On 'what's going on' with me

'The Thinker', on top of 'The Gates of Hell'. Auguste Rodin.

O.J. Simpson once said, "They say people don't change, but I say they're wrong. People change, but it's usually for the worst". He may be a man that doesn't always speak the truth, but he wasn't too wrong in saying that. Or maybe he was. I've always believed that in life change is inevitable, but qualitatively neither good or bad, just inevitable.

Recently I've had some well-meaning people ask me "what's wrong", "what's going on with you". Now, to the majority of the non-family, non-religiously-affiliated of my friends this question may seem a little odd so allow me to provide a little background. Who is Vanessa? Some people that know me may answer this differently to other people who know me. Which is the right version? Both! All angles, probably. I'm no different to anyone in this respect. But a lot of people who know me from either being family or a religious peer will describe me as shy, non-engaging, quiet, and abiding. They see me that way because I was that way for such a long time. I am not the perfect Christian or the perfect relative, but I am presumed to be pretty close to it. Worse than being presumed to be perfect is to buy into the belief that you have to be. Even worse than that is knowing you are being evaluated at every encounter to ensure you still meet the same criteria. What can I tell you about me? I can tell you I am human.... And let's consider humans for a little while.

A human is born a small dependent child that needs the basic things we need thoughout our lives: nutrition, hydration, protection, sensory stimulation, social contact, and what we broadly call love. The difference between a child and a grown adult is that the child is initially dependent on others for all these basic needs. As he enters adolescence the social contact he needs becomes more than that of his parents and immediate family members; he seeks and needs the interaction with other peers. Later, maybe into puberty, he comes to crave a sexual relationship (whether that be physically or emotionally intimate or both). As adults we don't stop developing; our physical, social, and psychological needs change and the tasks we have to achieve to meet these needs change too. We are a constantly growing being.

Have I changed? I hope to God I have! I'd hate to still be thought of that defenceless child lying in a cot with only a cry to communicate my needs, and then waiting and needing someone to come help me meet them. Everyone changes. It's human to. It's inevitable in this skin and body to stop being human without killing yourself and hoping that those things we believe in about the afterlife are true, whatever they may be.

What's going on with me? The same thing that is going on with every other human being: living, experience, change. I can narrow one thing down, though. I was always an insecure, shy, quiet girl when I was younger. Gradually, and very very slowly I must add, I became a bit more and more confident. And by confidence in my sense I mean more at ease at accepting that I am also human, and at the same time that it is okay to be and feel different to others. I became confident to form my own identity. A long time ago Erikson, a psychologist, described a series of psychosocial stages of development that a human being transgresses as he grows chronologically older. Everyone ages; everyone equally and inevitably must grow psychologically. I guess where I am different from a lot of other people is that because of my pathological shyness, the formation of my own identity didn't happen when it does in most people: puberty / adolescence. Me, as I've mentioned in a previous post, I couldn't even look at my own body comfortably until I was 26 years old. 26! I couldn't believe or accept that that body I had to look at only because I couldn't get away from it, belonged to and was me. And that was the external aspect; I can't even begin to explain what the psychological experience I struggled with, these feelings of depersonilization and unreality, were like. I reached 26 years without yet fully defining and deciding who Vanessa was. And I'm 29 now... There are those that are intellectually retarded, I guess I prove that you can also be psychosocially retarded :)

On doctors... Part 2

Just as I thought I’d finished this post, I remembered what exactly I set out to do: provide a dual view of people’s experience of health care. Now, it may seem that above I was just taking a defensive stance to explain what is experienced by the doctor himself compared to what the non-medical population, our patients, expect. But it must be acknowledged that a lot of patients do have these, perhaps out of date, perception of doctors – and doctors would be callous for overlooking this!

It’s already established that a doctor has a very specialized knowledge, access to which you can ‘buy’ for the cost of a consultation fee. However, this knowledge is of value to every human being because it deals with something that affects you directly and in the flesh. Access to this knowledge, the service the doctor provides, could potentially save your very life – there are very few services this could be said of! Patients know this and that is why they seek them. Doctors have to equally acknowledge this, so as to fulfil our duties (for which we are being paid for). Generally, people do not present to a doctor just to hand over some money for the consult fee and waste some time. Generally, they pay their fees in order that the doctor provides advice and or treatment for a sub-optimal machine fragment. That is an important thing for an ethical doctor to realise. Now, I say ethical speaking of work ethic more so than moral or philosophical ethic. If you paid a mechanic to fix the gearbox in your car and he dismissed your concern about it because he doesn’t feel motivated to work currently, and he did nothing to repair or investigate the problem in your gearbox, then charged you his mechanic’s fee, what would you think? You would think he has a poor work ethic, not necessarily that he’s an immoral person or that he’s not a good mechanic; quite simply he has not done what he was paid to do.

Patients don’t go to see their doctors when they are happy and healthy and life is grand. They seek the doctors when they are in need. And that to me is one of the biggest realisations a lot of doctors fail to make. Even the patients that abuse us, that blame us, that threaten and disrespect us, did not come to us without a need. Perhaps it may even be that they need treatment for their abusive behaviours and just haven’t realised it. But patients don’t present to us to waste our time. They perhaps have expectations of us that are above reality, but they do have basic needs that are not being met – and sometimes the cheapest treatment we can offer them is to acknowledge and validate their concerns.

Having said that, I can only emphasize that medicine as an industry does not always obey your standard commercial industry rule to give the client exactly what he asks for. You may ask someone to sell you a plank of wood of a particular length and he will gladly comply and bill you accordingly, but from a doctor you buy a service, not a product on its own. For example, if a patient attends a new doctor demanding a script for a drug of dependence, that doctor is not obliged to hand over a script at the end of the consultation. He is required to perform a consultation and apply his special skills to determine what the treatment indicated is, which may or may not be to provide a script for a drug. And in that, the medical profession differs because we do have a duty to both aim to improve the patient’s health and also to prevent negative health effects. A doctor does not sell prescriptions, investigation requests, or referrals to other health professionals in exchange for your consult fee. No, he sells his time and specialized knowledge, which may require referral, investigation, or medicinal or surgical treatment.

I suppose if I have to summarize this whole two-part rant I’d say I was trying to make two points: 1) Doctors are normal people doing special jobs, and 2) Doctors would be silly not to acknowledge that the non-medical public does attribute some beyond-human qualities to them. People do the jobs they do for different reasons. Medicine is also a job, but a special one in the personal and direct nature of it. As human beings engaging in human-human relations, both doctor and patient in the relationship need to acknowledge the fact that we are all deserving of the same respect and care owed to each human being aside from our duty in the transaction.

On doctors... Part 1

I particularly hate labels because of the stereotypes, often negative, associated with them. But today I will discuss doctors, as a label, just like the non-medical world sees/believes it. Now, I am during the hours of 8am-6pm, Monday to Friday, also one of these doctors so I will aim to give you some insight into what this is actually about.

Traditionally medicine as a field of study (science or art, as you choose to see it) was something that was practiced by a select, if not elite group of people. Guys from the times of Hippocrates were taught by apprenticeship. They had a code of practice, and they were taught by and from the knowledge others before them had acquired. Those chosen to partake in the training to practice medicine were children of the wealthy, of other doctors, and other persons who excelled academically or otherwise, etc. It was an elite group acquiring a very specialized knowledge. Their superior knowledge and skills on which others from the village depended on placed them in greater standing in their communities. They were people to be respected, protected, renumerated, and admired for their service to the community. Such behaviour was totally understandable when it’s considered how many people in a village one physician was entrusted with caring for (often for a fee because these were rarely men of religion or charity).

Fast track to modern times and a lot of people still have the belief that doctors are special people. They believe they are smart, inherently “good”, of high moral standing, wealthy, caring, and just somehow different to other human beings. Now let me consider a few of these points. Actually, first let me consider what it means in modern times to be a functional human being. A man or woman living in modern times needs nutrition, shelter, psychosocial support (usually family and friends), industry, recreation, self-efficacy and satisfaction, and the money to be able to afford a lot of these things. Doctors are human beings too. Doctors also need these things. Doctors are human beings who are practitioners of a particular profession – but they are first and foremost human beings born of other human beings and of the same substance of every other human being on this planet.

I will start by discussing first the most banal of subjects, because it is a subject neither doctors or non-doctors like to associate to the profession: money. A doctor is a person whose job it is to deal with other human beings in order to improve their health or wellbeing. Note first that he is a human being doing a job. Jobs are done for money. A doctor needs money the same way everyone else needs money. You can’t walk into a supermarket and grab your groceries and tell the checkout personnel that you won’t be handing over money for your items because you are a doctor. No! It’s absurd. Money is demanded of doctors the same way and for the same things it is demanded of any other human being. What makes people uneasy about this discussion is no-one likes to think that a monetary value can be placed on preserving or improving the wellbeing of another person – but try doing it without it! How without money can you buy the equipment you need to exercise your profession, to feed and clothe yourself, and to enjoy the recreation all human beings are entitled to? A doctor provides a service, a product if you will, a specialized service; in return a fee is charged for this service. There is nothing abnormal about this. Teachers, engineers, shop assistants (not shop owners), prostitutes, psychologists, and even a lot of clerics, do it. Are they bad people for practising a human profession? No. They are workers employed to render a service for compensation. To deny that doctors don’t think about money and how to make it is like to deny that they eat and breathe and defecate just like any other person on this planet. Interestingly enough, unlike the nursing profession, medicine was never so inherently related to charity and religious servitude. A medical man was always separate to the concept of providing charity; he always provided a service for which material reward was often gifted/charged/expected.

The other common misconception is that doctors are somehow different, or better people, than others. Well, what kind of people go into the medical field these days? All kinds of persons. People of wealthy families, people of poorer families, people who are religious, people who are atheist, people who are accepting and welcoming, people who have prejudices, people with high academic scores, and people of not so high academic scores. At the end of your medical school training all these people are awarded (or earn) medical degrees. The prejudiced guy’s degree and that of the religious girl are both equal – and they both are now doctors. The medical schools teach you medicine, not how to be a “good” human being. Therefore, post-graduation the only thing in common of the graduands is their medical degree not their moral standing or wealth or religious views or any other societal variable. A person with a medical degree is still just that, a person. To say “doctors are special” is like saying “children like birds”. Some children like them, others hate them, some of them don’t even notice them, some wouldn’t even know a bird if one stood on its head. What am I trying to say? There are as many “good” doctors proportionately as there are “good” people in this Earth.

Lastly, I want to consider the concept of the ‘caring’ professions. One complaint patients sometimes make of doctors is that they don’t care. Now, remembering what I just discussed about how different sorts of people enter the medical profession, we have to consider that the reasons that people do go into medicine are also varied. For example, a person may go into medicine for some perceived social higher standing, because it is a profession in which continual education is inescapable, because they find biology and science fascinating, because they want to be of assistance to other human beings, because they enjoy certain technical aspects of surgery or procedural medicine, because they enjoy interacting with other human beings, because science and biology was something they were good at academically at school so they may as well use it in their work… the list is endless. Of course, most members of the non-medical community assume all doctors have gone into work in the medical field because they ‘want to help others’ or because they care about human beings to the devout (and also sacrificial) extent a religious minister might. These patients are often disappointed by the doctor who treats them as a client receiving a service (which they are) and not as a saint tending to his disciples’ every need. Medicine is a health care profession, not a ‘caring’ one that implies caring for things other than the person’s health. Your fees pay for a doctor to render a health care service, his specialized knowledge.

Of course, I am not saying all doctors are uncaring, money-hungry, immoral people who care only about themselves. No. Neither am I encouraging the general belief that doctors are superior, all-knowing, all-caring angels of God sent here to heal people of all their woes, health-related or otherwise. What I am saying is doctors are human beings. Human beings doing special jobs, but they are just human beings no more special than any of their patients.

On mental illness / addiction

Recently I went to a show by comedian Wil Anderson and he spoke of what we commonly call addiction and mental illness. Now, I don’t mean to spoil the show for anyone, but I thought some points he made were very valid (and hilarious).

Last week I wrote about the strain mental illness places on relationships and about having more tolerance for the mentally ill. The point arose about certain people then using their illness as an excuse to any and all misbehaviour. I suggested that the person whose behaviour is really a result of their mental illness and not just personality traits will often lack insight into what it is they are doing or saying, but upon being confronted will often be apologetic of their behaviour and try to change. The person who is simply someone acting wrongly and then not apologizing for their behaviour but rather suggesting it is all part of their illness and you are in fact wrong for judging them negatively – that person is most probably just a person will a bad attitude who happens to also have a mental illness. Of course, it’s not always that simple and the lines are often very blurry between what is intentional misbehaviour and what is sequelae to the condition. Now, let me raise another scenario (which Wil Anderson raised in the show): what about those people that don’t have a mental illness diagnosis misbehaving?

What I mean is people who are not known to be suffering any mental illness suddenly noted to be doing something wrong and then identifying themselves as mentally ill and thus not responsible for their misbehaviour. As an example suggested by Wil is someone like Tiger Woods who as far as everyone (even his partner) knew was just a normal guy doing extraordinary things on the golf course. Then it became widely known that he was engaging in sex with a lot of women outside of his marriage, and without the knowledge of his spouse. He didn’t deny what was reported, but he did then claim to have a sexual addiction which no-one not even close family and friends had ever known he had. Not having ever met Mr. Woods, I can’t comment on his specific case but the questions that arises are: Isn’t that suspect timing for a diagnosis? And is there such a thing as sexual addiction?

Diagnostically a mental disorder implies that there is interference in a person’s social and or psychological functioning due to the behaviour, for example loss of jobs or relationships, etc. Substance abuse / addiction implies that a ‘substance’, which can be anywhere from alcohol, heroin, or a behaviour such as gambling, continues to be used/repeated despite negative sequelae from it. For example, a person who uses intravenous heroin on the weekends for recreation and the rest of the week holds down a job and has a good relationship with friends and relatives and is not in financial strife isn’t a “heroin addict”, simply a heroin user. If as a result of his heroin use he came to lose his job, money, relationships, housing, etc. and still continued to use heroin despite this, then that person could be said to have an addiction. The interesting thing about celebrities claiming sexual addictions (or other mental illnesses for that matter) to account for their misbehaviour is that they do often lose out financially and psychosocially after their misbehaviour is uncovered. The usual course of the story is that they then enter an addiction rehab centre and they’re “cured”. Suspect? Maybe. Real? You could anecdotally note that celebrities seem to have a much lower relapse rate after rehab than your traditional addict entering a rehab program… or maybe they have better support systems as a result of money and/or fame or family and friends… or some would say maybe they were never sick in the first place. It’s easier to cure a paraplegic who can walk than one with a severed spinal cord.

What about sexual addiction? If it meets the criteria of interfering negatively on a person’s psychosocial functioning and the person continues to engage in it despite these negative effects, then a person can be addicted to almost any substance or behaviour. A person with a sexual addiction, for example, may continue to engage in repeated sexual activity until the extent that it impacts on their ability to hold down a job because they ‘need’/want sexual stimulation at regular times, they may struggle to keep stable romantic or even family/friend types of relationships because of promiscuity and perhaps even indiscrimination as to sexual partners or context; it may cause legal problems, and it may cause physical health complaints such as sexually-transmitted infections. The short answer is yes, there is such a thing as sexual addiction. Is everyone who cheats on their partner a ‘sex addict’, though? No, of course not. If he/she manages the rest of their life well and just happens to be very adept at concealing sexual encounters with other people from their partner, then they’re probably not ill, just claiming to be so as to deny responsibility for their behaviour. Which raises another concept Wil Anderson spoke about, you can’t be “a little” addicted, or “a little” mentally ill. Psychiatry makes it really easy, actually: you either meet the criteria for a mental disorder or you don’t.

And one last topical mention: Charlie Sheen. When he started shooting off his mouth, behaving differently to the ‘good boy’ Charlie Sheen we all for some reason thought we knew, people started branding him as “bipolar”. Now, Mr. Sheen himself denied ever being diagnosed with bipolar disorder and reported drug and alcohol use which he was not ashamed of. Was he lacking insight into the manic phase of a bipolar disorder? Could be. Or maybe he just wasn’t sick at all and is one of a few celebrities who is honest enough not to use a mental disorder as an excuse for general human misbehaviour.