Categories
Random

Tools I Regularly Use and Recommend.

Because I’m apparently not taking sufficient care of the Muse these days, I don’t have fresh stories to share right now. Thus, I instead present to you the tools I use to write and organize my ideas, in the event that you might find them useful for your work.

I was an ardent user of the now retired Writeboard. Though there are many who extol the virtues of Google Drive documents for rough drafts and editing, I found it lacking in comparison to Writeboard. I then stumbled upon Draft.

The feature I find most useful about Draft is the ability to review all previous drafts in their entirety. As I strive for brevity and clarity, sometimes I realize that what I had written in draft 2 is more useful than what I have in draft 7. It is easy to both review and compare what you previously wrote.

Draft also has a simple, uncluttered interface. The navigation is clear. The running list of documents (both in general and in any folders you have created) makes it psychologically easier to let go of (but not erase) those crappy first drafts, which often don’t seem as hopeless and terrible a few weeks or months later.

I use Field Notes to capture ideas and reminders. I’m fond of stationery and enjoy trying new notebooks. I’m that person who can spend hours at a stationery store, admiring all the different pens and pencils, looking with wonder at the staple-free staplers and brightly colored and curiously shaped sticky notes, and feeling the textures and weights of the pages in all the various notebooks. Many notebooks seem “too serious” for me: The sheets are crisp and formal, the cover fonts and designs are somber, and I worry that any scribbles from my mortal hand will ruin the pages.

An empty notebook is a useless notebook.

Field Notes are whimsical and hardy. As they travel through the world with me, the covers get dog-eared, pages crease, and the colors on the cover fade. Because they’re informal, though, these blemishes of time only add to their character and encourage me to fill the pages to completion.

I currently use bullet Space Pens to write in my Field Notes, though not because I am writing upside down, in oil, or in zero-gravity environments. Women’s pants often have small pockets and bullet Space Pens are small enough to remain inside the pockets. That’s it.

I otherwise am fond of Pilot G2 gel pens (ultra fine tip, usually black) and Marvy Uchida’s Le Pens (all the colors!). Le Pens have helped me get through many textbooks and journal articles.

Lastly, like this fellow, I am a believer of TeuxDeux. While I use Field Notes to capture the things I both need and want to do, TeuxDeux helps me schedule those things so that I actually do them. It is uncluttered, easy to use, flexible, and helps me stay focused on what I should do on a given day.

Though my penchant for paper makes me yearn for a paper-only organization system, the reality is that TeuxDeux is easier to manage. (As much as I would like to use the Bullet Journal system, I know I cannot sustain it.) I find TeuxDeux technical enough for efficiency and effectiveness, but not so technical that I spend a lot of time tinkering with it.

(May this be a sufficient offering to the Muse.)

Categories
Education Homelessness Policy Reflection

Commercial Sexual Exploitation.

I recently attended a presentation given by one of the founders of The Organization for Prostitution Survivors (OPS).

If you or your organization want to hear a compelling, educational, and thoughtful talk about commercial sexual exploitation, I encourage you to contact OPS.

The talk did not necessarily alter the way I go about my work as a psychiatrist, but it did challenge my assumptions about prostitution, highlight the different perspectives men and women have about sex (to be clear, the talk was not at all “anti-male”), and encourage me to reconsider the influences of our culture on commercial sexual exploitation.

I’ve included my notes and reactions from the presentation below. Any errors and lack of clarity are entirely mine.


The speaker (a man) began with a discussion about the social construction of gender. What does it mean to “act like a man”? The stereotype is that a “man” excels at sports, fights well, doesn’t show emotions (particularly sadness, fear, etc.), is dominant, and is skilled at and knows a lot about (heterosexual) sex.

Boys learn these stereotypes throughout their youth. Boys are eventually introduced to pornography, which may actually serve a means of male bonding (passing around a copy of Playboy, sharing links to online pornography, etc.). Pornography doesn’t teach boys how about sexual relationships, but instead offers flat, two-dimensional representations of women solely in the context of sex. Masturbation leads to orgasm, which is a potent reward for viewing women as sexual objects (instead of actual people).

The speaker then asked the audience for adjectives attributed to “good girls” and “bad girls”. The assumptions about “bad girls” are often the same for prostituted women[1. The speaker used the phrase “prostituted woman” instead of “prostitute” for the same reason that I use “man with a diagnosis of schizophrenia” instead of “schizophrenic”. Let’s please remember that we are talking about actual people here.] (they have multiple sex partners; they drink alcohol and use drugs; etc.). The words we use to denigrate women are synonyms for prostituted women: whore, slut, etc.

As a consequence, prostituted women become a legitimate target group for male violence. We somehow come to believe that it is okay for men to hurt prostituted women. They are, after all, “bad girls”.

The speaker discussed Gary Ridgway (the “Green River Killer”), who sought out prostituted women and murdered them. Nearly half of the women he killed were under the age of 18. The speaker asked why the media consistently describes these women as “prostitutes” and omits that nearly half of them were, in fact, “children”? What if we described Gary Ridgway as the “most prolific killer of children” in American history?

The speaker then described how a former pimp would find and select women (girls). His strategy was essentially this: If he spoke to a woman and she responded with any direct eye contact (even if she was flattered), he would walk away and end the “grooming” process right there.

Why? Because he knew that those women who made no eye contact with him already had life experiences that would make the pimp’s job easier. “Someone else has already beaten her down so I don’t need to do as much to make her work.”

The speaker then noted that researchers often wonder about the mental health of prostituted women… but why hasn’t anyone examined the mental health of buyers and pimps (mostly men)? Prostituted women often develop PTSD, which is unsurprising given the chronic trauma they endure while working. What is wrong with us as a society that we haven’t shown the same interest in what is “wrong” with the johns?

A discussion followed about the words we use to describe men viewing women. In the US, we often say that men “ogle” or “leer at” women. Those words have a “hubba hubba hubba!” quality to them; men who want an interactive, romantic relationship don’t “ogle” or “leer at” women. When was the last time you heard of a man “beholding” a woman?

One of the most striking points the speaker made was when he asked, “To the men in the audience: What do you do to protect yourself from rape?”

Silence ensued. Some men in the audience were perplexed.

“To the women in the audience: What do you do to protect yourself from rape?”

Many women answered immediately: “Travel in pairs.” “Keep my drinks with me at all times when I’m out.” etc.

Both men and women in the audience were stunned at the disparity of responses.

The speaker then discussed the issue of consent: Consent for sex should be an “enthusiastic yes!”, not something that requires negotiation. In prostitution, the exchange of money for sex is coercion. Economic coercion is never true consent.

The speaker also commented that buyers aren’t paying to learn the reality of the prostituted woman. If the girl is 16 years old and the buying man asks her age, of course she is going to say that she is 18. If he asks her if she has a pimp, of course she will deny it.

The speaker then challenged the audience to speak up even when someone tells a sexist joke against women. Doing so helps to construct a world of equality where women aren’t reduced to sexual objects. He commented that a sexist joke is on a continuum that also includes a man forcing his wife to have with him (“why did I get married if I couldn’t have sex with her whenever I wanted?”), paying a prostituted woman for sex, rape, and murdering women.

The speaker shared that prostitution “is like domestic violence on crack”. The cycle of abuse applies to both. He reported that prostituted women leave and return to their pimps between seven and ten times before leaving for good. It is often difficult for the women to leave because they often identify with their pimps due to something like Stockholm syndrome, though “trauma-bonding” is probably more precise. Prostituted women also frequently develop drug and alcohol problems as a means of coping with the ongoing trauma associated with the work. (Imagine getting into the cars of buyers multiple times a night without knowing if you will get hurt; imagine a pimp beating you because you did not bring back sufficient earnings; etc.)

The speaker also discussed the “bad date list”, which has historically been a paper list that prostituted women have passed around with names and identifying information of buyers who don’t pay, hurt the women, etc. He said that they hope to develop a “bad date” app because of the ubiquity of smart phones.

The speaker closed by discussing different models of managing prostitution in societies. He said that he is strongly opposed to legalized prostitution. He cited some data where states and countries with legalized prostitution often results in more sex trafficking and prostitution. He gave the example of Germany: The demand for prostitution has gone up since it has become legal, so Eastern European women are often lured and trafficked into Germany to work as prostitutes.

He expressed hope in the “Swedish model“: Sweden has taken the approach that women working in prostitution are victims and, thus, the selling of sex is not considered a crime. However, buyers, pimps, and traffickers are prosecuted to the fullest extent of the law. Some data suggests that, as a consequence, there is less visible prostitution and fewer women working in prostitution.


Categories
Nonfiction Observations

Boundaries.

A bus approached the curb and I looked up from my book. It took me a few seconds to realize that he was talking to me.

“Dr. Chang? No, Dr. Wang. It’s Dr. Wang, right?” he called. He slowed the pace of his walk. In one hand he clutched a plastic bag filled with loose papers. A backpack bounced against his shoulders. Though it was a crisp autumn day, he wore only a tee shirt one size too large for his frame and had tied the arms of a jacket around his waist. The hems of his jeans were frayed.

“Hi,” I greeted, trying to recall his name. I hadn’t seen him in nearly six months. He stopped and extended his hand to shake mine. His skin was softer than I had anticipated.

“Dr. Wang, I don’t like how they’re treating me at The Clinic,” he began. “They don’t know what they’re doing and I’m done with them. I think they’re working with the FBI, Dr. Wang, but I can’t do anything about that. I don’t feel safe in my apartment and they know this. They’re bugging my apartment. I don’t know what the FBI is looking for, but would you want to live somewhere that is bugged? I don’t. I’m done with The Clinic, Dr. Wang, I really am. What do you think I should do?”

He stood still, waiting for an answer.

Pedestrians filed past. Buses roared along the street. An occasional yellow-orange leaf fluttered to the ground. A dozen people looked down the avenue, looking for their bus to whisk them away.

I opened my mouth, still uncertain of what to say—

“I’m sorry,” he interjected. “You’re not here to provide psychological help right now.”

Before I could reply, he began to turn his body away from me.

“I’m sorry, Dr. Wang.”

He began to walk away as the bus I wanted approached the curb. Before stepping towards my bus, I looked back at him.

“Have a good day, Dr. Wang!” he called, waving at me. I waved back.

As I boarded the bus he looked back as he continued to walk forward. Over the heads of the people between us he shouted: “Thank you, Dr. Wang! THANK YOU!”

Categories
Observations Reflection

12 Hours.

He sat in the chair and swung his legs out every few minutes, though he never stood up. He had not stood up for over 12 hours.

His calloused fingers picked at the hems of his jeans. He dug a thumbnail near the outseam and tried to scratch out a loose thread. Unsuccessful, his fingers travelled farther down his pant leg.

His left hand tugged on his earlobe. The size of his pupils fluctuated as his eyes darted around the room.

“Do you want anything to drink?”

“In a minute.”

When presented with a sealed water bottle, he laughed. It was a fearful laugh, quivering and choking.

“Someone could’ve poked a hole in that water bottle,” he said, waving it away. “No, I don’t want any of that.”

Then came a can of soda.

“It’s metal. There might be something wrong with the metal.”

His head swiveled on his neck, his eyes searching the ceiling.

“Can you tell them that I want to surrender?” he blurted.

“Who?”

“The police. Tell them that I will surrender. I don’t want them to fire a taser at me or shoot me with their guns.”

“There are no police here. No one will shoot you.”

“Uh huh. Right.” His eyes glimmered with tears as he sucked in a breath.

“I’m really scared, I’m so stressed out,” he said, rubbing his face. His legs twitched as he kicked them back under himself.

When we made any move to leave, he’d beg us to stay. When we offered him anything, he’d implore us to leave him alone.

What happened over the past 12 hours? Was his paranoia there all along, but he had enough “cognitive reserve” to mask his symptoms when we first met? Was it the lack of sleep? the lack of food and drink? Or was it something someone said? the way someone looked at him?

What happened that broke his mind? How was he fine one day—anxious, but smiling, talking, eating, resting—and not the next? How did reality walk away from him while he remained rooted in the chair?

Categories
Consult-Liaison Education Informal-curriculum Lessons Medicine Observations

Informal Curriculum: Lesson 1.

It’s been over a year, but I haven’t forgotten about the Informal Curriculum.

The first recommendation in the informal curriculum in medicine, which I still believe is “paramount, the most difficult to define, and often challenging to implement”[1. It is no coincidence that a topic that is “paramount, … difficult to define, and … challenging to implement”, is also difficult to write about.] is to be a person.

What does this mean?

Be the best professional person you can be. Be a person who actively listens to patients, who shows empathy and emotions. Be courteous. Show humanity. Be a person.

Non-psychiatrist physicians seem to have an easier time with “being a person” than psychiatrists. Psychiatrists, as a population, can be weird. We can demonstrate exceptional skills at not being people. Sometimes we come across as intrusive, awkward, and odd.

I get it. I’ve had peculiar interactions with psychiatrists who knew I work as a psychiatrist. That might explain why the conversations were even more uncomfortable than expected. (Those are stories for another day.)

Do note that this recommendation exhorts you to be a professional person. This doesn’t mean that you tell your patients about your relationship or health problems, how crappy of a day you’re having, or why your political views are correct. That stuff makes you a person, too, but that doesn’t make you a professional person.

If patients are telling you things that worry them, be a person and acknowledge their worry. If they tell you something funny and it’s not inappropriate to laugh[2. Being a person does not mean that you toss clinical judgment and boundaries away. There are times when you shouldn’t smile and laugh, even if you want to. That topic is beyond the scope of this post.], smile and laugh. Talk with them like they’re people, not diseases or case studies.

Be a person.

Patients often want to share a connection with their physicians. Patients suffer and worry. They want to know that you care about their suffering or worry. That’s what actual people[3. Yes, there are anecdotes that people will share their woes with and find comfort in a computer program.] do: They care about the suffering and worry of others.

Be a person.

Why is this paramount? Why is this my first recommendation in the informal curriculum?

Because relentless forces exist in medical training and work that can transform you into a non-person.

You use words that most people don’t use. Most people don’t talk about MELD scores, Glasgow Coma Scales, or HIV classification systems. You see a lot of emotional and physical anguish. You see people who are ill. Sometimes they cry. Sometimes they scream. Sometimes you see parts of them that they will never see. Sometimes you see them die.

These are the things that can make you turn into a non-person.

So make an effort every day to be a person. If you’re not, none of the other suggestions in the informal curriculum will matter.