Category: Nonfiction

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Consult-Liaison Education Lessons Nonfiction Reflection

Five Things You Can Do When You Have to Talk to Someone You Don’t Like.

We all have to talk to people we don’t like, whether in our professional or personal lives. We try to avoid these people. We try to work around them. Sometimes we spend a lot of energy trying to get away from them. And, despite our efforts, we often still have to spend time with them.

Most people don’t like the experience of disliking people. Some blame it all on the disliked person. Some people assume all the blame themselves (“why don’t I like that person? what is wrong with me?”). And, despite self-reflection (or lack thereof), the uncomfortable sensations remain.

It’s okay to dislike people. It happens. Sometimes we don’t have rational reasons for disliking people. Even if the reasons elude us, one of the most useful things we can do for ourselves (and for everyone else) is to acknowledge our dislike. Once we recognize our internal reality, we can then take useful steps in our external reality when we have to spend time with these people.

Here are five things you can do to make the best of the time you have to spend with someone you don’t like:

1. If they are much older than you, really look at them and picture them as kids. Kids are cute. All of us were kids at one point. Sometimes things happen to kids that lead them to act in certain ways as adults. These certain ways helped them cope with and survive in the world. Maybe these strategies don’t actually work well now, but they may have been lifesaving when they were kids.

Have compassion on the kid.

2. If they are much younger than you, really look at them and picture them as elderly people. You might recognize that, if they keep doing whatever it is that they are doing, they will have difficult lives as older adults. Maybe they haven’t learned what they need to learn yet. Maybe the time you spend with them can help them learn something different so they aren’t destined for decades of misery.

Have compassion on the elder.

3. Try to get to know them better. Abraham Lincoln remarked, “I don’t like that man. I must get to know him better.”

Yes, this means that you might have to spend even more time with someone you don’t like. When you start exercising curiosity about people you don’t like, though, you often learn that you both have something in common. Sometimes you learn things about the person’s past that might explain why they he does the things he does. Instead of thinking of him as an “annoying dickwad”, you may notice that you now think of him as “that poor guy who no one cared for as a kid”.

4. Assume that the person is having a rough time in his life. None of us shine when we’re dealing with the problems and failures that inevitably occur. We often have no idea what challenges people have in their lives. Even though their challenges may occur in contexts that have nothing to do with you, the ways they deal with those challenges may affect how they interact with you. What they do that vexes you may be the best way they know how to cope.

5. Approach them with the assumption that these people are your teachers. Everyone you meet can teach you something. Because we often have no idea what has happened or is happening to people, it is foolish to believe that we know more about life than those around us. This person might teach you how to show more compassion or exercise more patience. This person might be an accurate reflection of those aspects of you everyone else finds annoying. Your reaction to this person could help show you how you can make your other relationships better.

You may protest that these suggestions may not reflect actual reality: “These are just mind tricks you play on yourself!” However, you cannot control the behavior of other people. You are limited to choosing how you can react to and interact with the people you dislike.

Thus, if the goal is to make the best of your time with people you don’t like, would you rather be “right”? or would you rather be “effective”? These five suggestions may not be “right”, but they are more likely to make you effective.

Categories
Nonfiction Observations Seattle

Bridges, Frustration, and Coping.

The longest floating bridge in the world is in Seattle. It is 7,710 feet (2,350 meters) long and spans beautiful Lake Washington. Locals call it the “520 bridge” and, in its current incarnation, only cars may use the bridge.

Yesterday, the Washington State Department of Transportation hosted the grand opening of the new 520 bridge. On the bridge were several food trucks, booths with information related to the engineering and construction of the bridge, and equipment and heavy machinery used in its creation.

To get to the event from Seattle, people had to take shuttle buses that originated at the University of Washington campus. The buses drove about three miles on the old bridge and delivered the crowds to the start of the new bridge.

Tens of thousands of people took the opportunity to walk across the bridge and enjoy the surrounding views that, prior to then, one could only enjoy by car.

In the early afternoon hundreds of people got in line to get back to Seattle. A young man wearing an orange vest carried a sign that read “End of the Line Here”. He folded the line back and forth to compress hundreds of people into a narrow area while we awaited the shuttle buses.

Behind us were two women who appeared to be in their 60s. One wore a visor that pushed her short white hair out of her face. The other had a greying bob.

“This is ridiculous!” Visor exclaimed. “This isn’t organized at all! We’ve been waiting in line for over 30 minutes and I don’t see any buses coming!”

“I know!” Grey Bob agreed. “We haven’t moved at all. This is terrible. This is ruining the entire event!”

Thin white clouds were streaked across the bright blue sky. A refreshing breeze swept around us. Mt. Rainier stood in the distance, a lenticular cloud atop its peak like a floating hat.

“OH MY GOD we’re actually moving!” Grey Bob squealed as the line shuffled forward. “We might actually get off this bridge!”

“I’m not going to be that optimistic,” Visor replied. “I’m going to wait until we actually get to UW before I say that.”

Shimmering white light danced on the dark blue ripples of Lake Washington. As the clouds dissolved under the sunlight the snow-capped peaks of the Cascade Mountains revealed themselves. A media helicopter, less than 100 feet above us, drifted past.

“HELP US!” Visor screamed at the helicopter.

When we could no longer hear the helicopter, Grey Bob sighed, “It’s been over 45 minutes. This is unacceptable.”

“If I have to wait in line any longer, I’m going to jump over the side of the bridge and kill myself,” Visor squawked.

Grey Bob laughed before commenting, “The barriers aren’t that high. Someone could really jump over. It wouldn’t be that hard.”

“Oh yeah, you’re right,” Visor said, her voice non-plussed. “That’s not good.”

At around 55 minutes the line was no longer still. We walked in quick strides towards five buses. Two of them faced West to go to UW. Three of them faced East.

“All the buses are gonna go to Seattle,” the event planner shouted at us. “Get on any bus on the other side of the barrier. All the buses will go West.”

I smiled as I watched my father scramble over the barrier—while not a spring chicken, he is still spry—and my husband and I made a point of scurrying away from Grey Bob and Visor. The three of us got on a bus facing East.

Nearly 100 of us packed into the bus. My father sat to my right. A woman in her 50s wearing a bicycle jersey sat to my left. My husband gave up his seat in an act of chivalry for her. He stood near the rear exit of the bus.

The bus headed East towards the fancy-pants neighborhoods of Medina and Hunts Point. Once the bus was off the bridge, it passed an exit. Then another.

“WHAT?” Bicycle Jersey exclaimed. She leaned forward and barked at her friend, an older woman with glasses reading a newspaper, “Why is the bus driver not turning around? Doesn’t the driver know that we’re supposed to go to SEATTLE?”

Someone pulled the wire to signal the bus to stop. People snickered.

The bus slowed to a halt at an intersection with several other shuttle buses. It did not move for nearly 15 minutes.

“This is so disorganized,” Bicycle Jersey said. “This is not worth it. This has ruined the entire day for me.” Her right thumb scrolled through an article by Nick Kristof: “When Whites Just Don’t Get It”.

The bus then crept north towards Kirkland.

“WHAT?!” Bicycle Jersey shouted. “Why are we going to Kirkland? We’ve been on this bus for over half an hour! We should’ve gotten on a bus that was going the other way. They’re already back home.”

“I never take the bus,” a woman standing over my dad said to no one in particular. “I’m never doing this ever again. Unless it’s a shuttle bus at a really nice wedding. And I mean a REALLY nice wedding.”

A young man with facial stubble near my husband hugged a pole. “We’re almost out of water. We’re going to die on this bus.”

“It’s like we’re hostages on this bus,” Bicycle Jersey spat.

The bus stopped at the Kirkland Park and Ride, but not at the curb.

“He better not make us get off this bus,” Bicycle Jersey said.

One man got off the bus.

“Did we come all the way here just for that one guy?” Bicycle Jersey continued. “What about the rest of us?”

The bus rolled back down the hill and stopped at an intersection.

“WHY WON’T THE DRIVER GET BACK ON 520?” Bicycle Jersey shouted. “TURN RIGHT HERE.”

“We’ve been on this bus for almost an hour,” Facial Stubble announced.

When the light turned green, the bus turned right and we were back on 520.

“We’ve been on this bus for almost an hour,” Facial Stubble announced again.

The bus rolled past the line of people waiting for buses. It was nearly a mile long now.

“DON’T GET ON A BUS HEADING EAST,” Bicycle Jersey shouted at them. None of the windows of the bus were open. The bus was going over 40 miles an hour.

“We’ve been on this bus for an hour now,” Facial Stubble said. “This is the worst mistake of my life.”

Some people have to wait over an hour every day just to get food and water.

I’m going to guess that you ate breakfast this morning. I’m also going to guess that you’re going home. Because you didn’t have to work today.

You’re not showing any overt signs of dehydration. Shut up. You’re not going to die.

The only person holding you hostage right now is you. Your bitterness isn’t going to make us get back to Seattle faster.

If you are joking about suicide because you’ve been waiting in line outside on a beautiful day for 45 minutes, how do you deal with actual stress?

Maybe you sustained a brain injury in your frontal lobe and that’s why you have low frustration tolerance.

Maybe your prefrontal cortex hasn’t fully developed yet. That process isn’t complete until your mid-20s, at which point you’ll hopefully have better impulse control.

Maybe no one ever taught you emotion regulation and distress tolerance skills. So maybe this is a skills deficit.

Maybe you’re having a rough time in life right now. Maybe a relationship you value is ending. Maybe someone you care about is sick and dying. Maybe, under different circumstances, you’d exercise more patience.

Maybe you’re a victim of specific operant conditioning: Maybe you’ve learned that people only pay attention to you and value what you say when you’re expressing snark or distress. And that people will only take you seriously the louder you talk.

My dad shrugged.

“We just had bad luck today.”

Categories
Nonfiction Reflection

Entitlement.

“Do you have any questions for me?” I asked. It’s how I usually close clinical interviews. It’s also a way to acknowledge how one-sided the interviews are.

“Will you go out on a date with me?” he replied. We were looking at each other through the window of his cell. His face was serious.

“No. Don’t ask me that again.” I want to be clear. There’s no ambiguity in that answer. “Do you have any other questions for me?” Even though I said no, I will still talk to you in my professional capacity.

He said nothing, but now he was frowning.

“Are you angry?”

“Yes, I’m mad. You said no when I asked you out on a date.” His cheeks were now red. He roared, “I HAVE SEXUAL NEEDS, TOO!”

“Good-bye, sir.” He was still shouting racial and misogynistic epithets at me as I left the area.

It’s not his request for a date that was noteworthy. That, unfortunately, has occurred before. It doesn’t happen often.

This is usually how these conversations occur:

SCENARIO 1: “Do you have any questions for me?”

“Will you have sex with me?”

“No. Don’t ask me that again.”

“Okay.”

And the subject never comes up again.

SCENARIO 2: “Do you have any questions for me?”

“Will you give me a blow job?”

“No.” (walking away)

“I’M SORRY, I’M SORRY, I WAS JUST KIDDING….”

These men usually apologize again the next time I see them.

SCENARIO 3: “Do you have any questions for me?”

“When I get out, I’ll take you to that burger place, I’ll buy you a burger and small fries, you can choose Pepsi or Coke—”

“Thank you, but no. That won’t happen.”

“But you can choose your own soda—”

If it comes up again, the requests are benign and may not make a lot of sense.

What made this man’s reaction noteworthy was his rage.

Nobody likes rejection. We all feel that visceral crushing sensation when we want something and we can’t have it. That crushing sensation is particularly harsh when we can’t have what we want due to arbitrary reasons. Like when a woman declines a date with a man.

This man and I had an interaction in a jail through the door of his cell. It was civil. To me it was a clinical interview. To him it may have been a nice and encouraging conversation. Something about the interaction made him feel comfortable enough to ask me for a date.

(Never mind the cues that indicated that such a request was inappropriate: He was in a jail cell. He knew that I worked as a physician there.)

The men in jail who have asked for dates or sex, though, recognized that they were not entitled to either. Sure, they could ask whatever they wanted. But, they also had the understanding that I could respond however I wished.

This man, though, was furious that I declined his request for a date. His reaction suggested that he could not believe that I had the gall to say no to him. How dare you say no when you were the one who asked me if I had any other questions? You started this. If my role as a physician was to help him, he had ideas as to how I could do that. Boundaries had blurred for him. He disliked that they had not blurred for me.

And, to be clear, this sort of behavior is not a function or manifestation of psychiatric illness. Some people with severe psychiatric conditions have extraordinary manners. Some people without any psychiatric conditions have vulgar manners.

If we look at the entire population of heterosexual men who are talking with a female psychiatrist:

  • Some (most?) men will never think to ask for a date or sex when asked, “Do you have any questions for me?”
  • Some men will think to ask that question, but won’t actually ask it.
  • Some (few?) men will actually ask the question (whether earnest or not), though will not react as this man did.

And, as unpleasant as this interaction was, he did use his words to express his displeasure with me. Would he have shared his thoughts with me had I not asked him if he was angry? There are all the ways this interaction did not play out:

  • He could have spit on the window (and if the window wasn’t present, his saliva would have landed on my face).
  • He could have hit or punched the window.
  • He could have reached through the open slot in his cell door and grabbed me.
  • He could have thrown something—wet or dry—at me through the open slot.

What would have happened if this interaction had occurred outside of the jail?[1. As I write often here, context matters. Some behaviors occur in jail because of the jail. When you are deprived of your freedom and must spend time in an uncomfortable place with limited to no privacy and nothing to do, you may find yourself behaving in uncharacteristic ways because you are angry or bored… or just because you can.]

He might have walked away.

He might have grabbed me to demonstrate his power and elevate his status.

He might have hit or punched me to express his rage.

He might have grabbed me and taken what he wanted.

Categories
Education Nonfiction Policy Reflection Systems

A Review of the National Council for Behavioral Health Conference.

Those of you who follow me on Twitter already know that I spent much of last week in Las Vegas. I attended the National Council for Behavioral Health Conference, “featuring the best in leadership, organizational development, and excellence in mental health and addictions practice.” Here are my reflections about the experience:

It was large. I have never attended a conference with 5000 other people. I already find Las Vegas overstimulating. Not being able to get away from thousands of people for hours on end was draining for me.

There were many sessions I wanted to attend, but could not. This, of course, was a function of the size of the conference. Humans, thus far, can only physically be in one place and mentally elsewhere. During this conference I often wished I could physically be in two places at once.

The sessions that most inspired me often had little to do with formal behavioral health. Nora Volkow, the director for the National Institute of Drug Abuse, gave a talk about the neurobiology of addictive behaviors. Did I learn anything new? No, only because I had learned this while in medical training. Did she present the information in an engaging and compelling way? Yes.

Charles Blow, an opinion writer for the New York Times, authored a memoir about his youth and past sexual abuse. During his talk he read from his book and shared his reflections about his experience. Did I learn anything new? Nothing obvious that would affect either my clinical practice or policy considerations. He won me over with his personal perspective, grace, and vulnerability.

Susan Cain spoke about introversion and leadership. Did I learn anything new? No, because I had already read her book. Was it nonetheless worthwhile to hear her speak in person? For me, yes.

The conference featured a large session called “Uncomfortable Conversations”. The intention was for Big Names in the field to discuss controversial topics. These included involuntary commitment, confidentiality laws that are specific to substance use disorder treatment that can interfere with clinical care, and the concept of cultural competency. Each pair, however, had less than ten minutes to discuss their issue. The moderator also seemed to speak more than each member of the pair. The session could have been thoughtful, though ended up feeling underdeveloped and unfocused.

Where were my psychiatrist colleagues? I understand that this is my own issue—after all, this was not a physician conference. The National Council, however, is supposed to be the leadership conference for community behavioral health. Are psychiatrists involved in leadership in community behavioral health? If not, why not? [1. As I have noted elsewhere: “Physicians, as a population, don’t advocate for ourselves as much as we should because we’re “too busy taking care of patients”. This is true. However, our busy-ness creates a vacuum where non-physicians step in and make decisions for us. We then express resentment that we have to follow the edicts of people who have never done the work. If we did a better job of regulating and advocating for ourselves, we might not be in this position.” Advocacy in this case is leadership.]

Only two “small” sessions I attended featured physician presentations. One involved the introduction of trauma-informed care into primary care settings. The other discussed a concrete integration of mental health, substance use, and primary care services. In both cases the physicians were family practice physicians. Which, to be clear, is fantastic. We must work across systems to provide good care for individuals and populations. I nonetheless felt both puzzled and disappointed with the lack of psychiatrist representation. [2. To be fair, Nora Volkow and several of the panelists for the “Uncomfortable Conversations” are trained as psychiatrists.]

There was a “medical track” meant for medical professionals. Few of those sessions discussed systems issues or leadership. I had planned to attend one that discussed guidelines for benzodiazepine use, though there was no room by the time I arrived. (One of my colleagues, a psychiatrist, later told me that many attendees were not doctors.)

The conference will be in Seattle next year. My colleagues and I are already discussing what we can present.

A lot of people want to do good. I often comment, “Life is terrible… and life is wonderful.” That people have done good work to help others and want to share what they learned in the process is remarkable. That people continue to strive to provide useful services to people who are suffering is humbling. That people are creating new programs to help solve problems, often rooted in inequality, a variety of disparities, and the randomness of existence, is inspiring.

When we have our heads down in our own work, we often forget that we are part of a system. Though I have critical opinions about the conference, I am grateful that I could attend. May we all seek inspiration and always learn from others.

Categories
Nonfiction Reflection

My Conflicted Relationship with Fried Chicken.

They are clear memories from my youth: After riding our bikes along the beach on warm summer mornings, my parents frequently picked up a bucket of Kentucky Fried Chicken. After we settled into our seats at the kitchen table, I always got the drumsticks and biscuits. My parents both preferred dark meat. My mom would take the cole slaw. My dad enjoyed the mashed potatoes and gravy. Chilled watermelon or papaya completed the meal.

A pot of tea was now on that same kitchen table. The wedding band was loose on my mom’s finger.

“You know why I got cancer?” she asked me in Chinese. Before I could say anything, she replied in English, “I ate too much Kentucky Fried Chicken.”

“No,” I blurted out.

“There’s too much grease in it,” she continued.

“No,” I repeated, now both amused and disturbed that she was attributing her lung cancer to Kentucky Fried Chicken.

“If I didn’t eat so much Kentucky Fried Chicken, I probably wouldn’t have gotten cancer.”

“NO.”

I repeated what the oncologist had told us: It was probably genetics. She was a relatively young, non-smoking, Asian female. Something about all that put her at higher risk of developing non-small cell lung cancer. The Kentucky Fried Chicken had nothing to do with it.

She looked away and sighed. Even though I had a medical degree, I was still her daughter and my statement was a child’s opinion.

“I’m not hungry, but I should eat something,” I said, wiping the snot from my nose with my arm. Less than an hour had passed since I had learned that my mom had died.

When we got home, we pulled the paper containers from the plastic bag and put them on the kitchen table. Tears were trailing down my cheeks and my chest still hurt, but I started laughing as I bit into the fried chicken from Ezell’s.

“I get a senior citizen’s discount,” my dad said, smiling. He put the red tray down between us and opened the red and white box.

“I’m glad,” I replied, smiling back at him. He reflexively gave me the drumstick and the biscuit. I handed him the mashed potatoes and gravy.

“Mmm,” he said between bites. “Kentucky Fried Chicken is good.”

“Mm hm,” I mumbled in agreement while chewing. I’m going to enjoy this fried chicken and cancer can go f-ck off.