The hardships of being a Sith Lord: implications of the biopsychosocial model in a space opera
2016; American Physical Society; Volume: 40; Issue: 2 Linguagem: Inglês
10.1152/advan.00026.2016
ISSN1522-1229
AutoresRonan M. G. Berg, Ronni R. Plovsing,
Tópico(s)Optimism, Hope, and Well-being
ResumoIlluminationsThe hardships of being a Sith Lord: implications of the biopsychosocial model in a space operaRonan M. G. Berg and Ronni R. PlovsingRonan M. G. BergDepartment of Clinical Physiology and Nuclear Medicine, Frederiksberg and Bispebjerg Hospitals, Frederiksberg, Denmark; and and Ronni R. PlovsingDepartment of Intensive Care 4131, University Hospital Rigshospitalet, Copenhagen, DenmarkPublished Online:22 Apr 2016https://doi.org/10.1152/advan.00026.2016MoreSectionsPDF (114 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat case studies from popular culture have proven to be useful tools for conveying various physiological concepts to undergraduate physiology and medical students (16). This motivated us to use Anakin Skywalker, also known as Darth Vader, from the Star Wars saga to teach respiratory physiology (1, 12). Based on a careful reassessment of the events that take place a long time ago in a galaxy far, far away, we have furthermore found that Episodes I–VI (Table 1) of the acclaimed space opera may provide a means for integrating the biopsychosocial model in the respiratory physiology classroom setting (4). From our analysis, it is clear that a critical aspect of the Star Wars saga that has largely been neglected until now is Darth Vader's vulnerability beneath his fearsome exterior, which likely renders him particularly susceptible to various emotional stressors and contributes to a deterioration of his lung function.Table 1. The first six Star Wars installmentsTitleYear of ReleasePlot OutlineStar Wars Episode I: The Phantom Menace1999Frustrated with the ever-increasing bureaucracy and corruption in the Galactic Senate, the secret Sith Lord, Senator Sheev Palpatine, manages to become Chancellor of the Galatic Senate with the help of a teenage queen. Furthermore, the child prodigy Anakin Skywalker is recruited to the monastic Jedi Order.Star Wars Episode II: Attack of the Clones2002Chancellor Palpatine orchestrates a separatist movement that rebels against the Galactic Republic in order to provoke a civil war, so that he can receive emergency powers while a private building project of his can be commenced entirely unnoticed: a Moon-sized battle station called the Death Star. Meanwhile, Skywalker develops severe emotional problems and gets secretly married.Star Wars Episode III: Revenge of the Sith2005As Skywalker's wife becomes pregnant, the emotionally troubled father-to-be seeks comfort with Palpatine, who invites him to join the Sith Order. Although initially reluctant, Skywalker accepts and assumes a new identity as Darth Vader. Palpatine then transforms the Galactic Republic into the Galactic Empire, declaring himself Emperor; however, he opts to maintain the Galactic Senate until the Death Star is completed. Darth Vader's wife dies in childbirth; unbeknownst to Palpatine and Darth Vader, her newborn twins survive and are brought into hiding.Star Wars Episode IV: A New Hope1977Two decades after the events of Episode III, Palpatine's Death Star is finally completed, which allows him to dissolve the Galactic Senate altogether. His totalitarian reign is now a reality but this triumph is complicated by the Rebel Alliance. Despite Darth Vader's best efforts to stop them, the Rebels manage to blow up the Death Star.Star Wars Episode V: The Empire Strikes Back1980Darth Vader comes to the realization that he has a son and initiates an intense manhunt across the Galaxy to recruit him to the Sith Order. Darth Vader succeeds into luring his son out of hiding by taking his friends from the Rebel Alliance into custody. Darth Vader's son nevertheless tenaciously declines his proposal of joining the Sith Order.Star Wars Episode VI: Return of the Jedi1983A second Death Star has been built, and Palpatine attempts to use it to demonstrate the superior force of the Empire to Darth Vader's son. As Darth Vader's son is not impressed and still refuses to join the Sith Order, Darth Vader has a sudden change of heart and brings Palpatine's glorious career in Galactic politics to an abrupt end. Meanwhile, the Rebel Alliance somehow manages to demolish the fully operational Death Star with the assistance of a tribe of dwarf-like bears, and, as the Empire falls, Galactic citizens seem to lose all inhibitions and run recklessly into the streets and cause chaos throughout the Galaxy.In Episodes I–III, we learn that Skywalker's journey from an extremely fit and athletic Jedi Knight to the severely physically disabled Darth Vader is above all an emotional one. Skywalker sets off as a highly talented member of the monastic Jedi Order, which serves the Galactic Republic as a peacekeeping paramilitary elite unit. The course of events is, however, complicated by Skywalker developing severe emotional problems in his youth, probably due to a borderline personality disorder (3, 6), although the applicability of this diagnosis in Skywalker's case remains the subject of intense scientific debate (3b). His emotional problems lead to numerous conflicts with his Jedi Masters, and Skywalker repeatedly violates Jedi Code, for example, by getting married and (even worse) by conducting an unauthorized massacre on a whole village in a fit of rage.In the midst of all this hassle, Skywalker's close friend, Sheev Palpatine, who is Supreme Chancellor of the Galactic Senate, manages to persuade him to resign from the Jedi Order. Even though Palpatine has a somewhat odd habit of laughing loudly at the most unfortunate times, he is one of the few mentally sane characters in the Star Wars saga (6) and functions as a father figure and moral compass to Skywalker. Skywalker subsequently joins Palpatine in a competing monastic society called the Sith Order, which is much more exclusive than the Jedi Order, at least in terms of membership, because Sith Code dictates a “Rule of Two,” which implies that it only allows two members at any given time. While the Jedi preach ascetic abstinence, the Sith Order strives to invoke actual changes in the real-life Galaxy, and its members therefore often show a great level of political involvement. Accordingly, Skywalker's enrollment in the Sith Order is part of a carefully planned coup d'état arranged by Palpatine to subvert the corrupt and bureaucratic Galactic Senate and replace the Republic with a more well-organized and meritocratic Galactic Empire (9).Due to his controversial change of careers, Skywalker, as the new Sith Lord Darth Vader, soon clashes in a light saber duel with a former Jedi Master of his on a volcanic planet. This results in a near-fatal outcome for Darth Vader, who loses several limbs in the fight and, furthermore, inhales volcanic fumes and suffers severe third-degree burns and consequently develops acute respiratory failure. Even though appropriate diagnostic chest imaging is not provided as would be required here on Earth (5), we have recently asserted that Darth Vader fulfills the diagnostic for acute respiratory distress syndrome (ARDS) at this stage (1). He nearly passes away, but Palpatine evacuates Darth Vader in time for medical droids to perform extensive surgery, placing him in a life-saving whole body armored suit, which functions as an advanced bilevel positive airway pressure system that supports his intrinsic breathing both during inspiration and expiration (12).As is often the case in survivors of severe ARDS, Darth Vader subsequently develops chronic lung disease, and as we reencounter him two decades later, it turns out that the treatment with the whole body armored suit has been maintained during all the intervening years. From this stage, there is furthermore evidence of a progressive decline in Darth Vader's pulmonary function. Setting aside the marked fluctuations that are well accounted for by his activity level (1, 12), there is a clear trend of an underlying increase in his respiratory rate (Fig. 1). Resting respiratory rate is known to increase with the severity of chronic lung disease (2, 8), and since this gradual increase in respiratory rate is otherwise unaccounted for in the narrative of Star Wars, it suggests that Darth Vader's respiratory condition is gradually progressing to end-stage lung failure.Fig. 1.Evidence of progressive respiratory failure in a Sith Lord (n = 1). The y-axis shows the respiratory rate (in breaths/min). The solid line shows the respiratory rate at a given time; the dashed line is the trend line for the respiratory rate, which shows a clear increase across the films (Darth Vader's death scene, where the respiratory rate ceases to 0, is excluded from the trend line). Of note, the respiratory rate reaches a nadir at 11 breaths/min in Episode V, when Darth Vader is having a seemingly comfortable conversation with his only friend, Emperor Palpatine, at a point where the friction between them is still trivial; it peaks in the same film at 46 breaths/min during a light saber duel with his son Luke Skywalker, a situation that must be both physically and emotionally challenging.Download figureDownload PowerPointBut what is the cause of this decline in lung function? To answer this question, it is pertinent to consider the mental and physical impact of the severe psychosocial stress that Darth Vader is exposed to as a high-ranking official in the Galactic Empire. Because of his whole body armored suit, one easily forgets that he is, in fact, a severely physically disabled human being that furthermore has to struggle with a personality disorder and the mental trauma of the untimely loss of several close family members. With this in mind, his psychological working environment is far from ideal. In Episode IV, it is clear that Darth Vader's change of careers in Episode III did not go quite as planned. Two decades have passed, but Palpatine's coup d'état is not yet complete, and Darth Vader's exact responsibilities in the Empire are somewhat opaque to the audience and probably to Darth Vader as well. It is nevertheless clear that his shift to the Sith Order has turned out to be a de facto demotion, since he is used as Palpatine's personal peon that has to do all kinds of odd jobs across the Galaxy, while Palpatine enjoys a seemingly quiet life in an undisclosed location. Furthermore, Darth Vader is neither well liked nor respected by other high-ranking officials, and military officers in the Empire express their obvious contempt toward him on several occasions and, furthermore, mock him about his religious convictions. Apart from meditating in his personal chamber, Darth Vader mainly copes with this distressing working environment by clinging desperately to a management by fear strategy that involves threatening and executing several disobedient and/or incompetent colleagues and employees.As Palpatine finally manages to dissolve the Galactic Senate, his and Darth Vader's common ambition of “bringing order to the Galaxy” is within reach (perhaps explaining the otherwise enigmatic title of Episode IV: A New Hope), but this dream is quickly shattered. Palpatine's moon-sized battle station, called the Death Star, which is intended to ensure his totalitarian reign, turns out to be full of flaws (14), just like we know from numerous oversized, prestigious, government-funded building projects here on Earth. This is discovered by the so-called Rebel Alliance, seeking to restore the Republic, which manages to blow it up through an otherwise unnoticed thermal exhaust shaft. Since the construction of the Death Star has an estimated cost of at least $850 quadrillion in steel alone (3a), this must have a catastrophic impact on the Galactic economy with loss of tens of thousands of jobs and decades of extreme poverty with utter turmoil throughout the Galaxy.As with politics here on Earth, such a disastrous development sets off a skyrocketing career for those responsible. Accordingly, Darth Vader has clearly become the honcho, an irrefutable enforcer of the totalitarian reign as we reencounter him in Episode V. Despite his promotion, Darth Vader most probably starts doubting the benevolence of his and Palpatine's aspirations to bring order to the Galaxy at this stage, where the Galaxy is expectedly in chaos despite their good intentions. Furthermore, somewhere along the way, Darth Vader realizes that he has a son. All of this clearly starts to wear on Darth Vader and Palpatine's otherwise harmonic relationship and provokes an unexpected turn of events when they, despite the Rule of Two, agree to attempt to recruit Darth Vader's son, as if to test their friendship. They both obviously know that at least one of the three will not survive the venture; tragically, both Darth Vader and Palpatine end up paying with their lives.Together, Darth Vader's ever-changing working conditions in the Empire, a subversive working environment, personal success and failure, the severe strain on his only friendship, and unexpected familial relations are all sources of severe and ever-increasing psychosocial stress during Episodes IV–VI. This may dispose to illness (7), and in accordance with this, previous studies have demonstrated that psychosocial stress is associated with a deterioration of lung function in patients with chronic lung disease (10, 15). As we see it, this is indeed the most probable cause of Darth Vader’s progressive respiratory failure described above. Of note, regular meditation, as practiced by Darth Vader has previously been demonstrated to reduce psychosocial stress (11), but according to the Star Wars saga, this does not appear to be sufficient to counteract the adverse effects of psychosocial stress on lung function.To conclude, even though Darth Vader's chronic lung disease is suitably treated with a whole body armored suit that features an advanced bilevel positive airway pressure system, and despite regular meditation, he experiences a progressive decline in lung function, which is probably facilitated by severe psychosocial stress. Hence, the physiology teacher may use Darth Vader as a starting point for teaching the relationships among respiratory rate, tidal volume, and minute ventilation while defining and distinguishing basic concepts such as tachypnea and bradypnea, hyperpnea and hypopnea, and hyperventilation and hypoventilation. Moreover, this case study may be used to discuss the importance of psychosocial factors in the context of chronic lung disease. Apart from bringing a touch of adventure into the physiology class, the space opera's plethora of tales on broken friendships, Galactic politics, and competing monastic societies may thus provide a unique case story that illustrates that the biopsychosocial model is indeed universal.DISCLOSURESNo conflicts of interest, financial or otherwise, are declared by the author(s). NoneAUTHOR CONTRIBUTIONSAuthor contributions: R.M.G.B. and R.R.P. conception and design of research; R.M.G.B. analyzed data; R.M.G.B. and R.R.P. interpreted results of experiments; R.M.G.B. prepared figures; R.M.G.B. drafted manuscript; R.M.G.B. and R.R.P. edited and revised manuscript; R.M.G.B. and R.R.P. approved final version of manuscript.REFERENCES1. Berg RM, Plovsing RR. Breath of the Sith: a case study on progressive respiratory failure in a galaxy far, far away. Physiol News. In press.Google Scholar2. Browning IB, D'Alonzo GE, Tobin MJ. Importance of respiratory rate as an indicator of respiratory dysfunction in patients with cystic fibrosis. Chest 97: 1317–1321, 1990.Crossref | ISI | Google Scholar3. Bui E, Rodgers R, Chabrol H, Birmes P, Schmitt L. Is Anakin Skywalker suffering from borderline personality disorder? Psychiatry Res 185: 299, 2011.Crossref | ISI | Google Scholar3a. Centives. How Much Would It Cost to Build the Death Star? 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Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation Cited ByUsing Case Studies from Popular Culture to Teach Medical Physiology11 September 2018 More from this issue > Volume 40Issue 2June 2016Pages 234-236 Copyright & PermissionsCopyright © 2016 The American Physiological Societyhttps://doi.org/10.1152/advan.00026.2016PubMed27105743History Received 3 February 2016 Accepted 11 March 2016 Published online 22 April 2016 Published in print 1 June 2016 Metrics
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