGP/Tec) during RC was significantly lower (p < 0.01) than during MVC; moreover, IEMGP/Tec values during MVC and RC were significantly lower in patients than in control subjects (p always < 0.01; Table 3). However, when, compared with MVC, the rate of rise of IEMG during RC was significantly less steep in patients than in control subjects (p < 0.01). Furthermore, patients’ IEMGP and IEMGP/Tec during RC were inversely related (rs = −0.86 and −0.85, respectively, p always < 0.01) to the level of clinical disability (Figures 3B and C).

Table 3Data table

View Larger Version

Average patterns of ramp IEMG activity of the abdominal muscles during MVC and RC, both in patients and control subjects, are diagrammatically illustrated in Figure 4. As shown by the original recordings reported in Figure 4, as a rule, not only the rate of rise of IEMG activity, but also its decay was slower during MVC and RC in the patients. The time course of the decay of IEMG activity was not quantitatively analyzed.



Diagrammatic representation of average IEMG patterns during voluntary (solid lines) and reflex cough (dashed lines) in control subjects (A) and patients with Parkinson’s disease (B) [More]

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The most important finding of our study is that the intensity of voluntary and reflex cough efforts, as indexed by the peak and rate of rise of abdominal IEMG activity, was significantly lower in patients with Parkinson’s disease than in age-matched control subjects, whereas cough threshold, although slightly higher in patients, was not statistically different in the two groups (Figures 1 and 4, see also Table 3). Another interesting result is that Pe max, as well as IEMGP and IEMGP/Tec during RC, were inversely related to the level of clinical disability in Parkinsons disease patients (Figure 3).

These findings suggest that coughing is impaired in patients with Parkinson’s disease, and also indicate that, at least in patients in the less advanced stages of the disease, motor rather than sensory components of the cough reflex are primarily involved. Furthermore, they confirm that the force generated by the expiratory muscles is reduced in these patients (10), as revealed by data on Pe max (Figure 2). The reduced Pe max in Parkinson’s disease patients has been shown to reflect expiratory muscle weakness (10). In keeping with this conclusion, studies on the flexor and extensor muscles of the superior limb in these patients have demonstrated a reduction in peak muscle force and in the rate at which it was achieved (24). The main reason for muscle weakness appears to be a decrease in EMG activity of the agonist muscles. Peripheral changes in muscles or nerves are unlikely to explain muscle weakness because they cannot account for the finding that the strength of both respiratory and limb muscles is increased by antiparkinsonian treatment (10, 24). Thus, it seems plausible that expiratory muscle weakness in Parkinson’s disease patients is related to an impairment in the central activation of motor units. On the basis of these considerations, the reduction in Pe max appears to reflect a reduced neural drive to expiratory muscles in our patients. Since, as already mentioned, the force developed by the contracting muscles is proportional to the corresponding IEMG activity, to appropriately compare IEMGP values in patients and control subjects it seems reasonable to apply the correction procedure reported in Methods.

We measured the intensity of cough responses noninvasively by making use of IEMG recordings of abdominal muscles. The force developed by contracting muscles is proportional to their IEMG activity under both isometric and isotonic conditions (18, 21, 25). The rate of rise or slope of the IEMG activity reflects the rate of recruitment of motor units, as well as the increase in their firing frequency, while IEMGP is an expression of the total number of units recruited and of their maximal firing frequency (26). Admittedly, the measurement of variables such as expiratory flow and pressures would have been useful in clarifying the dynamics of expiratory thrusts during coughing. However, we did not use a pneumotachograph because, as explained in Methods, this device might have affected the assessment of the cough threshold. On the other hand, we could not obtain reliable mouth pressure measurements during coughing due to obvious disturbances of the pressure signal induced by the cough noise. In this context, it can be recalled that in a previous study in normal subjects (18) we found that IEMGP and IEMGP/Tec correlate with expiratory flow. It seems conceivable that this correlation is also valid in patients with Parkinson’s disease. In fact, since there is no reason to assume that the force–IEMG relationship is disrupted in these patients, the major factor determining the rate of expiratory flow at constant airway resistance is the intensity of IEMG activity and the consequent force development by the abdominal musculature.

It can be observed that patients’ slower rate of rise of abdominal IEMG, leading to a delayed development of a positive subglottic pressure during reflex coughing, could also be associated with a delayed glottis opening, so that a slower building up of subglottic pressure may not necessarily result in a weakened cough effort. In this connection, it should be recalled that in normal subjects the glottis is actively opened, as a rule, 0.2 s after its closure, which occurs simultaneously or just after the onset of IEMG activity (27). Thus, since in control subjects Tec was approximately 0.2 s, glottis opening did occur at peak IEMG activity. During reflex cough, Tec was abnormally prolonged in the patients (Table 3); even if glottis opening was also delayed, maximal subglottic pressure and expiratory flow should have been attained at IEMGP. Because IEMGP is reduced in Parkinson’s disease patients, the intensity of the corresponding expiratory thrust also should be reduced accordingly.

The reduction observed in IEMGP and IEMGP/Tec during cough efforts probably reflects one of the most prominent functional disturbances in patients with Parkinson’s disease, i.e., slowness of movement that is ongoing, or bradykinesia. Although Tec is similar in patients and control subjects during MVC, this finding does not necessarily mean that bradykinesia in our patients is limited to RC. Although peak amplitudes of IEMG activity in AU during both MVC and RC in patients were quite similar to those observed in patients (Figure 4B, right side), it should be recalled that this was due to factors affecting recording conditions in different experimental sessions, particularly the gain of EMG amplification (see Methods). In fact, following normalization, we were able to reveal that IEMGP values are actually reduced in the patients, as diagrammatically shown in the left side of Figure 4. The reduction in normalized IEMGP observed in the patients also resulted in a significant reduction in the slope of abdominal IEMG activity during MVC (Table 3). This reduction can reliably be taken as an index of bradykinesia (1, 3, 4, 28, 29). A contributing feature of bradykinesia has been clearly established: it consists of a failure to energize muscles up to a level necessary for the execution of rapid or ballistic movements (3, 4, 28, 29). Because cough can conceivably be regarded as a fast or ballistic-like motor act, the same pathophysiological mechanism could account for impaired motor cough responses in Parkinson’s disease. Studies with transcranial magnetic stimulation (28, 30) indicate that not only akinesia, i.e., failure to move or slowness to initiate a movement, but also bradykinesia, may depend, at least in part, upon a deficiency in activation of the motor cortex. Rigidity may also contribute to slowness of movement but it is not the cause (31). The finding that not only the rate of rise of abdominal IEMG activity, but also its decay is slower in patients, suggests that both the recruitment and the derecruitment of abdominal motor units (Figure 4) are affected.

Although the rate of rise of abdominal IEMG activity was reduced during RC compared with MVC both in control subject and in patients, this reduction was markedly less pronounced in the latter. This suggests that RC is relatively more impaired than voluntary cough in patients with Parkinson’s disease. The reasons for this phenomenon are at present only a matter of speculation. In this connection, it can be recalled that not only cough, but also other autonomic reflexes, such as the pharyngeal phase of swallowing (15), are impaired in Parkinson’s disease.

A detailed discussion on the complex circuitry of basal ganglia is beyond the scope of the present report. We can just emphasize that the major output of the basal ganglia arises from the inner segment of the globus pallidus and the pars reticulata of the substantia nigra; the disruption of basal ganglia function in Parkinson’s disease is mainly, although not exclusively, due to profound degeneration of the nigrostriatal dopaminergic system (see, e.g., 31, 32). Pathways to the thalamus are mainly involved in the control of voluntary movements, whereas projections to the pedunculopontine nucleus of the mesencephalic pontine tegmentum and to the pontomedullary reticular formation are possibly implicated in postural and reflex influences (1, 32).

Present results, obtained in a group of patients with prevailingly mild to moderate clinical disability, clearly demonstrate a defective motor control of cough in Parkinson’s disease; the finding of an inverse relationship between IEMG variables and the level of clinical disability (Figure 3) leads us to hypothesize that, with the progression of the disease, more marked impairments in cough motor control may result in a substantial deficit of the protective mechanisms responsible for airway clearing. We cannot even exclude that in airway responsiveness to tussigenic stimuli may also be reduced in the most advanced stages of the disease. However, present data do not provide any evidence to support this possibility. Nevertheless, even in the absence of an increase in cough threshold, a defective motor control of coughing, along with the well known swallowing disturbances (10, 15), may per se account for the high incidence of potentially fatal respiratory infections in the late stages of Parkinson’s disease.

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Supported by grants from the Ministero dell’Università e della Ricerca Scientifica e Tecnologica of Italy.
Correspondence and requests for reprints should be addressed to Dr. Giovanni A. Fontana, Dipartimento di Fisiopatologia Clinica, Sezione di Fisiopatologia Respiratoria, Viale G. B. Morgagni, 85-50134 Firenze, Italia. E-mail:

Received May 30, 1997

© 1998 The American Thoracic Society

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(2004) Cough in children with congenital central hypoventilation syndrome. Pulmonary Pharmacology & Therapeutics 17:6, 425-429
Online publication date: 1-Dec-2004.
(2004) Physiological down-regulation of cough. Pulmonary Pharmacology & Therapeutics 17:6, 465-468
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(2003) Impaired Efficacy of Cough in Patients With Parkinson Disease. Chest 124:3, 1009-1015
Online publication date: 1-Sep-2003.
(2003) Disorders of the Respiratory Muscles. American Journal of Respiratory and Critical Care Medicine 168:1, 10-48
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(2002) Therapy for Cough: Active Agents. Pulmonary Pharmacology & Therapeutics 15:3, 335-338
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(2002) Water Aerosols and Cough. Pulmonary Pharmacology & Therapeutics 15:3, 205-211
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(2001) Pulmonary function tests in Parkinson’s disease. European Journal of Neurology 8:4, 341-345
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(2001) Fog-induced Respiratory Responses Are Attenuated by Nedocromil Sodium in Humans. American Journal of Respiratory and Critical Care Medicine 163:5, 1117-1120
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(1999) Coughing in Laryngectomized Patients. American Journal of Respiratory and Critical Care Medicine 160:5, 1578-1584
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(1999) Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke. Archives of Physical Medicine and Rehabilitation 80:2, 150-154
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