Category: Observations

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Observations Reflection

Some Thoughts on Equus.

I saw the 1977 film Equus this afternoon at the recommendation of some friends. Some of my reactions:

– Had this scenario—a young man believes that horses are gods, which ultimately drives him to stab out the eyes of six horses—occurred in present day he most certainly would have received antipsychotic medication for a presumed psychotic disorder.

(All of the hugging, acting out, night sessions, etc. also would not occur in present day. At least one would hope not.)

– In a monologue near the end of the film the psychiatrist comments:

Passion, you see, can be destroyed by a doctor. It cannot be created.

Indeed! More than one person has shared with me that, while taking psychotropic medication, they don’t feel like “themselves”, their emotions feel muted, they feel “numb”, etc. Certainly medications are not the only agents that can destroy passion: Consider the potential violence in societal expectations, cultural norms, and other social structures.

Only the gods know where passion comes from. People have tried to thwart the gods for as long as we’ve been around.

– In another monologue the psychiatrist notes:

The Normal is the good smile in a child’s eyes. It’s also the dead stare in a million adults. Both sustains and kills… like a god.

Much of the film focuses on the idea of “normal”. Though most people don’t believe horses are gods and experience sexual ecstasy when riding one, everyone has their own penchants that others will find disturbing or peculiar. Most of us have learned to mask these proclivities from public view.

A few times a year people will ask me, in my professional capacity, if I think they are “normal”. While there are a variety of reasons why people ask me that, what often underlies this inquiry is the belief that I can distinguish between “normal” and “not normal”.

Can I just say—I’m sort of joking, but not really—that psychiatrists shouldn’t be the arbiters of “normal”? As a population, psychiatrists are a weird group of people.[1. You will note that I wrote “As a population, psychiatrists are a weird group of people.” To be clear, I didn’t add “as a population” to suggest that I, as an individual, am three standard deviations less weird than the average psychiatrist. I’m weird, too.] Some of the strangest social interactions I’ve experienced have been with psychiatrists… and we all knew that we were all psychiatrists. On more than one occasion I’ve wanted to exclaim, “Why are we so awkward? Can we please just be actual people right now?”

– There’s a lot of violence in the story. I refer not only to the actual stabbing of the horses’ eyes. I refer to the lies about the “truth serum”, the hypnosis and medication administration that seems to occur without consent, the father’s reaction and shame related to his son’s attendance at the “skin flick”, the dreams the main characters have.

Sometimes what we think is kindness is actually violence.

– There’s a bit of dialogue before the climax of the film that goes like this:

Martin: Where are you now, Alan?

Alan: Cabbages, with the moon on them.

I’m pretty sure that Alan’s response is meant to add a rustic, romantic touch to the scene. What do I do? I laugh out loud.

– I don’t recommend the film, though I’d like to see a theatrical production. The monologues of the psychiatrist are noteworthy, though I couldn’t understand much of them until about halfway through the movie.

Categories
Observations Reflection

Ashes to Ashes.

From the pier the waves looked like fluttering sheets of dark silk as they floated towards the beach. Neither the sun nor the ocean breeze had risen yet.

A small circle formed; there were quiet murmurings that ended with a hushed “amen”. Out of the backpack came white paper tubes adorned with white flowers. They each took one, then tipped the contents of the tubes into the water. First, a rushing sound, then quiet splashes into the ocean below.

The sky began to glow peach and pink with the rising sun. The ashes floated up from the water with the ease of a flower blooming, each petal stretching out to welcome the sunshine. The thousands of bits of dust dissolved into the morning light.

From the pier six hours later the turquoise waves carried hundreds of thousands of small fish. Their scales caught the light of the sun and made the water look like it was covered in glitter. Occasionally the giant ball of fish would dart abruptly in one direction; it was a living organism, a creature that shifted and swirled right underneath the lurching waves.

The thousands of bits of dust had dissolved into the hundreds of thousands of small fish. Ashes to ashes, dust to dust.

AM-PM

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Education Homelessness Observations Reflection Systems

Do People Choose to be Homeless?

One of the things we talked about during dinner was whether people choose to be homeless.

“Yeah, it seems like some people want to be homeless,” he said.

“No… I don’t think so,” his friend replied.

They looked at me.

I cannot speak for all people who have ever been homeless. However, I have several years of experience working with people who were homeless and refused housing again and again[1. When working within a housing first model, the goal is to give people housing without any expectations that people will participate in mental health or substance abuse treatment. The goal is really just to get them inside.], as well as people who left their housing and returned to the streets.[2. In my experience, people who leave housing usually return to street homelessness. Most do not return to the shelter system.]

Thus, I believe that people who are homeless do not want to be homeless. They usually have concerns about the housing offered to them.

Here are some reasons people have shared with me when I have asked them why they don’t want housing:

I can’t move in anywhere. I have to stay outside. The aliens say that if I move in anywhere, they will exterminate me. I’ve already been exterminated three times. I don’t want to get exterminated again.

I don’t want to live inside. It never feels safe. Bad things happened to me when I’ve been inside. It’s too hard to get away.

But I don’t need your housing. One day my boss will hire me again–I was really good at my job–and when I start working again I can pay for my own apartment. (This man, for years, sat on the sidewalk across the street from the building where he said he previously worked.)

There’s too many rules: Curfew at 10pm? No guests? What if I want to bring a lady friend over? Nope. Don’t want to deal with all that.

I know that place. There’re too many people using dope. I know what’s gonna happen if I am around that crowd. I’m trying to stay away from all that.

That place? Isn’t that where all the crazy people live? No, thank you–I don’t want crazy neighbors.

If I could move in without giving my name or social security number, then, yes, I’ll move in. But people keep asking me for personal information and I don’t know what the government will do with that.

So, the reasons people give generally fall into three categories:

  1. People want freedom and don’t appreciate the constraints of rules.
  2. People are concerned about their safety within the building. These reasons may or may not have any basis in reality.
  3. People may feel some guilt or shame related to the housing (whether they deserve it, what it would mean if they moved in, etc.).

It’s hard for those of us who have a stable place to live[3. One consequence of working with people who are homeless is that you never stop giving thanks that you have a place to live. You don’t have to worry about where you’re going to sleep that night. You don’t have to worry that someone might try to rob you or set you on fire. You don’t have to worry about the police picking you up simply because you have nowhere else to go. These are the things we all take for granted.] to understand why some people seem to “choose” to live outside. Sometimes people point to Maslow’s hierarchy of needs and ask, “But isn’t housing a physiological need? People need water, food, and shelter. Why would someone ignore this basic need?”

Yes, shelter is a basic need. However, people who live outside can and do meet their basic needs, including shelter. They sleep in abandoned buildings, underneath bridges, in tents, in covered doorways, in wooded groves, in bus shelters, etc. These are not ideal places to live, but they’re sufficient.

No one wants to be homeless. What they want is psychological safety. For those individuals who decline housing, sometimes the need for psychological safety will override what seems like the “logical” choice of accepting housing.

People continue to astound me with their resilience. When people resist housing for years, though, it makes me wonder what happened to them that resulted in this resilience.

Categories
Medicine Nonfiction Observations Seattle Systems

On What Medical Directors “Should” Look Like.

I recently answered a survey about race. One question asked:

“If you ask to speak to the leader of your organization, can you expect to see someone of your race?”

I snorted. I didn’t mean to. I just had never thought about that before.

In my previous job my title[1. As I have noted elsewhere, “titles, at the end of the day, are just words.“] was “medical director”. During the first few months of that job the title felt alien to me. It was as if people at work said, “Oh, Dr. Yang? She’s the one over there with the blonde hair.” Meanwhile, I’d touch my black locks, feeling perplexed.

Early on I conducted interviews to hire staff. One applicant, a psychiatrist, was a Caucasian man in his early 50s. His greying brown hair was cropped close to his head. A striped burgundy necktie adorned the light blue dress shirt underneath his navy blue suit. Cuff links poked out from under his sleeves. A silver pen was clipped into the breast pocket of his jacket.

Turning to the program manager, I murmured, “THAT guy looks like a medical director, not me!”

She, a Caucasian woman, laughed before she said, “Yeah, you’re right!”

In the jobs I’ve held the medical directors have all been Caucasian males, with the exception of my first job: He was Asian. In residency training the chair of the department was a Caucasian male. The paintings and photographs of leadership that lined the halls of the medical school were all of aging Caucasian men.

That’s how I came to learn that medical directors don’t look like me; they’re older white men.

Leadership at this agency believed I had sufficient qualifications and hired me, an Asian female, to serve as the medical director. However, the idea that someone in this position “should” be an older white male persisted in my mind.

What does it mean that I felt doubts about my ability to work as a medical director simply because of the way I look?[2. While this post is focused on race, it could easily focus on sex, too: Most medical directors are men.]

Categories
Nonfiction Observations Reflection

Baseball Rituals.

Prior to attending a minor league baseball game recently, I learned about racing events that occur at certain ballparks:

“Baseball is so schlocky,” I said after viewing a YouTube video of the Presidents with their oversized heads teetering along the perimeter of the field. “No other professional sport has anything like this.”

“That’s not true,” my husband replied. “They throw octopuses onto the ice in hockey.”

After learning that, indeed, there is a Legend of the Octopus, I still expressed skepticism: “Could you imagine a whole bunch of sausages running around on a football field?”

“Football has cheerleaders,” my husband retorted.

Good point.

The mascot was busy at the minor league baseball game. Not only did Rhubarb the Reindeer hustle around the stadium with a flag at the start of the game, but he also came out in boxing regalia at one point and, later, wearing a dress shirt and slacks, “performed” a Talking Heads song.

A few rows behind us a man with a voice rattling with gravel shouted at the players:

This is baseball, not first base ball!
Communicate!
Boring!

His son started shouting similar things at the players. When we turned around to see who they were, we realized that the higher pitched voice did not come from his son; it came from his wife.

When the 7th inning came around, we all stood up and sang “Take Me Out to the Ballgame” in different keys. I then ate some Cracker Jack.

I wondered if all this schlock these rituals are meant to appease our short attention spans. Ball 1, ball 2, strike 1… the man with the gravel in his throat shouts unsolicited advice, people get up to buy hot dogs and beer, the bugle calls “Charge!” It’s hard to wait. We want stuff to happen.

Then I wondered if these rituals give us simple comfort while everything else changes. Even if my boss doesn’t give me enough time or credit for the work I do or my wife is angry at me for reasons I think are ridiculous or my kid is not meeting my academic expectations or my friends are worried I have a drinking problem or my boyfriend has hit me twice this week or I lost all of my savings at the casino or my sister died in a car crash last month…

… at least I know that I can caterwaul “Take Me Out to the Ballgame” in the 7th inning, Rhubarb the Reindeer will dance on top of the dugout, and the pierogies will race.