Category: Reflection

Categories
Consult-Liaison Reflection

Killing and Suffering.

To become a doctor, one learns how to prevent disease and death. To do this, one first must become acquainted with them: What happens? What does disease and death look like? sound like? smell like? What are their textures and patterns? What shifts over time, until the patient has no more time left?

As medical students learn what disease and death look like, they witness human suffering. Many students are unprepared for this. The tears that physicians in training shed are not from recognition of the mechanisms of disease and death. They cry because of the human suffering that surrounds them, that submerges them.

We don’t cry because we recognize that the proteins in the coagulation cascade aren’t reacting fast enough. We weep because there is so much blood everywhere. We see how pale their skin is, hear their rapid heartbeat on the monitor, and feel the coolness of their skin.

We see the contortions of their loved one’s face. We hear them scream, their sobs escaping their throats.

If we cry when we witness the suffering of one or two human beings, won’t we still cry when this happens to multiple human beings who are infected with a pandemic illness?

What if the cause of death isn’t a disease, but is instead a person? How do we then react?

Some psychiatrists recently shared the mental model of projection to explain why people kill others. Briefly: Projection is an unconscious process. People generally don’t think of themselves doing “bad” things:

  • I would never hate people because of their religion.
  • I would never treat people differently because they are poor.
  • I would never deny someone a place to live.

… even though they may have fleeting thoughts or impulses that align with these.

In projection, someone will “project” negative thoughts and impulses onto someone else and deny that they themselves ever have them:

  • I’ve done the work and I don’t have implicit biases. That guy, though, hates anyone who belongs to that religion.
  • I’m open-minded and understand that people who are poor are still people. That person, though, thinks poor people are all lazy and stupid. Just a bunch of moochers.
  • Of course everyone deserves a place to live. That guy, though, thinks some people deserve to be homeless. He thinks they’re all criminals and deserve to die.

In projection, we (unconsciously) don the gown of righteousness. We can do no wrong. Our intentions and motives are pure. In projection, we (unconsciously) coat The Other Person in the rags of depravity. They are evil. They only want to do bad things.

We are nothing like them. We could never be like them. They could never be like us. Anything we do glows with virtue. Anything They do is wrong.

We crush cockroaches underfoot because we are nothing like them and could never be like them.

How different are They from cockroaches?

We can’t test for projection. This is supposed to be an entirely unconscious process. (If we were conscious that this were happening, we would (should?) be horrified. We could not tolerate this and would take steps to stop it.)

I don’t discount the idea of projection for killing, but because there is no way to validate it, this is not the first explanation I go to. There are also a lot of steps: I’m a good person, you’re a bad person, you’re so bad that I don’t think you’re a person anymore, so killing you isn’t actually killing a person.

The dehumanization that comes from neglect is more compelling to me than the dehumanization that comes from projection. Indifference can cause more harm. It can be a conscious choice.

It’s not that I think you’re subhuman or an animal. I just don’t think about you at all. Torturing and killing an animal, even a cockroach, means that I at least thought of you as something that can react. If I don’t think about you at all, then you already don’t exist. And what sort of reaction could you possibly have if you don’t exist?

What harm could torture, rape, and murder have on nothing? If you don’t exist, then I’m not killing anyone in hospitals and schools. There are no children. I’m just flattening buildings.

You don’t matter. You have no matter.

People, like you and me, weep around the world.

A man cries for his son who will not live to start school because of the cancer in his brain. A son cries for his mother who died in an accidental plane crash. Someone cries for a friend of 60 years because their heart stopped beating.

Death from disease and the random events of life already causes suffering. Do not cause more suffering by killing other people. You will not only destroy others, but you will also destroy yourself.

Categories
Homelessness Reading Reflection

Words and Sounds.

The reason behind my recent silence here is I am attending to a beloved family member whose health continues to deteriorate. Surely other medical professionals have written about the difficulties of our roles and responsibilities: We are not (and should not be!) doctors or nurses for the ones we love, though it is difficult to push the professional knowledge out of our minds. Sometimes (often?) it doesn’t feel like love is enough, even as we realize that our professional knowledge isn’t enough, either.

I have spent most of my career working with people experiencing homelessness. I don’t recall newspapers and other media writing about this topic as much as they do now:

Homelessness is a federal problem. Was there ever a time when the feds tried to solve the problem of people having no place to live? What is the history of homelessness in the US?

Well, there’s actually a FREE, short paper (it’s an appendix!) from a long report about permanent supportive housing with the title “The History of Homelessness in the United States“. That article led me to the book Down and Out, On the Road: The Homeless in American History. I’m about 80 pages in and, so far, it’s not encouraging. The arguments and opinions about homelessness from 100 and 200 years ago are similar to what we hear now in 2023 (deserving vs. undeserving poor, work tests, etc.). I’m hoping the author will describe the intersections of homelessness (“vagrancy”) and health, including substance use (alcohol? opium?) and mental illness.

If this problem were easy to solve, we would have already solved it… right?

The inimitable Ed Yong is leaving The Atlantic! His stellar writing about Covid over the past three years were invaluable to me: Not only did he provide meaningful analysis about how Covid was affecting individuals and populations, but he also accurately captured the horror of what was happening.

In his recent newsletter, he shared the following:

… I want to double down on my journalistic values: not only describing what is happening but helping people actually make sense of it; bearing witness to suffering; speaking truth to power; revealing wonder in the obscure; and pushing for a more just and equitable world.

He has succeeded in adhering to his values (and received a well-deserved Pulitzer along the way). This has prompted me to consider what values I hold in my writing. (Are the values I hold in my professional role transferrable to my writing? Is writing part of my professional role? Why am I mincing my life into roles when they are interconnected, as per the first paragraph of this post?)

Let’s end this post with some lighter fare:

  • 15 Relaxing Mario Jazz Medley (just go listen)
  • If you’ve seen the Barbie movie: I know most people are fawning over the song “I’m Just Ken”, but “Push” is the underrated gem. I’ll never hear the word “granted” the same way again.

Categories
Observations Reflection

Catastrophization.

There are valid reasons why people catastrophize (to imagine the worst possible outcome of an action or event): Terrible things happen. Uncommon calamities occur, things that we never thought would happen to us. Common catastrophes occur, too, things that we know will happen, and yet all of our preconceptions do not provide adequate preparation.

Are common catastrophes really “catastrophes”? Like death and dying? Death by “catastrophic implosion” is a catastrophe by definition. What about migrants drowning at sea? People dying from heart disease? overdoses?

Do the reactions and opinions of other people determine whether something is a catastrophe? If you’re the only one who thinks it is a catastrophe, is it still a momentous tragic event?

To catastrophize is to have an active and creative mind, one that brims with possibilities. These options are unlikely to happen, but they could.

One function of catastrophization is to provide mental rehearsals. Practice gives us a sense of mastery: We thought about a Thing, we considered the consequences of that Thing, and now we have plans to avert disasters related to that Thing.

Doesn’t “Emergency Preparedness” sound better and induce less anxiety than “catastrophization”?

However, “catastrophization” often omits the “preparation” part of “emergency preparedness”: We get lost in loops of apocalyptic ideas. Paralysis (and perspiration) ensues.

More recently I’ve wondered if catastrophic thinking reflects a lack of self-confidence, or at least a fear that we are incapable of dealing with disasters. We are terrified that we will not survive.

It seems the most debilitating aspects of catastrophization do not always involve material things. We may fear the flames engulfing our home, but we fret more about the potential destruction of our pets and loved ones who live with us.

Material destruction is distressing, though annihilation of our identities is intolerable. Who am I if my children die? What does it mean if I’m the only person left who has these memories? What will happen to “me” if I can’t deal with this Thing?

Maybe this is a lesson that only comes from time and experience: We can survive more than we think we can. The world can shatter our hearts in unimaginable ways, but we persist. What was unimaginable becomes part of our personal history. We weren’t eradicated; we endured.

This is not to say that the experience was “fine” or that we are “fine”. The external and internal wreckage is real, but we are still here.

How do we persevere among the ruins, though? What do we do when catastrophic thoughts descend upon us, demolishing the tenuous safety and security we think we have now? What do you do when your thoughts take you to a world that doesn’t exist right now (and may never come into being)?

It sounds trite and overdone: Bring yourself back again and again to this world and yourself. What is actually happening right now? Where are you? What are you doing?

See the summer trees, their limbs full of luscious leaves. Hear the wind rustle the branches, a green applause filling the air. Feel your toes in your shoes, the way the small bones in your feet support all of your weight. Do you feel your tongue in your mouth?

Indeed, what is the texture of the pain in your lower back? Is it mostly sharp right now? Or a monotonous throb? Can you trace the direction of the sensation? How do you respond to it? How does it respond to you?

The sirens that wail: Can you hear how they change pitch? When does the “WOOOOoooo” finally disappear? Did you hear it dissolve, or did you only hear its absence a few minutes later?

What are the shapes of the letters in that text message? What punctuation is present? What are the colors in the emojis? What might happen if you took a full breath before sending a message? What message are you sending yourself with a short breath? A long one? A noisy one?

Life, in all its beauty and ugliness, continues to unfold whether or not you are giving it your full attention. You could live your life entirely in your thoughts, one catastrophe to the next. What might you miss in the world outside your head if you do that?

And have your catastrophic thoughts diverted any disasters? Thinking about all the things that could go wrong might help us feel like we have control over something, but do we really? Things will go wrong whether we think about them or not… and things will go well even when we think they won’t. Thoughts are magical, but magical thinking is ultimately a collection of ideas in our minds.

In catastrophization we have great confidence in our thoughts. When living in this world, let us have more confidence in ourselves. We can make it, even if we don’t believe it.

Categories
Blogosphere Lessons Nonfiction Reading Reflection

Time Millionaires, etc.

A cartoon illustration of a father and son aging together, from birth to the grave.
Artwork by Pascal Campion

Since my last post, I have recovered from illness, though spasms of coughing still occasionally overtake me. Other circumstances have changed, too, that have highlighted to me the importance of spending time with people we love. American culture often focuses on becoming financial millionaires when becoming time millionaires is vastly more important.

Here are some things I read while recuperating that may be of interest to you:

What My Father’s Martial Arts Classes Taught Me about Fighting Racism. “Self-defence means to protect yourself, to protect others around you, and to protect your opponent from committing a crime.”

The Politics of Paying Real Rent Duwamish. This is of greatest interest to people who live in the Seattle-King County area. After reading this article I stopped paying Real Rent. The tagline is accurate: “Why a simple act belies a complicated history.”

“A 1996 Super Mario 64 manga suggests that 1-Up Mushrooms grow from the bodies of dead Marios, perpetuating the cycle of life and death.” The image is what drew me in.

What It Felt Like to Almost Die. “My near-death experience taught me not to fear those final moments.” I hope that this is true for us all.

Generation Connie. I am a bit older than the cohort of Asian American women who were named Connie (and my father said that my parents never considered the name Connie for me), though I definitely remember seeing Connie Chung with Dan Rather when I was growing up. Fun photos in the article.

A Killing on the F Train. Of all the writing I’ve read about Jordan Neely, the man experiencing homelessness and psychiatric symptoms in NYC who died when another subway passenger restrained him (via chokehold), this piece by John McWhorter resonates the most with me. His perspective is kind, nuanced, and empathic. Highly recommended.

Categories
Consult-Liaison Observations Reading Reflection

Therapy and the Use of Words.

Photo by Pixabay

A flurry of mental health-related articles have piqued my attention recently, many of which are worth writing about. We’ll start with one article from the New York Times’s new series, It’s Not Just You: A Times Opinion project on mental health and society in America today.

Huw Green, a clinical psychologist, writes in We Have Reached Peak ‘Mental Health’:

The contemporary cultural landscape’s recent zeal for mental health as an important good has been accompanied by a faith in therapy as the best way to obtain it. …

Therapy is important as a valuable health intervention for many, rather than a universal prerequisite to a good life. Most people simply cannot afford to have lengthy therapy, or it doesn’t fit with their cultural or religious worldview. Do we really want to suggest that this compromises their mental health or their ability to do things like parent well?

Recently, a man at work asked me if he should “get therapy”. A horrifying event happened in his life about six months ago. Someone who cares about him has been haranguing him to go to therapy. He wondered if he should heed that suggestion.

I have provided therapy. I’ve also received therapy myself, which I found both helpful at the time and since it ended. How did I respond to this man?

“The only person who can answer [if you should get therapy] is you.” (Which I realize is a shrinky thing to say that is also not helpful. I elaborated further, which is what follows.)

I don’t think there was ever a time that I thought that “everyone should go to therapy”. Can it be helpful? Yes. Can it improve your life in multiple dimensions? Yes.

Can it take a lot of time? Yes. Can it cost a lot of money? Yes. (Do you think about things you’d rather avoid? Often. Do you sometimes dread going to therapy? Absolutely.)

Could you do something else just as valuable and healthful with your time? Yes.

The thing about conventional therapy is that it has a heavy reliance on words. You have to be able and willing to use words to describe your internal experiences, whether they be thoughts, emotions, or behaviors. You have to be able and willing to sit in a room with another person for dozens of minutes, week after week, often for months, and sometimes for years while using words. (… though I personally believe that no one should be in therapy for many years: If you’ve been routinely seeing a therapist for five or ten years and your presenting concerns or symptoms have not improved, is therapy actually helping you?)

And you know what? Not everyone likes using words. Or using words is not one of their strengths. It is true that part of the task of therapy is learning how to use words as a skill and for therapeutic purposes. While some people will, in the course of therapy, learn to use words instead of drinking three bottles of wine a night or making superficial cuts on their limbs, some people will find using words difficult, uncomfortable, or artificial.

Therapy is often the most successful when people have clear goals (that they can express in words). It’s hard to say you’ve achieved a goal when you are unable to describe it through the specific medium of language.

Furthermore, much of the task of therapy is learning about yourself: How do you react to events in life? Do your reactions cause problems or difficulties for you? For others? Does your reaction serve other purposes in your life? (e.g., Are you always apologizing because you always believe that you’re doing something wrong, and this is how you absolve yourself?) What would happen if you viewed life events, whether internal or external, differently? What if you believed you could make different choices? What if the stories you tell yourself aren’t accurate or true?

Do you need to receive therapy to learn about yourself in this way? I don’t believe so.

People can achieve psychological wellness (note: wellness, not perfection, which is what the term “mental health” seems to suggest these days) through many non-verbal activities:

  • playing a musical instrument
  • listening to music
  • dancing or other inspired movement
  • walking alone
  • walking with trees, mountains, and skies
  • drawing, whether the process is seen or unseen
  • running
  • sitting, with or without spiritual practices like prayer

… and other things that don’t involve words.

People want to live healthy, meaningful lives. Huw Green is right: Therapy isn’t required for this.