On what we don't know

Let me propose a very sinister scenario for your consideration. I propose it only because I don’t know exactly what to conclude from it but it raises a lot of very interesting ideas.

The scenario: There’s a 25 year old man; a man who you know to be a nice guy, who is studious, who is playful and just generally a fun guy. He is a foreigner and speaks with a somewhat funny Indoasian accent. He goes to university and he likes to tell jokes. He is respectfully religious but not over-the-top with rituals. He even volunteers in a community youth group. One day this guy is joking around, playing with a boy who is 11 years old. In the spirit of the moment he makes a penis joke and makes a move towards the child’s genitals. The child pulls away, pushes him, and the day proceeds. One day this man is accused (by a third party) of indecent sexual dealings with a minor because of this particular incident.

Now, all of which I described above actually happened, the actions are exactly as I described. You can picture the man, you can picture the child, you can picture that they were having a laugh and engaging in the physical play which all children enjoy. Even the man in question clearly admits the incident occurred as described. However, the only things we don’t know are the thoughts and intentions of the 25 year old man. The matter went to court and the man was ordered to have no further unsupervised dealings with children, especially not in institutional settings like in his university studies. He was sentenced to 12 months probation and nothing else. Now, most people’s responses to this story are either 1) ‘the pedophile got away with it!’, or 2) ‘I know that guy and he’s totally a nice guy. It is such a shame that he has had his name tarnished with such a terrible accusation’.

Further from this, let’s consider one possibility. In the case it was alledged that the man meant no ill-harm because when the child pushed him away and said ‘no’, he obeyed. It follows from this that the man was acknowledging that this contact was against the child’s wishes. They added this to his character references from people who knew the man prior to this incident to conclude that he was a good man who was innocently playing with a child, joking, and incidentally happened to have made a move towards the child’s sex organs while in the course of a non-sexually intended activity. Makes sense, right? Good guy made bad move.

But imagine for a second that he wasn’t a good guy; propose he is a big bad pedophile. What would a pedophile do in the same situation? He would play a non-sexually-seeming game with the child to “groom” him, to teach him increasingly more sexually-explicit acts that the child will not associate with “bad” (or sexual) things. In the way of this grooming he will “accidently” touch the child’s genitals or allow the child to accidently touch his. The child thinks ‘we’re playing!’, meanwhile the pedophile just scored sexual contact. As I mentioned, the “play” will become increasingly more explicitly sexual, but the grooming for the pedophile involves a bit of trial and error. Sometimes he overestimates his steps; sometimes the child is more docile than first imagined. If the child were to become uncomfortable in a situation, he knows he has to slow down – because a comfortable child is much easier to take advantage of! Can you see where I’m going with this? If the child in the scenario had not pushed the man away, what would have happened? The man would could either have just been playful with the child and possibly never meant to even touch him (like a ‘normal’ person); or he could have sexually fondled the child to his own sexual gratification (like a pedophile). So therein lies my problem with judging the man either guilty or not-guilty of a sexual crime against a child: the fact that he withdrew his attempt does not prove his actions either way.

The second question this case raises for me is which is better? When this case went to court there were four possible outcomes that could have come from a verdict of either guilty or not guilty: 1) an innocent man walks free, 2) an innocent man is punished, 3) a pedophile receives deserved punishment, and 4) a pedophile goes free. All of these outcomes have an equal probability of happening. I would hate to have been a judge in this case and have to make that very hard decision. Ideally the evidence of the case helps you make the right decision (options 1 or 3 above), but as we saw in this case, judging intention is something that maybe only God can do. So now the judge has to make an even harder decision, which is the least unjust finding: set a guilty man free or convict an innocent one? Of course, the case we are considering here is not just any case, but an accusation of pedophilia. And in fact, that is what the judge based his decision on in setting the man free. He reasoned that if the man is innocent because he didn’t actually “do anything” to the child then he hasn’t been unfairly deprived of his freedom. Yet if he is guilty then his punishment will be that his name will be always be known and associated with ‘that guy that tried to touch that kid’.

Of course, to the general population this may not seem be enough (punishment to a presumed offender). After all, don’t the courts and governments also have a duty to protect the public from exposure to harm (e.g. pedophiles and other villains)? Yes, it’s in the constitution of most countries’ governments. But before I consider this last point, you have to excuse me as I recede back a step.

The man in the scenario we discussed in the beginning in fact pleaded guilty to the actions of that day as they happened (and conceded the possibility that they could be deemed to be pedophilic in nature – thought he never said that it what he intended). So the judge never even had to make the judgement of labelling the man “guilty” or “not guilty”, he just had to decide on the punishment for the man’s actions. So in a way you could say that a guilty man walked free based on the judge’s reasoning as was discussed earlier. And maybe that is what we need to focus our attentions on: setting adequate penalties for crimes against children. I know the frustration of victims and of police officers who strive to find the bad guys only to have them go to court and receive a sentence that seems to be but a mere formality and without any intention to actually punish offenders, to rehabilitate them, or even to protect the public.

(P.S. I hope the guy whose story I based my scenario on can forgive me for using his example to illustrate my point. Only God can judge you.)

On teen suicide... and living

A few months ago when Declan Crouch, a 13 year old boy, went missing, his disappearance was likened to Daniel Morcombe’s. However, after some time it proved that the age of the boys and the fact that they were reported as missing persons may have been all they shared in similarity. The fate of both boys have become more clarified in the recent months and it’s not my intention here to rehash the news. But I do want to rehash a thought I once had on teenage suicide.

I read a book by Udo Grashoff called ‘Let me Finish’. It’s a copy of and study on a series of suicide letters. One of the interesting findings is that the suicide letters written by teenagers are the most mysterious, confusing, and give the least detail on motive. They're often very profound philosophically and spiritually. They list their motives not in terms of their personal struggles, but rather about the plight of humanity in general. For example, a child who is being bullied or is being subject to abuse from their carers actually rarely writes about their personal experience and their circumstance. Their suicide letters tend more to be filled with their insights into humanity, the negative aspects of our society in general, and they often conclude with a wish for us who remain alive to be well. To an external party looking at their case we may see a child who was suffering due to abuse and become so stressed that they choose to end it all. What the children themselves tell us is that it is not dissatisfaction with their own circumstance, but rather with our society and our world in general.

One of the things often said of suicide is that it’s a permanent solution to a temporary problem, and in the case of adolescents you could even argue that their decisions are made on generalizations about the rest of the world based just on their personal negative experience of it in their microcosm, for the short time of their lives that they’ve had to experience it. However, having said that, isn’t it true that our world is, in fact, a lot like a typical adolescent’s microcosm? The ‘popular kids’ with money and power (corporate types and politicians) set the trend for the majority of us. The majority of us are here just to do what they’re meant to do to survive (the ‘working class’), and trying to behave so as not to piss off the popular kids or those in power, like our parents and teachers (law and government). And no-one really wants to get in trouble with these people (jail-time, fines, oppression, getting fired, etc.)! When teens suicide, we as adults think, 'but they have so much more to lose by dying', but it's almost as if they leave us saying 'we have so much more to gain via death'. And compared to more mature adults, their decision to die seem to be more definitive. They hesitate less.

Is there something adolescents see about our society that makes them so sure? Before I get onto that, I just want to acknowledge that we already know that the human brain’s prefrontal cortex, which is tasked with making our ‘mature’ and ‘rational’ decisions, isn’t fully developed until about the age of 21 years. Of course, people “mature” at different rates and it is said that females will reach this stage before males do. It is also not a yes-no type of separation between maturity and immaturity. Possibly since before the age of 2 years a child can make decisions based on preference (of colour, taste, texture), etc. Gradually, as a child matures, different aspects of a particular choice creeps into their decision-making process (e.g. immediate and long-term consequences, cost, effect on self and others). So what I am trying to say is that I acknowledge that an adolescent is not ‘fully mature’, but taking a look into their thought process is definitely worthwhile, especially given that a teen who suicides is making a very significant and conscious choice.

What, in signing off ‘I have so much more to gain via death’ does a teen aim to achieve? An older adult may see in the teen potential in terms of years of life remaining, in abilities that can be developed, and in knowledge to be gained. But it's almost as if the teen turns around and says, 'I can see where this is going and I'm not interested'. What exactly about our world are they seeing? I suggest that a teen may be rejecting a world they perceive as being unjust or incoherent. Now, I already mentioned that they may be overgeneralizing their particular situation to the whole of the future and the whole of society, but let’s pose for a second that they aren’t exaggerating in their perception. Let’s consider. for example, what the “adult world”, the “real” world is like.

As a child when I didn’t get my way, I cried and threw a tantrum. As I grew older I learnt to hold back the tears and the rage (things I instinctively want to do when I don’t get my way), to accept that things aren’t always going to go my way. Now I was considered mature. Yet the same reality was still true: I lost! As adults we always have a choice, though not all options necessarily produce equally ego-syntonic results: to accept things as they are, or to act so as to change them. The truth, however, is that most people live in stagnation, we get too used to accepting injustice; trying to change things is too hard. That’s the reality and cowardice a lot of people live/exist in. A lot of adults in our society become docile little cogwheels, indifferent, accepting of injustice (to ourselves and other human beings), dampening our true feelings and passions, working the jobs we have rather than the ones we want – always at the bequest of the ‘popular kids’ and in fear of punishment. How is that living? Really? What really is the difference in between an existence like that and death? I can see how to the teen this inaction may look remarkably close to death already.

And yet having said all this, you’d think I’d be petitioning for us all to suicide! In fact I’m petitioning that we all instead start living, deciding our own fates. Every revolution is fought by individuals, and we are all qualified. No-one ever asked permission to start a revolution. So why not start living as if we were actually alive?

On a curious incident

A few weeks ago I received a phone call at work from Centrelink, our blessed government welfare agency. Usually when they call doctors it’s to verify that their clients haven’t been falsifying medical certificates to exempt them from job-seeking activities or to ask further details about a patient’s medical condition on one of their thousand forms (which they so commonly misplace). This time when they called me, it was to ask another request of me: to diagnose a medical condition that would label my patient as permanently disabled. Wait, what?! To make my patient sick? To label my patient as sick? But, more intriguingly, why? And here was the Centrelink officer’s reason: because it was getting to be too much hard work to try to find this patient work!

I get it; sometimes the patients want us to give them a medical certificate to excuse them from work for a few days, almost always for very legitimate reasons. Then those who would cheat the system regardless of whatever system was in place want us also at times to write similar certificates to secure government disability pensions, have their airfares or gym memberships refunded, to postpone academic assessments, to get those much-coveted disabled parking permits, etc. etc. But this “please diagnose disability” did not seem to me as a simple request (even though you could very rightly refer to it as a request to be a co-participant in federal fraud); it was at least to me about something much more than about money. It also was not something the patient himself has asked of me.

I’ve previously discussed about the dangers of labels. And surely also some labels have their advantages, for example, in forming self-identity and bringing likeminded people together. However, my concern at this particular request was (aside from the fact it is at least unethical if not illegal to lie about a patient’s medical condition) about the effect labelling my patient as disabled, as ‘writing him off’, would have on him. The patient had seen me previously and not asked that I fill out any Centrelink form and surely did not mention about considering himself unfit for work due to physical and/or mental limitation. As almost every other patient that walks into a consulting room, their focus was on getting better and that was what we discussed – and one reason he wanted to get better was that he was keen to re-enter the workforce and get on with other socially-enriching activities of life! This reason especially is why the Centrelink officer’s request so surprised me. Of course I asked her to not just send me forms but rather to send me the patient back because I wanted to ensure we were all on the same page.

In short, the Centrelink officer’s agenda was an act of desperation because she was struggling with her own job: helping my patient find paid employment. It is very much easier in this, as in many other “people jobs”, to just give people what they want despite the company policy or government rules or laws or our own position on a matter. It’s the easy way, right. But the easy way is so rarely the right way. What I’m trying to say is I don’t blame this poor public servant for wanting to make perhaps two people’s lives easier. What I do, however, have a problem with is to allow this person (the patient) to opt out of life.

I say opt out of life rather than opt out of the workforce or even opt out of ‘effort’ not to be dramatic, but because a simple fact of human life is that in the majority of situations we define ourselves by our work. Think for example how when you first meet a person one of the first few questions you ask them is what they do ‘for a living’. Knowing this tells us a lot about a person, yes based on stereotypes, but in education stereotypes are one of these essential things for learning. Knowing what a person does for work tells us about their education, their finances, their likely social circles, etc. But, of course, none of these things are of primary importance and the stereotypes fade once you get to know the individual. Have you ever been unemployed or met someone who is unemployed and they referred to what they previously did for a job or what they’re looking into getting? It’s a bit of a matter of healthy pride, to let you know that they are still a part of human society.

I have previously touched on the concept of maintaining societal involvement in order to preserve our mental health. The DSM defines mental illness by a variety of particular symptoms, and furthermore that they cause significant “distress or impairment in social, occupational, or other important areas of functioning”. For example, we all have felt sad but not as many of us have been so sad that it interfered with our ability to shower or eat, etc. for weeks or months and so being able to be rightly diagnosed with depression. OK, but here I am discussing not mental illness but rather societal involvement. Mental illness leads to decreased involvement, but it also worthwhile to consider that the decreased involvement can also exacerbate negative mental states. As I have mentioned in a previous post, one of the methods used as punishment in our society is imprisonment. The punishment isn’t just about keeping you separate from your family, friends, and other people, but also of depriving you of all other types of social environments such as work.

So, let me summarise why this whole incident caused me such a dilemma 1) it was not a request by my patient but a third party, and 2) I didn’t feel right about labelling my patient as disabled, and 3) I didn’t want my patient to be excluded from societal involvement and be exposed to the negative effects that come with it. 

On the government 'doing something about it'

One of my favourite quotes ever is by Lily Tomlin about a realisation she once made that changed her world: “I said ‘Somebody should do something about that.’ Then I realized I am somebody."

The reason I was thinking of this quote recently (besides the fact I have pinned a copy of it in my room for years) is I was reading a comment in a medical magazine addressing the high rate of mental illness in our society. The writer rightly identified that it is the way our society has been shaped, leaving people with few others able to be called friends, people to talk to, less faith in the spiritual and religious clerics, less time to meditate and accommodate our inner thoughts, that have contributed to greater psychological distress levels than before. Our jobs demand increasingly greater time and mental efforts, our motives have been adjusted to the pursuit of material things rather than personal growth and realization, etc., etc. But it’s not that that I want to discuss today, rather it is the next part of this commentator’s contribution. She suggested that ‘the government should do something about it’. “It” referring to having less friends, spending more time at work, etc….

The government should do something about it. Really? “The government”? The government is expected to tell us and mandate how we spend our time on this Earth, who to trust and who to believe, what to prioritise? I couldn’t believe such a suggestion should be made by someone who is in our society regarded as “intelligent” just by virtue of having earned a medical degree. But the issue isn’t one of how intelligent a person is but rather of feeling so drained of power. Remember Seligman and Maier’s dog experiments where they described “learned helplessness”? That is exactly the situation so many of us can find ourselves in when we forget that we are human – and powerful! Even a very academically learned person can learn helplessness, believing that an only an external, greater body can bring about change. It is such a shame that we have forgotten that we as individuals are in the driver’s seat, that we are deciders of our fate not merely victims of it, that we can be the somebody that brings about the change you long to see. And I don’t mean to imply that we are one individual to change the world (though that is also a choice if you’re brave enough to believe it), but ‘the world’ radiates out from ourselves and it does start with us.

The other thing I find disturbing about  the government ‘doing something about it’, being expected to bring about change not just in operational standards of running a society but also in that society’s consciousness is that the past has shown us that it’s not a very wise choice.  Some of the things democratic societies pride themselves on are things like freedom of speech and religious choice, etc. But handing these rights over for the sake of uniformity is a very dangerous thing! By definition the way governments “do something about it” is by enacting legislation, by outlining specific rules and specific exceptions to these rules. Human psychology is not very amenable to these sorts of rigid concepts! Consider, for example, countries with laws governing certain types of “morality” where governments can make it a crime to have sexual intercourse between consenting adults who are not legally married to each other or who are of the same sex. That is a government with a right to govern over private matters, with a right to “do something about” the things you do in your own bedroom and a right to mandate who you can express your feelings for.

What am I trying to say? I am just hoping to remind us that we aren’t powerless, helpless, completely reliant on external constructs to bring about any change. If we identify a condition we are dissatisfied with, it IS within our power to start a change.