Daniel Frouman Memorial Scholarship Fund

The Daniel Frouman Memorial Scholarship Fund at Safe Passage Foundation has received an annual donation pledge that will provide scholarships of at least $500 per year for at least two students per year for five years (from 2012 until 2017).  If you can,  please donate to the scholarship fund.  If you are interested in applying for a Safe Passage Foundation Scholarship funded by the Daniel Frouman Memorial Scholarship Fund, please visit their Scholarships page at http://safepassagefoundation.org/scholarships.

Safe Passage Foundation (EIN: 30-0188676) is a not-for-profit 501(c)3 tax-exempt organization that provides resources, support and advocacy for youth raised in restrictive, isolated or high-demand communities, often referred to as “cults” by society at large.

In November 2011, Safe Passage Foundation will begin accepting scholarship applications and plans to make the first awards in January 2012.

Daniel Frouman was born in the Children of God (now known as The Family International) in April 1976 and remained there until April 1993 when he was freed by a judge who later ruled that Daniel’s basic human rights had been violated:

That in the long investigation, which has not yet concluded, by this court, to locate the FROUMAN brothers (two of the children, Emanuel David and Daniel Pasquale,  have been returned to their father), it has become aware of the existence of conduct which undoubtedly cannot be tolerated in that it clearly infringes the articles of National Law 23.849[8] (Convention On The Rights of The Child[9]), Law 23054[10](American Convention On Human Rights called Pact of San Jose of Costa Rica[11]) and Law 10.067, among other legal bodies, and which undoubtedly deserves the pertinent procedural activity of the organs of competent jurisdiction to establish not only the existence and responsibility of typical conduct but also the consequent sanction, not only against Stuart Harris Baylin but also, as will be seen, against the identified organization as they have violated the fundamental rights of people.
This is what has happened to the FROUMANS in that their identities have not been preserved, and that they were prevented from being near their parents and relatives and that they were not able to visit their mother before she died. Article 9[16] of law 23.849 was also infringed every time they were separated from their parents as has been perfectly accredited “ut supra” in the judgment of this court. Not to mention the infractions of the norms contained in articles 9[16], paragraph 3[17] and articles 11[18], 12[19], 13[20], 14[21] and 16[22] of law 23.849 among others. In this respect, these violations against the FROUMAN minors are profusely documented in the court’s records (“sub-examine”).

 

During most of his childhood (primarily from 1980 until 1993) in the isolated, restrictive and high demand organization known as “The Family,”  Daniel routinely experienced and witnessed child abuse (both physical and sexual), neglect and exploitation.  Some of the sexual abuse he experienced at a very young age (6 and 8) was violent and horrific yet not a single one of the adults in the community who were aware of its occurrence ever did anything to protect him and other children from further harm.  In most communities outside The Family, there is a good possibility that an adult who witnesses a child’s abuse “outcry” will immediately report the matter to a law enforcement or child protection agency.   In the community Daniel lived in, most of the child abuse, neglect and exploitation he experienced was promoted and encouraged in the cult’s religious publications and practiced by its top leaders and most of its adult membership.  There was little respect or regard for the basic human rights of children and reporting a credible suspicion of child abuse to a law enforcement agency was strictly forbidden and grounds for expulsion from the community.  When confronted with factual information that their minor children had been sexually and physically abused by others, many parents in The Family did nothing except label their children delusional liars and do everything possible to protect child molesters from being held accountable. Naturally, this resulted in so few criminal convictions that The Family still maintains that the number is zero (the actual number is at least two).   In one of the two known cases that resulted in a criminal conviction, a father appeared in court at a sentencing hearing to beg the judge to show leniency and give a no jail time probation only sentence to the older man who spent 9 years repeatedly sexually assaulting his daughter (starting when she was 5 years old).  The judge may have astonished but he was not persuaded and sentenced the child molester to 11 years in prison (the sentence was low because the defendant only pled guilty to one count of aggravated sexual assault and most of the crimes occurred in other jurisdictions outside the United States).  In the other case, it was a father who was sentenced to 19 years in prison for sexually assaulting his children over a period of many years.   Until it began to disintegrate, The Family was always one of the safest places in the world for child molesters.

Despite the odds against them, survivors of childhood trauma in The Family were remarkably resilient and Daniel was no exception.  After an extraordinarily traumatic and painful childhood, he began a new life at age 16 without any formal education and little help from anyone except himself.   He overcame many obstacles and worked very hard to succeed in a number of fields including music, teaching and medicine.   In 1993, he obtained a GED certificate and later began attending Austin Community College.  In 1998, he enrolled at UT-Austin and in 2002 he was awarded a Bachelor of Arts in Spanish with honors by the University of Texas at Austin and in 2006, he was awarded a Master of Arts in Spanish by Texas State University.  The offered financial aid (most small grants and large loans) was never enough so he worked many jobs (including as a bus boy, bus driver, flower delivery, office assistant, tutor, home health care aide,  musician and bartender) to pay for his education and even participated as a subject in Phase I clinical drug trials (at Pharmaco, the same place Robert Rodriguez went to get funding to produce El Mariachi) for the cash provided to compensate subjects for the inconvenience (but not the risks) of participation.  He learned how to live on inexpensive foods like Ramen noodles, rice and beans.  Even a tiny scholarship such as this one could have made a difference.

He taught a chemistry lab at Texas State for awhile and then in 2006 enrolled in his first year of medical at UT Southwestern Medical School.   In 2007, due to financial hardships, he took a break from medical school to teach undergraduate Spanish courses at Texas State University.  In April 2008, he joined the U.S. Navy as a medical student in the Navy Health Services Collegiate Program and soon attained the rank of an E-7 Chief Petty Officer.  The funding from the Navy program covered his tuition and living expenses and enabled him to return to UT Southwestern to begin his second year of medical school without the distraction of financial hardships.   He was starting his third year of medical school after taking Step 1 of the USMLE (on which he received an acceptable score) when he committed suicide on July 8, 2009.   He overcame many challenges to accomplish extraordinary things.  However, in the end he was not invulnerable to the constant pain caused by the trauma (most of which, but not all, occurred during his childhood in The Family).  In this he was not alone; over the years many children born and raised in The Family have committed suicide.  A partial and incomplete list of deaths (due to various causes including suicide, unintentional drug overdoses and medical neglect) of people born and raised in The Family can be found at the Lost Children Memorial site.

He and other children freed from The Family via a successful individual escape plan (often simply running away) or judicial intervention (such as the child abduction case involving Daniel and three of his siblings) were among the first children in The Family to begin what would later become a mass exodus of youth from the organization that eventually resulted in the failure and disintegration of most of its structural components.  The Family International is finally fading into oblivion and one can hope that eventually it will be nothing more than a bad memory.

 

The Daniel Frouman Jazz Extravaganza – April 10, 2011

Spring is here and it’s time for another Extravaganza celebrating the life of our dear friend, Daniel Frouman. The HOPE Farmers Market will host this event on Sunday, April 10, 2011 from 11am-3pm. There is a new, covered stage on the West end of the market, which will host the event beautifully. Hopefully you all are available to be a part of it.

Musicians, please bring your gear and do the thing you do so well. HOPE FM has a basic 4-input PA, and  will gladly support you all however it is needed.

Runners, bring your running shoes and team shirts. We’d like to ask runners to find a sponsor for $20. The route will be the same as last year.  A limited number of Daniel Frouman Memorial Running Club shirts will be provided at no charge for any runner who doesn’t already have one.

This year, silent auction proceeds and all donations will benefit Anthropos Arts, a nonprofit dedicated to providing music lessons for students who couldn’t afford them otherwise. Anthropos has changed the lives of many local students in Section 1 schools by providing lessons, mentors, performance opportunities, and scholarships. Anthropos students will be at the market representing the organization, and might even join the performance if they are welcome to.

The silent auction will include art, passes to ACL Festival and Lollapalooza, jewelry, and anything else we can gather. We welcome any items you would like to contribute. If you want a donation letter for collecting auction items, contact Emily Stengel.

Daniel’s second near-death experience

Before his death in July 2009, my brother Daniel had at least three near-death experiences.  His first near-death experience reportedly occurred shortly after his birth when he contracted pneumonia and spent weeks in a hospital in Johannesburg, South Africa.   I don’t remember much about that first time and I wasn’t  there for the third but the second  is something I’ll never forget.   As children, the story was an important part of our family folklore and loomed large in both our memories and our imaginations.

In April 1977, New York Times reporter John M. Crewdson travelled to Austin, Texas to report on a unique urban renewal project: the rapid transformation of a a dilapidated apartment complex scheduled to be demolished into a clothing optional oasis and self-described” experiment in LIBERTARIAN community”  by  Terry Parker.    A few years later,  my mother and I and my two younger brothers ended up in Austin, Texas living in a house with Terry Parker’s father and my mother’s close friend Chuck.   Later,  we moved to  the “clothing optional” New Manor apartment complex after my father and my older brother Manoli arrived from Florida.  Manoli was 7 years old, I was 5, Daniel was 4 and Jonathan was 2.

We loved playing in and around the pool.  When the sun was out, a group of old naked men could usually be found around the pool working on their tans.  Not everyone was naked and wearing clothes was certainly tolerated.  However, there was a pool dress code and those found inappropriately attired (for example, wearing jean cutoffs) were allowed to use the pool if they removed their clothing.   Manoli was the only of us who was a competent swimmer so we tried to stay out of the deep end.

One day, Daniel fell into the deep end.  I don’t recall exactly how it happened.  Sometimes Daniel said he slipped and sometimes he said he was pushed.  He was underwater for a few minutes until an alert 20-year-old naked man dove in and saved him.  After getting him out, the technique he used to help him was hold him up side down by the legs while patting his back to get the water out.  Near-death experiences were covered extensively in the religious “education” we received during our childhoods so naturally we often asked Daniel what he observed while he was unconscious.  His answer never changed: absolutely nothing.   Perhaps we were disappointed that he didn’t remember a white light at the end of the tunnel or a soft voice telling him that he was too early and was being sent back to complete an extraordinary mission.  But Daniel rarely forgot to tell us that a pair of wrinkled wet balls was the first thing he saw when he regained consciousness.

Terry Parker obituary

http://www.tributes.com/show/Terry-Parker-82239726


Crewdson, John M. “‘Liberated Apartment Complex’ Offers Nudity, Frolicking”, New York Times, April 24, 1977. A26

http://select.nytimes.com/gst/abstract.html?res=F20F17FC395812718DDDAD0A94DC405B878BF1D3

Clothing Optional At Texas Complex .
Reading Eagle – Google News Archive Dec 16, 1976

Dress Informally, Or Not At All?? .
Bonham Daily Favorite – Google News Archive- Dec 16, 1976

Dress .Informally Or Not At All .
Times-Union – Google News Archive – Dec 20, 1976

78 More Apartments Go Nude .
Lyon County Reporter – Dec 17, 1976

—terry Parker, Apartment Manager .
Lyon County Reporter – Dec 17, 1976

Apartment Complex Offers Tenants .’raw Deal .
Calgary Herald – Google News Archive – Dec 17, 1976

the Liberated Space Apts

http://groups.yahoo.com/group/LibertyProspects/message/2569

UT Southwestern: Memories of Daniel by Kirtan

Written by Kirtan Nautiyal, a classmate of Daniel’s at UT Southwestern Medical School on July 9, 2009.

I too have heard a lot of people wonder who Daniel was. And I thought I’d re-share a little of what I said at
the gathering this afternoon, because I don’t want there to be any doubt that our community really lost someone
special yesterday.

I met Daniel through our colleges group. In the medical school world, where so many of us come from similar
middle and upper class backgrounds, always having shot for that medical career, he was such a breath of fresh
air. John mentioned his “25 things” facebook note today, and I agree that it was such
a wonderful thing. Reading it, I learned about what a life he’d led, the times spent on the street earning
money playing music, the years spent touring South and North America in numerous bands, the drunken shows, a
spontaneous mountaintop marriage with a cheap ring, and about how he was “the psychiatrist” for all his
“alcoholic musician friends”, patiently listening to all their problems for hours and hours on end. He’d had
such a life, and had this huge circle of friends all across 2 continents, and I really believe that he lived
aloof from many of his classmates, because he was living on a different level than most of us, with life
experiences and dreams that were so different from most of ours. That was a valuable thing. He deleted that
note a few days later; he was a very private person.

You know, a lot of us wrote about giving and about service in our personal statements, a lot of us talk about
it, but I think very few of us really lived those sentiments in the way Daniel did, every day. I really believe
that, and I don’t say this just because he died on Wednesday. Just a few examples:

Several students and I worked most of this past year to put together a medical service trip to Haiti. We were
very passionate about this, and I told (bothered) most people about what we were doing every chance I got. I
must have mentioned the trip to Daniel once in passing, but I definitely didn’t mention that we were
fundraising or that we needed money in any way. So it was such a strange and wonderful moment when he pulled me
aside after one of our very first interminable gross tissue sessions in September, reached in his pocket, and
gave me a check for $100, telling me he didn’t need the money, to use it on the trip, I’d really need it. I was
a little bit shocked to tell you the truth, because sadly, giving freely of one’s self in this way is just
something you just don’t see much. He was a student like you and me, he had to take several jobs in medical
school to support himself, he didn’t have any money, and yet he decided that I could use this money more than
he could. If it had been most anyone else I would probably have said I couldn’t accept the gift, but in Daniel,
I really could see he wasn’t giving me the money to feel proud about himself, but because he really had no use
for money beyond making the people around him happy, and that was such a unique quality to see.

I saw that quality again when we were putting together a party for Dr. Bash, our college group mentor at the
end of the 2nd year. We were talking about getting him a gift, and it really should have been no surprise that
Daniel showed up at our next colleges group meeting and gave me an envelope saying this is my contribution –
inside was a $50 gift card to Massage Envy. Man, what a guy. I said that was a wonderful thought, and that we
would all pitch in a few bucks to distribute the cost, but Daniel said no, he had more money than he could ever
use, and that he wanted to do this, but please to tell Dr. Bash that the gift card was from all of us. It was
just me and him in the room, he wasn’t doing this to impress anyone, that was just the way he was.

It’s fitting that the last time I spoke with Daniel he was trying to get in contact with me, because I had
posted on my Facebook page the day before my USMLE that my car had broken
down. He sent me a message with his phone number, saying he’d be happy to get up at 6 and drive me twenty
minutes to the test. I replied thanks for the offer, and that I didn’t know his test was the same day as mine.
He said it wasn’t, but that he knew what it was like to be without a ride. How many of the rest of us would
have gotten up early two or three days before our own USMLE exams and spent an hour driving an acquaintance
across town like that? And the more I learn about Daniel’s life, the more I think that just about sums it up –
he wanted to give me a ride because he knew what it was like to be without a ride. He gave his money freely
because he knew what it was like to be on the street without any money. He listened to the pain and problems of
his friends, because he had felt that pain deeply himself, more deeply than perhaps we ever realized.

You know, I wasn’t Daniel’s best friend, not even close to it. He had a rich life outside of school, and I
never hung out with him beyond the times I ran into him at colleges. And I can’t help but thinking that if he
did all these wonderful things for a guy like me who he barely knew, what a kind, generous, giving friend,
brother, and son he must have been to those he was truly close to.

The UTSW and world of medicine really lost someone yesterday, they really fucking did, because I have no doubt
Daniel would have been an excellent physician, a better one that I’ll ever be.

Thanks for reading, if you did.

-Kirtan

Words of Advice for Young People: Social Anxiety

Daniel Frouman’s words of advice regarding social anxiety/social phobia on August 30, 2008.

In publishing excepts from Daniel’s writings, I have been careful to redact anything that might affect the privacy of his correspondents.

I’ve been thinking a lot about what you were saying about your anxiety. I didn’t want to go into it around everyone but I felt like I should tell you what I’ve been doing to help my anxiety. I know how annoying and frustrating it can be to deal with anxiety and I felt like I should write you something. I hope I’m not crossing any lines with this email. Maybe what I have done to deal with anxiety may help you or maybe not. Everyone is different. But for what its worth:

First, you should know that my anxiety used to be so bad that I couldn’t talk to anyone without my hands shaking, getting dry mouth, sweating, filling dizzy, etc..
Giving presentations was a nightmare; the presence of cops or military made me hyperventilate; being on stage was very difficult. I did a ton of drugs and drank a lot for years b/c it seemed to help the anxiety and I played music all day so I wouldn’t have to deal with social settings.
After I got hit by a drunk driver while riding my bike I couldn’t play anymore and I was forced to be more social. I couldn’t drink all the time anymore cause of work and that is when I realized how bad my anxiety was.

Anxiety is very complex. It is caused by and it causes an over active limbic- hypothalamic-pituitary-adrenal axis (LHPA axis).
1) When you are in a place or situation you have learned to fear, the sympathetic nervous system is activated, you get a surge of NE / Epinephrine in the blood stream. This increase in NE/Ep. is responsible for the increases in cortisol and eventual damage to the brain if the system is over active, i.e you feel anxious a lot, over a long period of time. This is why the rate of anxiety and depression is higher in lower social-economic groups (more stress). In order to ameliorate the situation you need to find a healthy way of reducing cortisol since high levels caused by stress and anxiety damages the limbic system in your brain, specifically axons and dendrites, which makes the system hypersensitive. Voluntary jogging / cycling for 40 min. a day is a great way to do this.

2) The amygdala (part of the limbic system) is associated with stress/anxiety/fear memory. At some point in our lives we learned to fear certain situations and we are hardwired to get anxious since it is the way our body tells us to get the fuck of this bad situation. This is usually a good thing if we are afraid of harmful situations.

The plasticity of the brain is good but slow. We can change this gradually by creating new positive memories associated with the same stimulus, i.e. social settings.

3) Anti-anxiety / Anti-depressants like serotonin re-uptake inhibitors can help since they up-regulate the genes responsible for axons and dendritic growth in the limbic system. (anti-anxiety and anti-depressant drugs are a lot a like since they act on the same system, and the pathology is the same). The use of these anti-anxiety drugs can be beneficial if you are doing some kind of cognitive therapy. Research shows that psychoanalysis actually makes people worse since they spend years re-living all the bad memories which caused the anxiety, only reinforcing them. There is a reason we tend to forget these things. Cognitive therapy is the only form of psychiatry, which statistically has been shown to help since you form new anxiety-free memories with the same stimulus. The problem is that the plasticity of the brain (neuron growth) is very slow. It may take several months for your brain to create these new pathways.
Some anti-anxiety drugs are mild tranquilizers which can help momentarily by depressing the SNS. This is why alcohol is so great! It calms us down at low concentrations. At higher concentrations it acts on other receptors in the brain and feeds into the over active LHPA axis. Another problem is that these drugs, i.e. alcohol, are negative re-enforcers. If you drink / or do drugs every time you get anxiety it actually makes you more avoidant and fearful of the stimulus that was causing you to get anxious in the first place and on top of everything, if used chronically, it over stimulates the LHPA axis. So we end up in this vicious cycle for years and years and we have no idea what to do.

I will tell you what I did. First I read a lot about it. Then I quite drinking and I quite doing drugs. I started jogging everyday. I took 100-200 mg B-vitamins (complex) and 2000-4000 mg of vitamin C everyday (nerve health). My anxiety got worse. I even started to get anxious about getting anxious. So I allowed myself to get anxious. I accepted the fact that I was going to get real bad anxiety but if let it happen and I didn’t drink and I did something to get rid of the stress afterwards it would get better. I made a list of things that made my anxious and I ranked them in terms of severity. I tried to expose myself to the things that caused the least anxiety first. (This wasn’t always possible since work and school etc required that I do things that were going to make me really anxious.) I would put myself in a situation that made me anxious and I would stay there until I calmed down. This is what a psychologist doing cognitive therapy would tell you to do. (so you can do it on your own) I noticed that if I confronted the stimulus sober and accepted the fact that I was going to freak out and that there was nothing that I could do and I just let it happen, with time it progressively got better. Teaching college is an example. During my first semester teaching chemistry my hands would shake, I would get a real dry mouth, and I would feel like I was going to faint. A student asked me once why my hands were shaking and I said I had to much coffee. Once I was done, I would go run/swim or something to burn of some cortisol and try to reward myself somehow (great food, sex, buy yourself something you like, hang out with friends, etc). (I always wanted to go get a drink but I tried not to since I knew that it’s a negative behavior reinforcer). If I found myself thinking that I fucked up because I was so nervous I would tell myself that I did great because I was afraid to go to work but I was strong enough to go anyways. With time the anxiety decreased in terms of time. By the time I was teaching my second semester I only got nervous for 2-5 min. at the beginning of class. I also noticed that if I really took the time to prepare my lectures I wasn’t as nervous so I would spend more time working on my lectures. In a way I thing it’s good that we get nervous since sometimes it results in us doing a better job. A lot of people with anxiety are great artist, scientist, writers, etc…

I still get anxiety and I know that I will probably have some anxiety for the rest of my life. It’s very normal to be anxious Especially in new situations but the anxiety diminishes significantly with time, sometimes minutes, hours, days. It always gets better if you lear to deal with it appropriately. When I start drinking everyday and stop running my anxiety gets worse. Most people won’t admit that they have anxiety because our society see weakness in that. However, I’ve noticed over the years that almost everyone I know gets anxious about something. A lot of folks I look up to have real bad anxiety but they have figured out a way to deal with it.

A lot of doctors and psychologist don’t understand, forgot or never learned the biology behind anxiety and will just prescribe the newest drug on the block for anxiety. (What I have told you is a simplified version of the latest model). A lot of the mechanisms for these newer drugs are unknown. Psychiatrists will put you on one of these drugs for several weeks to months and then ask you if you are getting better. If you are not, they will either up the dose or switch you to another drug. They will continue to try different drugs until they find one that works. This is standard protocol. This is all they can do. These drugs only have a long term benefit in 20% of the population and the research isn’t scientifically sound since it is very difficult to follow everyone on the medication and observe if this 20% hasn’t done anything else to heal the anxiety. These medications can’t cure the problem. Doctors know this but it’s the best they can do. In terms of what we do understand, you can get the exact benefit that you get from long-term use of serotonin reuptake inhibitors (which has been shown to ameliorate anxiety and depression and is the only understood mechanism to date), if you exercise voluntarily, paint, play music, write, etc. Apparently, exercise and mental stimulation over several months up-regulate the exact same genes up-regulated by some anti anxiety/depressants thus healing the axonal /dendritic damage in the limbic system. This is more specific than taking these drugs since these drugs aren’t specific at all, which is why they have so many side effect. (the same receptor that stimulates one pathway in one group of cells may stimulate / inhibit thousands of other pathways in other groups of cells). It’s like trowing a pocket of paint on a painting because you didn’t like one line in the painting. Since in order for these drugs to have any benefit you have to lead a healthy lifestyle and do some form of cognitive therapy (which you already do every time you are in a social setting) you could probably get the same benefit without the side effects if you went did some form of exercise for six months or something.

That was my reasoning:

Exercise = LHPA axis health, up-regulate axons / dendrites in the limbic system
Cognitive therapy = continuous exposure to anxiety stimulus
Less alcohol = LHPA health, less negative behavior reenforcement

Of course, some of this goes against who I am. I love to drink and party and I don’t want to become a boring square but it has helped with the anxiety. So I guess there is a price for everything.

So this is getting really long.

Later man,

Daniel

Words of Advice for Young People: Working as a guitarist in Austin

Daniel’s Frouman’s words of advice to a Spanish guitarist planning to move to Austin. October 14, 2008

Perdona la tardanza en escribirte; ando medio loco coriendo de aquí para allá…

La verdad es que en Austin hay muchísimos músicos muy buenos y la mayoría son guitarristas. Claro que eso no quiere decir que no hay trabajo. Depende mucho en el estilo de música que toque tu amigo y también en las tocadas que él esté dispuesto a tocar. Hay buenas tocadas pero son pocas. Uno tiene que tocar un montón en cualquier lugar con cualquiera para poder vivir e ir conociendo músicos. Si por un tiempo no le importa tocar en bodas, bares y eventos sociales no tendrá ningún problema. Si sabe sabe improvisar jazz dile que vaya al Elephant Room los lunes en la noches para el “jam session” para conocer músicos. A veces no pasa nada ahí pero hay que ir seguido a esas cosas para que los otros músicos te conozcan y para que luego se acuerden de ti cuando anden buscando músicos.

Words of Advice For Young People: Medical school, the first year

Daniel Frouman’s words of advice to a first-year medical student on March 17, 2008.

I know UT Southwestern is different from many medical schools so I’m not sure if it will be the same as [your school]. My advice would be to make sure you have friends and hobbies outside of medical school. Make sure you do something not related to medicine at least once a week or you will go insane! I’m serious. Medicine, as a profession, has the highest rate of suicide victims in the US (as your friend will learn in psych.) and there is a tremendous problem with substance abuse among medical students and physicians. So my advice would be to make sure you go out, get laid, listen to music, join a soccer team or something, have a beer o two after tests, and don’t freak out if you get a C or something. If you got into medical school you probably never got anything but As, but test and grading in medicine is very different and it really doesn’t matter that much in the long run (your school might not even have a GPA since most schools are pass/fail).

If your friend got into medical school then he is probably used to studying a lot. However, the volume of material you cover is so enormous that you will have to study more than ever before and it might take a little while to get used to it. You will have to memorize tons and tons of minutia or medical trivia.
It will be very different from many courses you have taken in the past. It will be very fast paced and you will have to be able to, practically, recite your whole textbook and syllabus verbatim including all tables, figures and data. A lot of this is designed to push you to the limit and to teach you to be humble.

Medical students, at least at UTSW, are extremely competitive and if you do well (or are the “gunner”) it can be difficult and very lonely (at least that’s how it was for me) since you will become many folks “enemy.” Some students will try to mess with you and give you misinformation for exams, steal your books and notes etc, so be careful. My advice is to make friends outside of medical school.

I hope I’m not being too negative about medical school. It can be fun and very interesting. I enjoyed all the studying and the labs were very cool.

For anatomy: Put your scrubs, dissection kit, books, shoes, etc, in a large Tupperware container and don’t bring any of that shit into your apartment. It will smell for at least a year. Don’t wash your scrubs in your washer; go a public laundry mat if your school doesn’t wash them for you.

Get Netter’s Atlas and Flash Cards. Grant’s Atlas and Rohen’s Atlas are also great! I used all 3.

Keep one book and /or dissection manual in your tubberware in lab and have another clean book/dissection manual at home. I would use the Netter in lab and the Grant and Rohen at home.

Before lab watch these videos:

http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/courseinfo/video_index.html

http://www.anatomy.wisc.edu/courses/gross/index.html

While you are dissecting continuously “pimp” your tank mates, i.e., ask them what is the origin of the masseter muscles; what is the action of the teres major muscle; what artery can be found in the quadrangular space; what nerve innervates the flexor pollicis longus muscle; what muscles are innervated by the accessory nerve; what nerve provides postganglionic parasympathetics to the parotid gland, etc, etc, etc. That way you don’t waste hours just staring at your cadaver.

Here are some other sites that may be useful. The ones with anatomy and embryology images and histology and pathology slides are probably the most useful.

Anatomy:

http://anatomy.uams.edu/anatomyhtml/medcharts.html

http://home.comcast.net/~wnor/homepage.htm

http://www.lib.uiowa.edu/hardin/mascagni/index.html

http://www.bartleby.com/107/

http://courses.washington.edu/hubio553/modules.html

http://vhp.med.umich.edu/

http://info.med.yale.edu/caim/cnerves/

http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/

https://www.dartmouth.edu/~anatomy/index.html

http://www.meddean.luc.edu/lumen/meded/grossanatomy/dissector/index.html

http://ect.downstate.edu/courseware/haonline/quiz.htm

http://www.anatomy.usyd.edu.au/glossary/

Embryology:

http://isc.temple.edu/neuroanatomy/lab/embryo_new/

http://www.med.unc.edu/embryo_images/

http://embryo.soad.umich.edu/

Biochemistry:

http://themedicalbiochemistrypage.org/

Genetics:

http://ghr.nlm.nih.gov/

http://www.genome.gov/

Histology:

http://www.lab.anhb.uwa.edu.au/mb140/

http://www.med.uiuc.edu/histo/small/atlas/

Pathology:

http://www.path.uiowa.edu/virtualslidebox/

http://image.bloodline.net/

Physiology:

http://www.mfi.ku.dk/ppaulev/content.htm

Pharmacology:

http://www.nlm.nih.gov/medlineplus/druginformation.html

Ethics Discussion: Rights and obligations of patients in a teaching institution

This is a presentation Daniel made at UT Southwestern in October 2008.   It was later discussed at a Children’s Medical Center Ethics Committee meeting in November 2008 and resulted in changes being made to consent forms and the general information packet provided to patients.

ETHICS DISCUSSION OUTLINE      Daniel Pasquale Frouman

I.   Case Presentation        10/22/08

II.  Ethical Questions

III.  Principles of Medical Ethics

IV. Review of Literature

I.  CASE PRESENTATION

Ms. X is a Caucasian female in her thirties who presented to Parkland for an intense burning pain in her right eye.  She denied any recent trauma.  The pain was localized and did not radiate.  She described the pain as being worse than giving birth to two infants at once.” She reported no alleviating or exasperating factors. She reported feeling “hot and clammy,” which she attributed to generalized anxiety. She denied fevers, chills, and headaches. She has had a history of three Staphylococcal infections in the past three years and reported a past history of hypertension, heart murmur, asthma, bipolar disorder, and generalized anxiety. Her family history is significant for a father and mother with diabetes.  She smokes ½ a pack of cigarettes per day and does not drink. She is a full-time single- mother of two with no college education.  Ms. X and her two children live with her parents. She was diagnosed with a Staphylococcal infection in her right eye for which she received surgical and antibiotic treatment.

When we first approached the patient we explained that we were medical students developing our history and physical exam skills and asked for her permission to be interviewed and examined.  Ms. X was not aware that she would be acting as a teaching patient and said that she did not want to be interviewed nor examined at that time. However, she later obliged, provided that we finished promptly. The fact that the patient was hesitant to be interviewed and examined by medical students prompted the following questions for discussion:

II. ETHICAL QUESTIONS

Question 1

Does the patient have the right to refuse the role of teaching patient in a teaching hospital?

Question 2

Is the indigent patient obligated to act as a teaching patient in exchange for medical care from clinical teaching institution?

Question 3

Does the patient have a moral obligation to be a teaching patient given the critical role of   the teaching hospital in the education of future physicians as well as the advancement of medical  knowledge?

III. PRINCIPLES OF MEDICAL ETHICS

  • Beneficence  The obligation of health care providers to help people in need
  • Nonmaleficence The duty of health care providers to do no harm
  • Autonomy  The right of the patients to make choices regarding their health care
  • Justice   The concept of treating everyone in a fair manner

1.  Beneficence

i. Beneficence in terms of the healthcare provider is straightforward. The individual health  care providers and the teaching hospital as a whole have made a commitment to aid patients in  need and are, thus, obliged to assist the patient.

ii.  The patient’s obligation, however, is not straightforward.  Has the patient made a  commitment to participate in the education of future physicians?

iii.   If one argues that the patient has made such a commitment by accepting services at a  teaching hospital would this be a legal obligation or a moral obligation?

iv. If the patient signed a consent form when entering the teaching hospital that clearly stated  that she would be participating as a teaching subject in a teaching hospital, is she not obliged to  participate as a teaching patient?

The following questions could be asked:

a. Did the patient completely understand the consent form she signed when entering Parkland?

b.   Does the patient completely understand the meaning of being treated at a teaching hospital?

c.   Did the patient’s illness and/or associated discomfort limit her understanding of  the consent form when admitted?

If the answer is “yes” to anyone of these three questions, then one could argue that the patient  did not give adequate informed consent and is thus not obligated to participate as a teaching   subject.

2.  Nonmaleficence

i. Medical students should refrain from performing unsupervised potentially dangerous procedures since they may harm the patient.

ii. The patient history and physical exam is noninvasive and should pose no treat to the  patient’s health.

iii. The patient may be uncomfortable or embarrassed to serve as a teaching subject.

iv. The patient’s illness and/or associated pain may deem a procedure, performed purely for    educational purposes, unnecessary.

3.  Autonomy

“Autonomy is founded in the overall desire of most human beings to control their own destiny,  to have choices in life, and to life in a society that places value on individual freedom. In medical  ethics, autonomy refers to the right of competent adult patients to consent to or refuse treatment.”

(Access Medicine—Lange Health Policy. Chapter 13. “Medical Ethics and the Rationing of  Health Care.” McGraw Hill Companies. 2008)

i. In order for the patient to be autonomous she must be given a choice and her decision    must be honored.  We allowed the patient the opportunity to choose whether she wanted    to be interviewed and examined or not.  Did we honor her decision? Did she feel     pressured to go along with the H&P?

ii. Does the indigent patient really have a choice?  If the only health care available to the    patient is via the teaching hospital, the patient has no choice but to sign the informed    consent form and participate as a teaching subject.  The indigent patient has no autonomy   in this scenario and I would argue that the only way to restore the patient’s autonomy in    this scenario is by allowing her the right to refuse acting as a teaching subject.

4.  Justice

“The principle of justice as applied to medical ethics is newer, more controversial, and harder to define than the principles of beneficence, nonmaleficence, and autonomy.  In a general sense, people are treated justly when they receive what they deserve.  It is unjust not to grant a medical degree to someone who completes medical school and passes all the necessary examinations.  It is unjust to punish a person who did not commit a crime.  In another meaning, justice refers to universal rights: to receive enough to eat, to be afforded shelter, to have access to basic medical care and education, and to be able to speak freely.  . . . justice connotes equal opportunity . . . (and) differential treatment . . . is unjust…”

(Access Medicine—Lange Health Policy. Chapter 13. “Medical Ethics and the Rationing of Health Care.” McGraw Hill Companies. 2008)

i. It would be unjust if only certain patients (e.g., indigent patients) were asked to be    teaching subjects.

ii. It would be unjust if only certain patients (e.g., wealthy, insured patients) were allowed    to refuse being teaching subjects.

iii. It would also be unjust to society as whole if clinical education were limited to only a    given subset of the population. The physician must treat patients within the entire     spectrum of humanity, irrespective of socioeconomic status, race, ethnicity and sexual    orientation.  Given the wide range of human diversity it is only logical that clinical    education encompass this diversity.

V. REVIEW OF LITERATURE

i. Patients usually sign a consent form when entering a teaching hospital. However, many patients  have not been given adequate informed consent.

a. Serious illness at the time of admission

b.  Some patients may not completely understand the meaning of being cared for in a     teaching hospital

c. Some patients may not understand the different levels of healthcare providers, i.e.,    medical students, interns, residents, fellows, and attending physicians

d. Patients may not be aware of the possible tension between the need to train new     physicians and provide quality care

ii. Patients should be informed of procedures that are being done purely for educational purposes.

iii. Noninvasive procedures (i.e., auscultation, percussion, palpation) performed by students are  allowed even if they are unnecessary.

iv. Patient participation should be requested politely and “refusal should be accepted graciously.”

v. Most patients are more than willing to participate in the educational process and the occasional  patient who refuses should not be pressured.

vi. Patients are not obligated to participate in the training of future society’s physicians. Physicians  should be “grateful for their generosity.”

vii. The teaching hospital is vital to patient care, clinical research, and clinical education.  The best  medical education is done by the bedside. Extensive studies have shown that teaching hospitals,  when compared with non-teaching hospitals, provide better care not only for patients with rare  and complex diseases but also for patients with common conditions.  Teaching hospitals provide  better care for elderly patients and are capable of providing advanced services (i.e., complicated  surgeries and bone marrow transplants) that may not be available at other hospitals.

viii. High quality patient care, state-of-the-art clinical research, innovations in clinical care, and   clinical education come with a high fiscal burden. Before Medicare and Medicaid (1966), most  funding for medical education in the U.S came from the NIH in the form of research grants not  intended for medical education.  The mergence of academic medicine with indigent and elderly  patient care began as an effort to fund medical research and education.  The idea was to treat  indigent and elderly patients in teaching hospitals, have the government fund it via Medicare and  Medicaid, and use the income for clinical research and clinical education.

ix. The public is unaware of the teaching hospital dynamic.  Educating the public may encourage  patients to participate as teaching subjects.

References

Lo B. Ethical dilemmas students and house staff face. In: Resolving Ethical Dilemmas. 3rd ed.    Baltimore: Lippincott Williams and Wilkins; 2005: 226-234

Christakis Da, Feudtner C. Ethics in a short white coat: The ethical dilemmas that medical    students confront. Acad Med 1993; 68: 249-254.

Relman, Arnold S. Who will pay for Medical Education in Our Teaching Hospitals? Science Vol. 226, No. 4670 (Oct. 1984), pp. 20-23

Ayanian, John Z. and Joel S. Weissman. (Harvard Medical School) Teaching Hospitals and    Quality of Care: A Review of the Literature. The Milbank Quarterly, Vol. 80, No. 3    (2002), pp. 569-593

Access Medicine—Clinical Ethics. Chapter 4. “Clinical Teaching.” McGraw Hill Companies.    (2008)

———- Forwarded message ———-
From: ROBERT BASH <[redacted]@childrens.com>
Date: Wed, Nov 5, 2008 at 12:56 PM
Subject: Ethics Committee
To: KAREN ECKENFELS <email redact>
Cc: Ron Somers-Clark <[redacted]@childrens.com>, Danielfrouman@gmail.com, James Wagner <[redacted]@utsouthwestern.edu>, John Sadler <[redacted]@utsouthwestern.edu>, Susan Cox <[redacted]@utsouthwestern.edu>

Karen,
I talked to Ron about a presentation that one of the second year medical students (Daniel Frouman) made to our group at UT Southwestern in the Colleges Program.  The topic was the rights/obligations of patients in a teaching institution.

I think that it would be a good topic at our next Ethics Committee Meeting.  Ron agreed.

Here is a copy of his presentation.  He gave me permission to ask you to send it to the members of the Ethics Committee at Children’s.  Could you also include a scan copy of the Children’s “Consent for Treatment/Advance Directive Notice” and the consent for surgical procedures with the email.

I would also like to invite him as my guest at the next Ethics Committee meeting when we discuss it.

Thanks
Bob

Robert Bash, M.D.
Associate Professor
Pediatric Hematology-Oncology
U.T. Southwestern Medical Center
5356 Harry Hines Blvd.
Dallas, TX  75390-9063

Director, Pediatric Palliative Care
Children’s Medical Center, Dallas
1935 Medical District Dive
Dallas, TX  75235

———- Forwarded message ———-
From: ROBERT BASH <ROBERT.BASH@childrens.com>
Date: Thu, Nov 20, 2008 at 9:49 PM
Subject: Ethics Follow-up.
To: Danielfrouman@gmail.com, Ana Castillo <[redacted]@utsouthwestern.edu>, Ben Eckert <[redacted]@utsouthwestern.edu>, Eric Gou <[redacted]@utsouthwestern.edu>, James Wagner <[redacted]@utsouthwestern.edu>, John Mcgurk <[redacted]@utsouthwestern.edu>, John Sadler <[redacted]@utsouthwestern.edu>, Kirtan Nautiyal <[redacted]@utsouthwestern.edu>, Michael Mungia <[redacted]@utsouthwestern.edu>, Susan Cox <[redacted]@utsouthwestern.edu>

Daniel,

Sorry you couldn’t make the Ethics Committee Meeting today at Children’s.  We had over 30 minutes of discussion about admission and surgical procedures consents both in general and in regard to specifically clarifying that Children’s is a teaching hospital, and medical (and nursing, and respiratory therapy, etc) are all part of the team that will be caring for the patient/child after admission.

The hospital’s lead counsel (also a member of the Ethics Committee) is going to re-work the language to specifically include students in each of the admission/consent to treat, as well as the surgical/procedures consent form.

There was also discussion about including a section in the patient’s general information packet to better explain how a teaching hospital works, and what the roles of each of the members of the team are.  They are going to discuss this at the Family Advisory Committee at an upcoming meeting.

Great Job identifying the initial problem!
Changes often start with a single voice.
Bob Bash

Good luck on the exam.

Franquismo 1939-1975

Daniel Pasquale Frouman

Franquismo 1939-1975

Economía y Demografía

Aislamiento económico–La democratización de Europa occidental, que siguió la decaída de Hítler, deja a España económicamente aislada del resto de Europa. Las Naciones Unidas implementaron un boicot a las naciones fascistas de la segunda guerra mundial. Portugal (bajo el régimen de Salazar) y la Argentina (bajo Perón) no se someten al boicot.

Autarquía como ideal político—los tecnócratas, parte de la organización católica Opus Dei, intentan crear una España autosuficiente, libre de dependencia exterior. Se funda el Instituto Nacional de Industria, en imitación a la Italia fascista, con el objetivo de crear nuevas industrias en el país.

La población española aumenta en algo más de cuatro millones de personas entre 1940 y 1960. Muchos emigran a países del río de la Plata al igual que Europa. El balance demográfico cambia. En 1940 más del 60 por ciento de la población era rural, en 1970, alrededor de 40 por ciento de la población era rural.

Nuevos desarrollos industriales, electrodomésticos y automóviles, a partir de los sesenta fomentan la urbanización de la época. El desarrollo industrial no es uniforme, por lo tanto, existe un desequilibrio entre regiones ricas y pobres.

Los franquistas consideraban el desarrollo económico e industrial de los setentas prueba del triunfo de Franco. No obstante, la inevitable creación de una generación de consumidores que acompañó el desarrollo económico de los sesentas y setentas trajo con sí cierta desarmonía y discordancia entre esta generación y las pautas tradicionales de vida en la sociedad española, dictadas por el mismo régimen franquista. Inevitablemente, se desarrollan movimientos de resistencia y protesta, encarnados en los universitarios y los obreros.

El desarrollo industrial requiere el desarrollo de la educación avanzada. Por lo tanto, se desarrollan también las universidades durante los sesentas. Sin embargo, las universidades produjeron estudiantes radicales en vez de administradores neo-capitalistas como deseaba el régimen. El pueblo quiere cambio, los estudiantes protestan y los obreros crean, ilegalmente, las Comisiones Obreras.

Estructura política bajo Franco

El sistema político, y la política franquista cambiaba levemente con el tiempo.
A esto se debe la sobrevivencia de la dictadura por tantos años en un país rodeado por países democrático. El papel, al igual que la imagen de Franco cambia con el tiempo: Franco “el conquistador” y luego Franco “el padre de la familia española”.

Se promulga la ley Orgánica con fin de crear la ilusión de la participación del pueblo en las decisiones políticas. Se instituyen a las Cortes, formados originalmente por sindicatos, los jefes de familia. Se da lugar a simulacros de comicios en que votan los sindicatos y jefes de familia.

Franco es Jefe de Estado de por vida, poseyendo el derecho de fijar y echar a cualquiera del gobierno.

Legalmente España es una monarquía tradicional católica. No totalitario, sino conservador, bajo un sistema autoritario.

Existen dos grupos católicos bajo Franco, la Asociación Nacional Católica de Propagandistas, su misión es reclutar la elite política, económica e intelectual para la Iglesia, y Opus Dei, tecnócratas mencionados anteriormente.

El gobierno estaba divida ante el tema de la sucesión de Franco. Existía un conflicto entre los Falangistas (por Franco por vida) y los monarquistas, los cuales estaban divididos en dos facciones: los Carlistas y los Alfonsistas. Franco expulsa a ambas facciones (carlistas y alfonsistas) del gobierno.

Represión de los derechos humanos

Es ilegal la asociación libre política.

Se controla estrictamente la asignación de pasaportes al igual que la distribución de carreras profesionales.

Predomina la censura en la prensa y el cine, al igual que la persecución lingüística.

Cultura Franquista y el fallo de la imposición de ésta–La censura aquietaba quizás la emergencia de una nueva cultura española, no obstante, no podía imponer la cultura franquista.

Predomina una cultura de evasión en cual el pueblo esquivaba los asuntos políticos y económicos y se emergía en el cine, la televisión y el fútbol y la literatura de kiosco. Los españoles eran fanáticos del cine con mas asiento de cine por persona que cualquier otro país europeo. Las películas de Italia y los Estados Unidos al igual que la televisión, por más que fueran censuradas, introdujeron valores sociales en disonancia con los del régimen. Aunque la mayoría de los españoles no notaban las discrepancias entre Hollywood y Madrid, el cine y la televisión contribuyeron a la evolución de una nueva cultura española.

La oposición al franquismo–El Partido Comunista, el Partido Socialista Obrero Español, y la Plataforma Democrática de España

Los intelectuales y representantes políticos de la “otra España”, socialistas y izquierdistas, estaban exiliados en Francia, Méjico y la Argentina. Por lo tanto, el partido comunista fue quién inició la lucha interna en contra del régimen franquista al apoyar a las guerrillas de los cuarentas y al entrometerse a las Comisiones Obreras.

Los comunistas, considerados herejes bajo el régimen franquista, componían la resistencia más significativa hasta los años setenta.

El régimen franquista influyó, en parte, en la creación del partido comunista con el fin de crear una ente maligna, amenazadora de España al igual que el mundo occidental.

El papel del Partido Socialista Obrero Español, controlado por exiliados de la previa generación, es mínima hasta 1972, año en cual el poder del partido pasa a las manos de jóvenes españoles y el partido expande.

Se forma, en 1975, la Plataforma Nacional de Convergencia Democrática, constituida de cristianos democráticos, monarquistas liberales, socialistas democráticos, y grupos republicanos.

Angustia y desintegración–De la melancolía a la angustia

Dra. Ugalde
Daniel Frouman
Español 5310
Primavera 2004

Angustia y desintegración–De la melancolía a la angustia

En su estudio Poesía y estilo de Pablo Neruda Amado Alonso expone la metamorfosis de la poesía de Neruda al comparar dos distintas etapas poéticas del autor chileno, señalando que la poesía de Neruda sigue una progresión o una matiz de cambio de expresión. La expresión sentimental del poeta evoluciona hacia una reflexión o meditación profunda cada vez más aferrada a los sentimientos crudos del hombre y alejándose cada vez más de las estructuras objetivas y equilibradas (Alonso, 57).
Alonso mantiene que el carácter de la evolución de la poesía nerudiana sufre una progresión de la melancolía hasta la angustia y que este contraste se manifiesta en la comparación de la primera etapa de la poesía de Neruda representada en Veinte poemas de amor y la segunda etapa de la poesía de Neruda que inaugura con Residencias.
Las obras previas a Residencias poseen una tristeza inherentemente bella; la expresión de un dolor infinito no se presenta hasta Residencias.
La melancolía de Veinte poemas aparece disfrazada de nostalgia. El yo poético expresa su pesar por la pérdida de algo, encarnada en la pérdida de un amor, no obstante, el continuo adiós de las cosas perdidas le sirven al yo poético como medio de retención de lo perdido. Hay cierta coexistencia de la felicidad y la tristeza. El yo poético se haya en su melancolía y llanto como si fuera un vaso de vino amargo en el cual la joven voz del yo poética proyecta su sufrimiento y al mismo tiempo se escapa de ella. Al meditar en la melancolía el joven revive el pasado que tanto anhela, ve la mujer que tanto extraña, oye su voz, y hasta la llega a tocar de nuevo a través de la poesía.
Al contraponer la melancolía de Veinte poemas con la angustia de Residencias presenciamos la metamorfosis de la poesía nerudiana. En la segunda etapa de la poesía el yo poético no tiene para donde escapar; su pena y su dolor residen en él mismo y en todo lo que lo rodea. Su melancolía lo toca todo, lo encumbre todo y se transforma en angustia, desesperación, desilusión y decepción. Alonso declara que la expresión de la angustia del yo poético se ha movido de una expresión basada en lo episódico o circunstancial hacia una angustia perpetua y sin limites. En Veinte poemas la angustia provenía de una tragedia amorosa. El dolor es fruto de la pérdida de algo querido. Sin embargo, el dolor llega pero también se va. Este no es el caso en la segunda etapa de la poesía de Neruda en la cual predomina una angustia irreparable. La pena llega y no se va.
En la primera etapa de la poesía nerudiana el llanto del yo poético es en sí hermoso. La pena trae con sí belleza. Se podría comparar con la destrucción de una rosa. Del mismo modo que la destrucción de la rosa produce perfume, la descomposición del espíritu humano trae con sí belleza lírica. Alonso acentúa esta postura al señalar que las imágenes de Neruda cambian al describir la melancolía del yo poético demostrando que al principio Neruda usa la metáfora del llanto y el viento de una forma positiva. El llanto del joven melancólico se asocia con el viento del sonido musical que produce el sufrimiento. La metáfora del llanto y el viento se presencia aún en la poesía de la segunda etapa de Neruda no obstante su relación es otra. El autor usa la metáfora para asignar al dolor un carácter violento asociando el viento con una tormenta. Si en la primera etapa poética de Neruda el yo poético se emborrachaba con el vino de su melancolía, en la segunda etapa se ahoga en ella. La función de la melancolía, encarnada en el llanto del yo poético, evoluciona de una solución inicial o escape al sufrimiento humana en Veinte poemas hacia la encarnación del verdugo del yo poético en Residencias.
Neruda ya no se apoya en el sufrimiento humana como elemento catalizador hacia la creación de una bella poesía sino que usa la angustia en su visión poética para expresar una oscura visión del mundo. El poeta expresa la esencia efímera de la vida al notar que cada paso por el camino de la vida es un paso hacia la muerte. Se concentra en la descomposición del mundo natural y del hombre y sus esfuerzos.
Esta imagen negativa o realista del mundo queda patente en Residencias. Alonso destaca esta perspectiva pesimista del autor al ostentar la aludida tesis de Neruda: lo que está vivo lo está simplemente por que huye de la muerte. Consecuentemente, el fin de todas las cosas es la muerte, el caos y el desorden. Es imposible ignorar la semejanza entre el punto de vista de Neruda y la teoría del desorden y caos que dicta que todas las cosas van de mal en peor, que las construcciones del hombre se destruyen, que lo que sube baja, y que la energía invertida en la vida es energía invertida en la muerte. Alonso apoya esta postura al señalar el descomedido uso de palabras que expresan descomposición en Residencias, enumerando algunos ejemplos: lo desvanecido, lo desteñido, lo carcomido y lo consumido.
En resumen, al contraponer la poesía de la primera etapa de Neruda con su segunda etapa, se presenta la evolución no solo de la perspectiva del autor en lo que se refiere a la pena humana sino también una evolución de los símbolos metafóricos usados en el retrato poético del autor. Neruda intercambia el lenguaje positivo usado para alabar a los objetos naturales que representan la inherente belleza del llanto melancólico del yo poético en la primera etapa de su poesía por un lenguaje permanentemente negativo para así sostener la tesis de la segunda etapa poética distando que el sufrimiento no es una condición o un adjetivo de la vida sino que es la esencia misma de la existencia humana.