On loving

I must endure the presence of a few caterpillars
 if I wish to become acquainted with the butterflies

I’ve started to wonder again what it’s like to be in love. I know, I’ve spoken many times about being in love and have related it to my own experience, but now I feel like a novice again. What is it like to be in love? I mean, really in love; like the people who are so in love that they dedicate their lives to this love, to each other, and then they get married. What’s that like it? What is it like to love like that? I don’t think I know.

I imagine – and, yes, I believe imagining is not enough – that to be truly in love two people have to be really sure of themselves, of their feelings, of their partner’s character, and of their partner’s feelings. How else to do you put it all on the line like that? How do you accept such vulnerability if not by having at least a substantial amount of trust in someone else? It’s hard enough in this world to trust yourself (at least for some of us), but then to trust someone else too – Wow! That to me is what I have perhaps never experienced if I am now doubting whether I truly have known love.

The one question that niggles at the back of the mind of someone like me who has in the past believed that they were in love with someone else is ‘is it reciprocated?’ And an even worse and even more troubling question is ‘am I giving too much for what I can expect in return?’ I know, right, we all are told that biblical/romantic story that true “love is patient”, “love is kind”, “love is not selfish”, blah blah blah; so I should be feeling ashamed for having just admitted that those questions do go through the minds of so many of us, especially the majority of us who have been heartbroken in the past. But love IS selfish and unkind and impatient; I believe it has to be! For you to truly believe that the person whom you love is worthy of your love, you have to believe that they are someone special. And yet you have to convince yourself that they’re not so special so as to deserve someone better than us mere mortals with all the flaws in ourselves of which we have full comprehension. No, you have to be selfish and think, ‘yes, they’re special and deserve the best in the world, but I don’t care about that because I desire them to be mine’. There you go, that’s selfish! It’s selfish but I believe it’s necessary, and admittedly it is the same concept that brings about the impulse in us to better ourselves. We want to become that amazing person our own “special person” deserves – and there’s nothing wrong with that!

Is there something wrong with wanting or expecting someone to reciprocate our love? Oh yes, the biblical story again about giving unselfishly and without expectation of getting something is return… Well, I don’t believe it applies here. What’s the validity of loving someone if they don’t love you back? That is NOT love. That is worship or idolatry or something of that quality. It doesn’t console me to be loved by someone I don’t love in return, and it doesn’t rejoice my heart either to love someone who doesn’t love me in return (or whom I believe doesn’t). But besides wanting to be loved in return, I want to be loved equally.

Equality in love; oh gosh, I wish I could believe again that such a thing is possible. I mean, people get married all the time; it must be possible to love like that, right? Right? I’m at a loss here. I want desperately to believe it’s possible, but the evidence doesn’t convince me fully. Because I have been heartbroken in the past, maybe even too many times, I find it hard to ever imagine a time when I ask the question “am I giving too much?” and the answer is no. More interestingly is I (and perhaps others in my situation too) have never asked “am I giving too little?” I thought about this only a short time ago. I had never asked myself that question; and at the same time I was certain that almost 100% of the time I was giving too much, without a doubt. But what if I’m not? What if I am giving too little or what I give are only irrelevant things? Woah! That took some effort to overcome my ego to just write that last sentence. I often think that the things others are offering me are too little!

What would I give up for love? I’ve spoken of it; I’d give money, my career, lesser dreams than love, my religion perhaps, etc. But what won’t I give up? That is the more important question! Well, it would be hard for me to give up my family, especially my mother. It’d be hard to give up my desire to be a parent to a child during my lifetime. It would be hard for me to commit murder or break other deep-seated morals I stand against. It would be hard to give those things up for love, because it would be akin to abandoning my true self. What have I to offer anyone if I lack even my own integrity, my own character, my own self-respect? Sure, there is devotion and one can still do good even without a grain of soul left in you, but that is not living to me. Who would ask this of me? Who would expect I empty my soul in order to be with them? Well, some people would say that this is exactly what the devil does: ask for your soul even if there is nothing left in it. Could I love someone like that? Could I expect to be loved by someone like that? And it sounds dramatic when I put it in those terms, but you have to remember that the world we live in isn’t too far from my analogy. Adolf Hitler had a wife who adored him and loved him to the very last breath. Paedophiles often have wives who hide their secrets for them, who sometimes even assist their partners in their crimes.

One day I would like to be in love, truly in love. I would like to feel that my love is reciprocated, that it’s equalled, and that it is worth both my and my partner’s sacrifices.

On the greatest lessons I've learnt

Me and my primary school teacher.
She taught me my greatest lessons.

In the last week, several events close to me and others we’ve been able to witness through the media have made me think a lot about my own mortality and what things we’d like to leave those close to us. Most people assume this means monetary inheritance and other ephemeral things of that nature. In my case, I was born without these things and so they are of little importance to me. I got to thinking, however, of the legacies and the truly valuable things I have acquired that I would love to leave to my offspring, my peers, and to any and all who care to know of these things that Vanessa really cherishes. So, below, I’ve written a list of the most important things taught to me, or the greatest lessons I’ve learnt.

1. Education is the one thing that truly pits people as equals.

Why is education important to me? Because it was important to my mother, and it was important to her for her children to have it. My mother has a primary school education but was smart enough to know that what would keep her children out of these perpetual cycles of poverty that have dominated my family and ancestors – and that was/is within the reach of most people – is education. My family had always been peasants and servants, hard-working people but with little possessions to their name. Our name was nothing important; we are commoners. We didn’t have the money, the social or political connections, or much else. But my mum made sure that she worked very hard to be able to provide for her children not only food and shelter, but almost at an equal importance, also education. She taught us that we had the same potential to learn and succeed academically as any other person, even those with money or connections or whatever other perceived advantage. Then this, and not the name or money we didn’t have, would open our world up to as many opportunities as we were willing to accept and work hard for.

2. The single greatest thing you can teach a person is a hunger to know more, a lust to achieve more, and a passion for your subject matter. Passionate people don’t know satiety, and they also never learn defeat.

Great teachers aren’t the people who taught Nobel Prize winners the knowledge they used to achieve their success, but rather the ones who were able to transfer to them a passion into the field of their success. Passion, a burning insatiable desire, is the only antidote to failure.

3. “We are poor – not because of God”. No more effort is required to aim high in life, to demand prosperity and abundance, than is required to accept misery and poverty.

Two Napoleon Hill quotes. Why are they important to me? Well, the first I’ve discussed previously so I won’t go into it again, but the second took me a while to get my head around. It’s hard to be poor or to not attain your dreams, right? But it’s really really hard work to get what you want too. If you work hard, and I mean passionately and relentlessly hard, you probably can become a famous movie actor, a celebrated artist, a professional in a field with strict entry criteria and few spots for newcomers. It’s going to take a lot of very very hard work! But what’s the alternative? The alternative is actually equally hard. This is what blew my mind. It takes a lot out of you feeling crushed every day because you’re not working the job you’re really keen for. If you’re poor, it is really really hard to do physical labour to get just the bare minimum to feed yourself and go to bed hungry and know that you have to wake up tomorrow to do the same thing again so you can go to bed with a half-empty stomach the following night. It’s really very hard to be poor. So if both roads are hard, and I am suggesting here that they are equally hard, why not risk your pride and show some faith, and follow the path of your dreams? I mean, the alternative is just as hard.

4. You don’t fail until you give up. Failure is experienced only by those who when they experience defeat, stop trying. The only thing that separates success and failure is the number of attempts.

5. Improbable does not mean impossible.

6. You miss every shot you don’t take.

7. Be willing to risk failure in order to succeed.

8. Every soldier dies a hero.

I believe the thing that holds human beings back more than fear is pride. I will consider the last five points together as I believe they are intrinsically linked. Often people list a dim statistic for success as an excuse for not trying or for not going for the thing they really want. I always ask these people, “So? Someone has to get it, so why can’t that someone be you?” Oh yes, they tried that one time and they failed. Or they would try, but it’s just going to be a waste of time and effort as they will most likely not succeed. You know, because somehow these people believe they are fortune tellers too! The one 100% fool-proof method to guarantee failure is not to try. I mean, you can’t win the lottery if you don’t buy a ticket, right? So, as small and as uncontrollable the probability of attaining your goal on the next attempt is, it’s still greater than zero if you at least attempt it. So what if you don’t succeed? You’re only one attempt closer if you’re courageous enough to keep trying and don’t let that stupid pride convince you that lack of success in an attempt means failure forever.

That last statement came to me rather unexpectedly one day when I happened to be listening to the radio in my car to some news about a soldier’s death. Some days you have to contemplate that you will die, and you may die soon without warning. What if you died and you still had not achieved that one goal you had dedicated your life to? Does that mean you’re a failure? Does that mean you’re a loser? Well, think about soldiers. They literally risk their lives in order to achieve an outcome: to defend from the enemy and to destroy an attacking enemy. But sometimes soldiers die in battle, and when they die in this way you could say they have failed in their goal. Now, do we consider these soldiers who died in the line of fire as failures? No! We call them brave and courageous and war heroes. Yes, they didn’t succeed in what they were trying to achieve, but they weren’t failures because they died trying to achieve that outcome. I believe that similarly, in civilian life, we don’t die as failures if we died trying to achieve that one thing we really wanted.

9. Anger and hatred are the most successful ways to waste energy and to keep our enemies in power. People may hurt you in the present by some wrong action, but the anger and hatred we pay them well into the future is how we continue to hurt ourselves on their behalf.

This is one I learnt from experience when I was about 20 years old. I was getting so run down, so upset all the time, feeling so much anger and (I’m ashamed to admit it now) hatred towards one person. Now, this person had stopped tormenting me years ago and yet I kept feeling all these negative things towards them; they had probably forgotten I existed, and yet I kept hating them. It really takes so much energy to remain angry and sad! One day I realised this, that I must have been barely a speck of this person’s world and that was so long ago, and I still kept dedicating so much of my life to them, feeling for them, even if was hatred and anger. And I came to realise that I had given them enough of my life. I closed my eyes one day and said a prayer. I told them in my prayer that I forgive them, that I forgive myself, and that I wanted to forget the whole experience and become me again without traces or stains of their existence in my life. You know what? It was the best thing I could have done for ME to make my life about myself and not the people that have hurt me.

10. Money is the world’s most renewable resource. There’s no glory in being the richest man in the graveyard.

Mark Bouris once said that in business you don’t want to hire a man who has always produced a positive result, who has always managed to make his company profit. You want to hire the man who has had nothing, possibly being bankrupt due to his own mistakes – but that has managed to build himself back up. Money has a way of always renewing itself, so it’s not worth all the effort and value we place on losing it. Personally, I think we risk far too many valuable things like relationships, health, and true happiness to attain or maintain money. Eventually we will all die, and our deathbed it will probably be more comforting to have your loved ones by your side rather than the knowledge that in a bank somewhere there sits a big dollar figure associated with your name.

11. Do unto others as you would like have done unto you.

Every religion and most human philosophies will rephrase this in different words and attribute this concept to one of millions of God-like figures. That’s irrelevant, but the concept is more about the preservation of humankind, of our humanity, and of our own self-esteem. It actually comes naturally to most human beings from a very young age, but later it becomes a conscious choice of our own integrity. Mark de Moss defines integrity as, “Integrity is not what we do when it serves us. It is who we are in the dark and how we treat people when it makes no difference to us”. That’s one thing that would benefit anyone (and everyone) to learn, I think.

12. To be a man is to be responsible; to be ashamed of miseries you did not cause; to be proud of your comrade’s victories; to be aware, when setting one stone, that you are building a world.

Somewhere in the past century we all got so caught up in the various human rights movements that a corrupted self-entitled attitude came to develop from it and a lot of us came to forget about responsibility.

13. You have to tolerate the caterpillars if you want to see the butterflies.

Another Antoine de Saint-Exupery quote. Life isn’t always easy and it’s unreasonable to expect it to always be. Sometimes you just have to stay focused on what’s coming or what you want to come next.

14. Let every occasion be a great occasion.

Yes, a lot of the things I’m sharing above are of course not mine but things I’ve learnt from others. Some things I’ve learnt from experience; most are out of a book called ‘Success through a Positive Mental Attitude’, co-written by Napoleon Hill; some from my theological study; and some are probably from Oprah or the Dr. Phil show! There’s no shame in how you came to learn a thing, only that it is valuable to your own life somehow.

On levels of evidence

A patient asked me the other day if I thought she was a crazy person for telling me she was going to disregard my advice on managing her high cholesterol and high blood pressure and go have a chat to her naturopath instead. I said no, that doesn’t offend me at all. Actually, it has nothing to do with me. I had explained to her the risks of untreated hypertension and hyperlipidemia and about how medications can help those, etc. etc. I had disclosed sufficient information for her to make an informed decision on her own health. She has a right to refuse treatment just as I had a duty to provide that information to her as her treating doctor. Medico-legally, I was in a defensible/safe area. Aside from that, though, did I think she was crazy for refusing well-advised medical opinion? Well, no. And this is what I told her.

You know, I believe in God. I believe in the Judeo-Christian version of God and in creationism. I’m comfortable in believing these stories that if you applied the scientific level of “proof” are actually quite laughable. So how do I get around holding such preposterous beliefs and still having some sort of pride in calling myself both a Christian and a scientist? I don’t apply the same level of proof or set of rules to all my beliefs. And yet, why do I believe the Christian and not the Islamic or Mosaic or Taoist or any other version of life philosophy? A whole heap of reasons! Probably because the country I grew up in had 99% of its population listed as catholic. Probably because my family is Christian. Probably because Christianity was all around me and the stories were told to me since I was very young. I was told from very early on also that the people who lived in my house were my siblings, my mum, etc. and I believed it. Even now I do not see the need to demand DNA-evidence to “prove” the story that these people are related to me. Similarly, I was told stories about God and Jesus and prophets, etc., and I am happy still to believe them. But what has all this got to do with my initial story about the lady who wanted to see the naturopath?

I’ve been trained in Western Medicine. I have a system in my mind with which I approach illness and human functioning. Briefly, I studied anatomy and physiology and pathophysiology so I believe 1) The body has these organ systems working together to make the body function in the environment, 2) The body is trying to stay “alive” and function properly as it’s default, 3) When the body is failing at functioning, it is because of an illness, 5) Illness is brought about by microscopic processes, be it errors in naturally-occurring processes or external microscopic organisms bringing about this change. That’s it. That’s essentially the Western Medicine model of disease. When we approach illness, we are trying to restore the body’s function to its default. We give medications or we perform surgery to try to restore this balance somehow. We may also advise modifications in diet, physical activities, exposure to the external environment, etc. The “treatments” we recommend are based on scientific evidence that they have some effect on illness.

I am comfortable with the model of medicine I have been trained in. I am comfortable with the level of scientific evidence it demands. Because I’m both comfortable in this system and believe in the scientific method and the stringency demanded of the “treatments” in Western Medicine, I find it hard to accept other models of medicine. Is that a bad thing? That is akin to asking ‘Is it bad that I’m a Christian and not a Jew?’ No; it isn’t a bad thing. It’s what I’m comfortable with, what I know and understand, and the alternative is unknown to me. Alternative models of medicine are to me as foreign as Zoroastrianism. Because these things are largely unknown to me, I lack knowledge and exposure to them, and –importantly– I lack belief in them, it’s better that I stick to the kind of medicine and the kind of religion I know and believe.

Now, back to the point of scientific evidence. The model of medicine I practice in, Western Medicine, what I simply call medicine, has a few postulates that to me are important. For example, it demands that the positive effect of treatments be reproducible, that side-effects are minimal and predictable, that treatment is better than no treatment (and by a significant margin), and that the treatment has been tested many times over for safety. The treatments supported by other models of medicine may lack some of these stringent criteria in favour for other priorities (e.g. that it is derived from ‘natural’ products, etc.). As I said, to me (and for the majority of my patients), the level of scientific evidence that Western Medicine demands is all-important. But if others are happy with an alternative model of medicine and alternative levels of evidence that they demand of their treatment, then I can only respect that in the same way I see it as my duty to respect other people’s religious, cultural, and other beliefs.

For example, I have patients who tell me, against widely-accepted scientific evidence, that they don’t believe that smoking is bad because their relative smoked until the age of 100 and died of causes unrelated to smoking. This person requires a study of only one person who is significant to them to make their conclusions. Or they may tell me that their friend down the road told them that sunscreen causes skin cancer, and that is why they refuse to wear it. This person, again, requires only anecdotal “evidence”. Or they may tell me that blood-pressure-lowering or cholesterol-lowering drugs cause more harm than good, but the arsenic-containing but “natural” compound sold by their naturopath is the best thing for it. This person believes that a product being “natural” means it’s automatically safer and more beneficial than one that has been rigorously scientifically tested. What can I say to these people? Well, usually nothing that will change their minds if they don’t believe in the model of medicine I have been instructed in. But what I usually do is explain to them in Western Medicine and scientific terms why I believe the treatment Western Medicine suggests is appropriate, what the risks are of not treating it this way, and then ask them what else they wish to know about this particular treatment. After that, it’s up to the individual patient to make their own choices. And no, I don’t think of them as crazy for ignoring my advice :)

On "the disabled", and on limitations

In Spanish they changed the common usage of the term inválido (invalid) to the term minusválido (less-valid, or less-abled). This came about as politically-correct gesture to acknowledge that people with physical/intellectual/mental disabilities aren’t completely invalid –or useless– human beings; they simply are lacking of some standard human abilities. Of course, an aside issue that I won’t be going into is what is “standard” in humans. We all know of the concept of normality but none of us have run into a guy called Normal who has perfect stature, weight, skin tone, intelligence, emotional sensitivity, body symmetry, etc. etc. But back to the point about the change in terminology for certain people with markedly different limitations in their day-to-day functioning. An unexpected result of the lifting of labels off people is the new empowerment given back to them.

There are two stories that come to mind when I think of limitations. The first story is about 100 meter sprinters around 1968. See, prior to this year, everybody believed that no human being could run 100m in less than 10 seconds. I know I mention this now and we can chuckle or laugh at this as we’re all familiar with many athletes who have achieved this. In fact, running 100m in 10 seconds or just a few milliseconds over that in an international competition these days is almost considered a failure; but not so prior to 1968. Prior to then, humanity had come to believe –and accept– that no person could possibly ever run 100m in under 10 seconds. It was impossible! Right? God must have built into human beings an inability to run faster than this. Who questions God? Who would challenge this? No one did. Nobody could even pinpoint whether it was God’s law that no person should run faster than this or whether it was some athletics coach that decided this. Then one day one man decided he wanted to try. 

Jim Hines decided he didn’t care why somebody had said a person can’t run faster than 100m in 10 seconds; he wanted to do it. The first person he had to beat in competition was himself: his previous beliefs and his previous “personal best” (since that would have been over 10 seconds). Well, he must have tried over and over again (because no one is born at their peak ability) and he must have “failed” at his goal (running 100m in less than 10 seconds) many times. I guess he kept trying, though. Jim Hines proved God, someone, and everyone wrong at the 1968 summer Olympics when he ran 100m in 9.9 seconds. But more amazing than that feat was that Jim Hines didn’t just break a world record in running, but he busted a myth because of his refusal to believe it. And what was even more surprising and a feat more worthy than a simple gold medal was that Jim Hines’ achievement empowered others around him. That same night that Jim Hines broke the 10 second barrier in the 100m sprint, that feat that changed what we believed about human ability, that history-changing night, two other men were suddenly liberated from that limitation that somebody had said about human beings. Ronnie Ray Smith and Charles Greene ran the 100m in under 10 seconds that same night! How quickly can we change history, human ability, and overcome limitations once we allow ourselves to believe that we can rise above it.

The second story I think of regarding human limitations is about Dr. Temple Grandin, who I have spoken about in my blog before. Dr. Grandin was diagnosed with autism at age 2, this means it would have been in 1949. In 1949 society, children like Temple Grandin were thought of as mentally retarded and with little potential to be a useful or even meaningful part of society. Most “disabled” children would have been put in an institution with other children like her and left there for the remainder of their lives. No one would have tried to educate them or teach them any skills needed for daily living. Dr. Grandin’s parents were a bit different, though. Temple Grandin herself, if you had evaluated her back in 1949 and the early 1950s, would not have convinced you she had any particular potential that other children diagnosed with autism didn't have: she had a severe speech delay and she did not interact with others as a “normal” human being should have. But unlike the parents of other children with autism, Dr. Grandin’s parents didn’t believe Temple had yet reached her full potential, and they wanted to push her to it. I guess they wanted to believe that their girl was different, that she could be as close to normal despite this label of autism. So instead of accepting that Temple Grandin couldn’t talk, they sent her for hours and hours of intense speech therapy. They forced her to interact with other children and to learn what came “naturally” (or you could say easier) to other children: how to take turns, how to share, how to pick up on the emotional/non-verbal content of speech, what to say when others’ faces appear sad, how to control and self-regulate her behaviour when upset, angry, happy, etc. And you know what happened to Temple Grandin? You probably do; a lot of people do. She went on to graduate high school, she has a university bachelor’s degree in psychology, and she then went on to get a masters and then a doctoral degree in animal science. She runs her own business and designs large farm-scale machinery. She writes books and has had both books and films written about her. I suspect none of us would ever have heard of her story or that she would have even had the same successful story had her parents not refused to believe that a child with autism is an invalid human being, one without potential, and one that is unteachable.

Are there “invalids” in this life, though? Or should we push all people with physical and/or intellectual disabilities more so they can learn and change and be more like “normal”? The first question, I believe, is perhaps easier to answer. Are there people in this planet who have no benefit to themselves or to anyone in existing? I believe there aren’t. Don’t get me wrong, in our world there probably are people who exist only so their paid carers can claim a wage. Even they aren’t useless in this life; they aren’t invalids – their lives do have validity (even if only for this monetary reason). Of course, I’m talking about a worst case scenario here; the usual scenario is that people with physical and/or emotional disabilities have people around them that love them and care about them. Yet in this world the worst case scenario is not that uncommon either. We have terms like “wrongful birth”, and the termination of pregnancies due to social and medical reasons are seen as equally valid. I’m not trying to make a political or ethical point here, I’m simply pointing out that we all recognize that raising or living with a person with a physical/intellectual handicap is going to be more challenging, and not everyone wants to voluntarily submit to that challenge if there is a way to avoid it. The truth is that we as human beings have created a world that is easiest to interact with if you have an IQ of over 70, if you can walk with your own two feet, if you can use both of your upper limbs to interact with objects, if you can use your voice for verbal communication, if you can use both your eyes to orientate yourself visually in our environment, if you can perceive verbal communication and sounds through your own two ears, if you can control both bladder and bowels voluntarily, and the whole gamut of activities of daily living we associate with fully-abled human beings. So what if we want to avoid disability? There’s nothing wrong with that.

So should we be trying to make all “the disabled” into “normal people”? How many Temple Grandins can we create? Is it ethical? Is it doable? There’s a Spanish movie called Mar Adentro, about the life of Ramón Sampedro, a man who became quadriplegic from a spinal cord injury when he was young. Ramón Sampedro was a right-to-die activist who wanted nothing more than to be allowed to die because he considered his quadriplegic state, and what it turned him into, unworthy of living with. This statement caused an uproar, especially amongst other people who were paraplegic. Are the paraplegic unworthy of life?! Really? No, no; that is not what Mr. Sampedro was saying. He wasn’t making a statement about paraplegics; he was making a statement about himself. And that’s the point I’m trying to get at with this story, it is up to each human being to decide what we are willing to accept about ourselves as human beings and about our own limitations. The labels we adopt should be those we give ourselves. The abilities and limitations we set for ourselves should be those we decide. We may not all be able to learn to run 100m in under 10 seconds, and perhaps not every person diagnosed with autism will become like Dr. Grandin, but if we perhaps stop blaming the labels others have given us for our difficulties, we can start advancing.

On being a GP

A few weeks ago I wrote a mock lecture for a friend who is a nurse to “upskill” her into becoming a doctor. It was something I wrote in jest with the intention of training her to do my job (so she could see my patients while I went home to sleep). I was going through the files on my computer today when I found that “lecture” again, and I got to thinking how actually, it’s not that hard to do my job! I will show you now why I say this, incorporating part of my lecture. Think of this as something like the general practice version of the 'The House of God' rules :P



Yes, these treatment options apply to everything.


OK, now that the basics are covered – and remembering that the safest thing you can do in general practice is to do nothing, here is a more detailed (using the term ‘detailed’ in a very loose fashion) run down on the medical aspect of illness, by organ system.

Now, if you remember just a few of those things, you have very close to the medical knowledge of an Australian-trained GP. (You don’t even really have to worry about knowing how to do a physical examination. I mean, have a look at rashes and things patients like to show you, but it’s rarely going to be essential that you lay even a hand on them!)

On asking the clinically-relevant questions

There's a question out there in medical land that apparently asks whether you are racist or not. The question is: "Do you identify as of Aboriginal and/or Torres Strait Islander background?" Now, the response to this question  – which in Australia IS of clinical relevance – is not what matters, but the fact that some people are unwilling to ask this question in this first place for fear of "offending" a person who isn't of this background.

Fear of offending a racist person is the reason some people give as to why they feel uncomfortable asking the question. They imagine they may encounter a racist person who'll take offense at not clearly being identified as non-indigenous. More specifically, though, they fear that they'll meet a non-indigenous person who they will offend by implying the negative stereotypes associated with people of Aboriginal and/or Torres Strait Islander backgrounds. But who's given this question that connotation? The racist person who holds those prejudices – and that is the person fearing to ask the question! You don't know the strangers mind that you'll be asking, only that you imagine it may believe what you (either consciously or subconsciously) believe yourself.

And briefly before I leave this topic, let me explain why I say that it is clinically relevant to know whether a person is of Aboriginal and/or Torres Strait Islander background. In Australia, there is difference in the life expectancy, the mortality rate, and the burden from disease between indigenous and non-indigenous Australians. This difference is commonly referred to as “the gap” between indigenous and non-indigenous Australians. Clinically, a person may be more likely to suffer from one or another illness (e.g. diabetes mellitus) if he comes from an indigenous background than if he doesn’t, and his/her symptoms may be more likely to be caused by a disease that is more prevalent in those of indigenous background than those that aren’t. This is turn is relevant to both the adequate diagnosis and treatment of this person’s illness. Further to that, the government may have incentive programs aimed at “closing the gap” in the health of indigenous and non-indigenous Australians, some of which can be quite helpful in allowing indigenous persons to overcome some other indirect/social difficulties in accessing adequate health care. So, asking whether a person is of Aboriginal and/or Torres Strait Islander background needs to remain a relevant clinical history-taking question, and one devoid of prejudice from the person who has been tasked with the job of looking after the health of a community consisting of people of all types of backgrounds. And perhaps we should stop fearing to encounter a racist person if it will only make us become the racist one ourselves.

On my religious and spiritual journey - Part 3/3

When I started re-evaluating my concept of God and what his will was, I went back to basics. I remembered a scripture in the bible of when Jesus was explaining the purpose of what Mosaic law meant. The law given to Moses had hundreds of commandments of what the Jews had to do and not to and when, etc. The purpose of it all was to ensure that the Jews worshipped God in a certain manner and also that they be protected from harm. Then Jesus implied that after his death, Mosaic law was to be abolished and he said that the whole of God's will can be summarized in only two commandments (not the hundreds given to Moses): 1) Love only God as god, and 2) Love each other as God loves you. That was it.

I concluded that God's will had nothing to do with guilt, and guilt was not a virtue to God! Sure, the bible still has those commandments about how to practice his worship and no idolatry, no fornication, etc, but also it tells me that God does not ask of me any more than I can give and that He will be the only one to judge my sins, errors, behaviors etc. I am not God; I have no place trying to judge other's sins or punishing myself for my own. God who knows what is in my heart, my intentions, why I do the things I do, why I desire the things I do, I believe is the only person fit to pass judgement on me. And that is my "new" thinking. That is how I came to stop feeling depressed about having to make religious sacrifice and how I overcame my guilt for just being human. If I had to do it all over again, I don't think I'd pick a different faith, I'd hope I just merely came to this conclusion faster.

So what is my philosophy? As I’ve discussed previously, my personal values are my family, participating in and enjoying life while I am alive, and not making a world a worse place for anyone or anything. I believe in God, but I also believe in humanity. I believe human's greatest quality is our ability to think and reason for ourselves. I sometimes meet with a religious group whose ideology I mostly share and I call myself a Christian because I do believe in the Bible being a holy book and I aim to follow the guidance provided in it by Jesus Christ. I worship God because I am grateful to him for all I believe he has been responsible in my life. I follow the things the Bible says because I believe it is wise and its mandates are for my overall good. I’m not scared of God that he will punish me in any way because the God I believe in is understanding, merciful, forgiving, and not vengeful. I believe he is far too grand to be offended or hurt by the actions, words, or thoughts of one little person as I am. I understand also that my belief in God may be mythical, as real as he feels to me. So I hold nothing back from this life that I may experience it in an afterlife that I am not 100% guaranteed will actually happen. Once upon a time perhaps my faith was stronger, but for now this is the God and the rules and the values I believe in. This is the type of God I respect, and the type of God I want to emulate.

I love God. My God. I love the type of God that lets me love him and not at the exclusion of also loving myself.

On my religious and spiritual journey - Part 2/3

If it weren't because of the lack of contact with other believers and an ever deeper instruction in them, I would have joined a Jewish or Buddhist religious organization. I did wish that Judaism had reached out to me further rather than feeling that it was not a religion that encouraged new members from other cultures/ethnic group. So I delved further into going with what was around me, which was for a long time was only Catholicism. I asked a lot of questions and mostly I was shut down because, I was told, some things I just had to accept and believe rather than understand.

Only one religious group welcomed my questions and actively sought to reason with me using a holy book (the bible), "logical" deduction methodology, and my own knowledge of the world and science, etc. This group's philosophy and people welcomed me and I welcomed all their doctrines into my life too. The fact that I welcomed it too shaped the next few years of my life. Many of these group's ideals had been my pre-existing ideals also so that certainly helped to adopt this new religion. It interpreted the bible's New and Old Testaments largely literally - and it even tried to show with historical and scientific correlation how this text / prophecy was a true document that should inspire my belief and obedience. And I still to this day believe it is so, either in spite of or because of my academic background in science.

I came to believe that the bible was a document worthy of my respect and belief, and I believed then that I must do the things it says that I do and don't do in this life. Obeying bible advice was at times instinctive, but often contradictory to what I wanted and desired. No other aspect I think was more pronounced for me than its concept of "fornication" or sex outside of a traditional marriage. That was certainly not instinctive! Yet for very many years I bared my stake/cross and sacrificed my desire for sexual intimacy for the sake of not displeasing the God I had learnt about in the bible. I still don't feel that this sacrifice was in vain or bear resentment of it, but rather I am still proud (and amazed) that I was capable of such dedication, commitment, and self-control for all those many years.

If you asked my why I joined the religion I did (and I'm not talking about Catholicism, which I inherited and never chose), I would say it was because it was the one that to me seemed to have a concept of God and practice that I thought would most resemble a God that I could respect. This God (and this religion) encouraged my questions and helped me find the answers in a book believed to be inspired by God. He was also a God that had many good qualities, that encouraged new followers, and that gave commandments that were meant to benefit me and not merely fill me with guilt. I liked this God, and I liked what he stood for.

Over time I found myself becoming more and more unhappy, depressed, feeling guilty all the time. This was because I was finding it increasingly harder to do what God asked of me and it was really weighing me down. The more I tried to be a good Christian, the more it hurt. I became depressed. There were many reasons that culminated in my depression, but my spiritual beliefs should have been my saviour not the lead weighing me down further. Then I finally put the pieces together to my inescapable depression: one of the main characteristics of depression is undue guilt; and yet one of the tenets/virtues of Christianity is to feel guilt!

In Christianity it is believed that Adam and Eve were guilty of the the original sin (disobedience) and from them all human beings have inherited both the tendency to sin and guilt for this sin of theirs. Do you know how hard it is to overcome depression when you continue to feel guilty? I can see the futility of my thinking now, but for a long time I had no idea why so many of my other co-worshippers were suffering depression too. Guilt will eat you alive! Now, I'm certainly not saying that all cases of depression are due to undue religious guilt, but taking to this concept of Christianity as passionately as I once did does push you further down into a black hole. Luckily, I did not stop learning or thirsting for more knowledge and wisdom once I had become a full member of my new religion.

On my religious and spiritual journey - Part 1/3

I was baptized as a baby into the Catholic Church. This was not my mum's idea and nor did it actually signify anything as to what my life would be as it was purely done out of cultural and family tradition. Growing up my mum taught my siblings and I to be respectful of others, not hurt them physically or verbally, to be respectful of the law, and basically to treat all human beings as equal and as we wanted to be treated in return. She also taught us about this spiritual being called God that we could never see or hear but that we could talk to in prayer to ask for help and guidance in our lives. She taught us about this book called the bible that had all these stories about God and things he had done for other people who were "good" and others who were "bad". As a result of that I concluded that I wanted to be "good" to please this God being and have his blessing and not upset him and have his punishment in the future, which mostly meant after I was dead. She didn't teach us religious rituals or ritualistic prayers like those practiced in the Catholic Church as she herself did not believe they served any purpose.

When I was seven or eight it was decided that it would be nice for me to get to wear a pretty dress, like other girls in our town did, and partake in Catholic communion. Like my baptism as a baby, it was more about tradition than any religious or spiritual symbolism. A few kids and I met for a few weeks with a very nice and respectable member of the church to learn from an illustrated book about Catholic rituals and a bit more about the stories in the bible about angels, Jesus, his mother Mary, and also about how the communion ceremony would proceed in a few weeks. We rehearsed the ceremony and learnt some Catholic prayers and hymns. My mum had a really pretty white dress prepared for me. I still remember some of the songs we sung and the part of the communion ceremony where I forgot everything we had rehearsed for it, specially of what I was supposed to say to the priest the first time I took the Eucharist and he said something about the "body of Christ". I was completely blank standing in front of him and wondering what I was supposed to say back to him so that he would give me that sticky wafer. I remember he kept asking me over and over again, changing the intonation of his voice to a slightly more angry one, and I couldn't think of anything to say back to him. At one point he inflected his voice to sound like it was a question "body of Christ?" and I thought I had finally figured out the answer. "Yes", I said. No, he repeated it again and then asked if I didn't know how to answer properly. I said, "Yes, please". Finally a child standing behind me in line said to me "you have to say Amen". Finally I said it and the priest gave me the Eucharist, but before I walked away he asked who my communion teacher had been. I can laugh at it now but for years I felt guilty that I had gotten Cesar, my teacher, into trouble by forgetting the word "Amen". (Guilt, mea culpa, and penance were some of the catholic "traditions" of christianity that Cesar had also taught me.) At the end of it all, everyone commented on how pretty I looked in my communion dress, and that to myself and my family is all Catholic communion meant: a chance to wear a pretty dress in front of a lot of people. My baptism had been my grandmother's idea (my mother thought it was a waste of time because I was a baby and I would have had no idea about Christianity), and my communion was town tradition mixed in with vanity.

I completed my Catholic "confirmation" when I was about 10 years old or so. This time it was one my aunt's idea for whatever reason that one my brothers, her son, and I all partake in this ceremony. Again, I had to go to catholic Sunday school for a few weeks. We learnt from another illustrated book about angels, catholic rituals, and Jesus. The book was very colorful and I liked the drawings in it. We also had to go to confession where you'd tell the priest bad stuff you've done and, as if he was some sort of authority, he told you that God would forgive you if you repeated some ritualized prayers so many times. I hated going to it as I had to think for ages on what I could possibly have to feel guilty about at 10 or 11 years old so I could feed to the priest at confession. After some weeks, the communion ceremony was held and we got given little certificates, a little badge with a dove on it, and we took heaps of photos in our nice clothes. Our school principal was at the ceremony and participated in it, which I didn't like because he was very mean to everyone at school and often hit the boys' hands (and once mine also) with a wooden ruler for misbehaving. I thought he was a hypocrite and not a good person, even though he was apparently a good Christian. I knew, though, even at an early age, based on what mum and not any of my Catholic teachers had taught me, that it was not my place to judge him.

After arriving in Australia, I attended a catholic primary school (with the principal I spoke about) and then a catholic high school. High school for me was such a massive change from what I had been in primary school. I finally got over my shyness and I started to form my own ideas about life, etc. As any other teenage kid, I started challenging my superiors and rebelling just for the sake of rebelling. At school I wanted to challenge my religion teacher's doctrine, and at home I wanted to challenge mum's. My mum had started to become involved with a Christian group that went very much against idolatry and religious rituals. I began to wear a crucifix I was given at school as a necklace to irritate her. At school, I would question my religion teacher about some of the scriptures I'd overhead mum learning about at her home bible study and other things I had learn at Catholic Church too. I asked my teacher about worshipping a cross or a manmade icon when God had strictly forbidden such behaviour to the Israelites in what is commonly called "the Ten Commandments", or why I had to call the priest "Father" when Jesus had insisted that not even he (allegedly God's son) be called this let alone any other human being, or why had to talk to the priest to ask for forgiveness and not directly to God if God allegedly loved me and was all-powerful and so should be able to hear my prayer directly, etc. etc. I admit most of the time I was just trying to stir people, my religion teachers or my mum and her friends from her new Christian group, but underneath it all, I guess I was also curious about religion and spirituality. Gradually I started to become more and more interested in theology.

By the time I was 17 I was very much into reading about different religions and theological belief systems. I found Christianity particularly fascinating in that so many hundreds of denominations exist with slightly (or very) different focuses, practices or rituals, and interpretations of what is essentially the same story in one book. The common origin of Judaism, Islam, and Christianity seemed so enthralling to me. The more human-oriented philosophy of Buddhism and Eastern traditions inspired me to wonder more about what is "humanity" in humans. And the polytheist religions both inspired disbelief (because it was so foreign to all I'd ever learnt with only one God) and curiosity as to how models of religion and spirituality are constructed by the minds of human beings. By the end of my schooling and soon after starting university, I was sure I'd one day I'd either join Judaism or Buddhism. I was a lot more preoccupied with religion in my teenage years than in what other teenagers were interested in; yet not completely. Sex interested me. It interested me in the normal way, and it interested me in the way it was so closely related to spirituality in most religions.

On owning a house

I have always been scared of owning a house, but until the last week I haven’t really been able to explain it even to myself. Everyone has always told me that I should want to own “my own” home, that it’s the adult thing to do, that it’s the Australian dream, that it’s the successful person’s dream, that it’s the most financially savvy thing to do, etc… And yet at the same time knowing that it’s not my dream, I thought that I may be lacking something: maybe maturity, maybe the drive to think big. The thing is that I have rarely met people who “own” their houses, just a lot of people who think they own homes and really only own mortgages. In other words, in my eyes I know a lot of people who own large debts. I also, and not coincidentally, know a lot people who feel enslaved to jobs they no longer enjoy, a lot of people who feel a constant pressure that if they don’t earn they will lose a large sum of money and pride. I know a lot of people whose prisons are their jobs for the crime of loaning large sums of money to buy the illusion of owning the structure they take shelter in. Is the illusion worth it? Is a house really worth the slavery most people submit to for 20-30 years? But, people tell me, I am missing the point. See, they tell me, at the end of it you’ll own the house! And you were already going to be pay rent, so may as well use that same money you were already going to spend on the same thing (shelter and a living space) towards something you will eventually own. Yes, something I will own when I am over 50… and which serves me for what? Oh yeah, to live in. That’s it. That’s all the good I can see come of this.

But wait, you don’t have to just own one house, you can own several. You can own one and rent the other/s, or resell them at a higher price. And if you’re smart, you can earn a profit from doing this. Profit? Yes! Of course that is how people like Donald Trump have amounted massive amounts of wealth. However, I have to admit that I haven’t met many Donald Trumps. At the very least I haven’t met anyone who is made happy purely by the fact that they own many properties or have a lot of money. Is my view in this skewed? Yes, for two reasons: 1) I don’t know a lot of people who are made happy by money or property because I don’t share the same values as them and so don’t associate or attract these people as friends; and 2) it means little to me or my happiness how much money or property I own. If I am to be convinced that owning property is going to be beneficial to me, I have to be able to see how it would help fulfill me; unfortunately the properties and the money to be made from them would not make me feel more fulfilled.

What do I care about? My family, participating in and enjoying life while I am alive, and not making a world a worse place for anyone or anything. Call it Christian values or call it hedonism or my own particular philosophy, but it’s as simple as that for me. Yet wouldn't having more money allow me to spend greater time with my family, or “enjoy” life more, or participate in life to a greater extent, or increase my likelihood of what I could do to improve social justice or the environment? Probably. And don’t get me wrong, I usually support thinking “long-term”, but I have come to realise that life is actually not that long. Perhaps it’s as a result of the environment I grew up in with the life-expectancy of those around me being so unpredictable due to poverty and warfare, or perhaps it’s because of the job I do, but I think it’s not always wise to put off living. I genuinely worry that if I spend too much time engaged in earning (to provide for my family or enjoying life, etc), I may well miss out on my family or the time to enjoy life. Sure, most of us in Western society can quite safely expect to live past the time we would've finished paying our mortgage and past retirement, but should we really wait until then to start enjoying the profits of our labour? Maybe it is my yet immature thinking or the fact that I don’t yet have children that clouds my vision, but I don’t want to it put off too long.

Now, what if -worst case scenario- and I work, pay off my mortgage, and then die? Shouldn't I be proud and glad that at least I will have provided for my children a house for them to inherit? I mean, that’s good, right? Sure, that’s noble. How many of us, however, have not inherited houses and still turn out quite OK? I’d say that’s the majority of people. So I’m not convinced at this stage that that is a good reason to own a house. I think it was the billionaire businessman Warren Buffett who said that the perfect amount of money/things  to leave your offspring is "enough money so that they would feel they could do anything, but not so much that they could do nothing”. That is exactly what my mum did for my siblings and I and she never owned a house or anything of that cost; she just made sure to be supportive and educated us. I want to do exactly that for my children. The rest they will provide for themselves if I manage to teach them responsibility and self-reliance well enough.

OK, OK, now back to the financial reasons as to why buying a house would be good for me. I am told that if I continue to rent, then I am throwing away money, that it is “dead money”. Dead because I can’t profit from it, apparently. But you know what else is “dead money”? The money paid on interest on a home loan. Yes but I’m forgetting about the part where I get to keep my house after I have finished paying the bank back the loan and the interest! Yes, that’s nice, don’t get me wrong; and I do get the fact that you can do whatever you like to a house you have a mortgage on as opposed to one that you’re renting. For all the money I “throw away” by renting, I could be slowly paying off my house, wouldn't that be nice? Yes… if things in life could be guaranteed. I wish someone could guarantee that I will want to work with the same agility, strength, passion, and desire in 10, 20, or 30 years as I do now. Because if I lose my enthusiasm, that is when work becomes my jail for the crime of owing my house to a third party: the banks.  So most people have to keep working in order to avoid defaulting on their loans, working past the time that work became enjoyable, and working with the pressure and fear of keeping the bank fed. That is stressful! It kills the joy in life. How do I know this? Precisely because I meet people who are overwhelmed by these stresses every day at work.

I know there is stress also to pay the rent if you are renting, but I have noted one fundamental difference between those who are happy to rent and those who want to own a house: those of us who rent may stress about getting the money together at the end of the month also, but we don’t share the stress of potentially losing a large sum of money that people who default on loans take on. When you’re renting and you move house, that is it; you pay again for the chance to occupy a space you can live in. Renting is the same as any other consumer product. When we move house or as time goes by, rarely do those who rent sit to add up all the money we have “lost” by continuing to pay our rent. It is the same way that I don’t feel bad when I buy food that I have spent a small amount of money for something that is gone after I eat it when I could have instead put the money aside to buy a farm so that I could grow my own food, which eventually will overall turn out to be cheaper than all that food I bought over the years. Housing to me is just another consumer product. But those who have a mortgage and are unfortunately unable to keep paying it for whatever reason, end up owing a lot of money – and that scares me! Houses cost a lot of money and I don’t enjoy the pressure of having a debt that big.

I met someone a few years ago that told me that he was overwhelmed by the amount of work he had to do in order to provide for his family and maintain all the properties he owned. I asked him why he had so many houses. He said that it was because that was the Australian dream. It wasn't his dream, though. And I started wondering to myself ‘who is selling us these dreams, then?’ And then I read an internet post recently that answered this question and summarised the financial reasons of my fear of getting a home loan: “It is necessary that you be forced deeply into debt, and therefore forced into slavery, for the banks to make a profit”.

On camaraderie

The rape and death of Jill Meagher in the last fortnight has brought to our attention some things we take for granted in Australia: that it’s not safe in the streets late at night when you’re walking home on your own, especially if you’re a woman. Now, lets assume that we have only just realised this, what now? Yes, we could focus in about how unfair it is that a bad person went and hurt an innocent woman, or focus in about Australia become more unsafe than we previously thought it was. But I wonder if this realisation could in fact serve to inspire positive change, and in fact inspire something that becomes ingrained into our culture and our human social conscience: camaraderie.

When we realised that climbing mountains was dangerous, we went on to recommend spotters. We have spotters when we bench-press weights. We recommend hiking partners. Essentially most activities and sports that have an inherent sense of danger in it make use of the “buddy system”, where one or more people in a group mutually monitor and assist each other. Now, in some cultures the concept of mutually caring and helping the other doesn’t need a name, it is a social expectation. Looking after and caring about and for our friends is a social responsibility most people take on themselves even if they weren’t directly taught it by schools or families. But perhaps the time has come for us to be actively teaching this concept, maybe even as a (social) health promotion strategy.

There are some places in the world that have a higher incidence of crime than others, but even in the “safest” of places, there are still times when crime is more likely to occur than others. A lot of violent crimes happen at night. A lot of crime occurs where they are lots of people gathered. A lot of crime occurs in the context of alcohol or drugs… And so finally back to why Jill Meagher’s tragic story made me think of all this. Of course she did not deserve what happened to her. And of course none of the friends she went out with did anything wrong; they only did what seemed normal to them. And my proposition is that we as a society promote a new kind of normal. Her friends may have offered to take her home and she may politely refused, but rather than place blame on anyone other than the criminal that killed her, I propose we learn from this story and make some changes to prevent other people suffering the same fate as this woman. Lets make camaraderie as common as going out and having a fun time with your friends. Lets promote a social responsibility amongst people, friends we go out for a drink and a laugh with at least. Have it as a rule, even if it’s no longer an instinct in our society, that we care for the people we hang out with when we go out.  That we care from the minute they leave to go hang out with us, and that we care enough also to ensure they get back home safely.

On anxiety in medicine

One thing we don't often talk about but which keeps so many people back from their lives is anxiety. I mean, of course, not the anxiety we all feel at understandably threatening or fearful situations; I mean anxiety which affects the way we live our lives, how we express ourselves, how we work, and our health. The best way someone explained anxiety to me is like asthma: your body is responding to a fairly harmless substance as if were something extremely dangerous; your body launches a response aimed at this harmless thing and the response itself hurts your body more than the harmless thing ever could!

Imagine a military battalion being on edge awaiting for an enemy strike. Suddenly a white sheet of paper gets flown into your team's territory, the area you're meant to be protecting. The area has been quite for so long, peace was declared years ago, but your troops remained on guard as if it was still in the midst of war. When the harmless piece of paper gets flown into your troop's protected area, no one knows what's going on and no one has time to think it through. Instinct kicks in. Fire!!! The troops launch an attack. Bullets go out, grenades, bombs, all and every weapon available is used. Eventually everything goes quite and you evaluate the damage: there's giant craters and fires burning throughout your own territory and your team's supplies are exhausted. What to do now? You restock your supplies (this costs your government money, time, and effort). You rebuild the areas of your territory that were damaged, and as you do so you curse that stupid piece of paper that brought all this about. You hate him now... Then one day another piece of paper will enter your territory again. And guess what? You will do exactly the same thing! You've come to believe that the enemy IS that piece of paper. The reality is that the real enemy is that jerk who let your troops keep believing there was still a fervent war going on, and the fact that you have now forgotten to think and evaluate each threat as it arises and are acting purely on instinct.

Anxiety works exactly the same way. The reason it arose was probably no fault of your own: you've probably lived through a war that required you to be on edge all the time. But now what? The circumstances changed and so must your thinking, otherwise you risk causing your own self more harm than the anxiety/worry/fear is worth.

In my job I meet a lot of people who give up on their own health due to anxiety. Sure, there are sometimes when I see the bravest of patients who present to me asking specifically for help to deal with the anxiety which they've realized is destroying their lives. I'm not talking about those people - they've already done the hardest part: they recognize their problem and have sought help for it. These people have victory guaranteed because they've already overcome the greatest obstacle! The people I am, however, wanting to discuss is those who still cannot identify their problem and believe their ill health is due to bad doctors, bad medicines, bad surgical procedures, etc.

Sometimes I see patients who refuse surgery for, for example, skin cancer. Why might they do that assuming they already know that cancer is a bad thing and they don't want to have it? Because the plastic surgeon who would remove the skin cancer from his face was a bastard and he wants nothing to do with him. Ok, so I suggest another surgeon. The second (and later third and fourth) is also a bastard! Wait, wait, wait, what's going on? Eventually I find out that the patient is really terrified of having surgery on his face - and until he gets over his fear of facial disfigurement every surgeon will keep being a bastard! I've seen the same time and time again with patients who have gynaecological problems, gastroenterological problems, cardiological problems, haematological and almost every other type of medical problem. I've had specialists ask that I please re-refer patients after they've had psychotherapy to deal with their anxiety. It ends up delaying treatment, and some patients go on to refuse treatment altogether.

What can I do? Many patients you just can't convince that it's not that every doctor is a bastard or has mistreated them. You can ask the questions and have the evidence right in front of them that this person has a debilitating anxiety problem but same as you can bring a horse to water but can't make him drink it, you just can't help those who refuse to acknowledge their greatest problem. What I sometimes do is tell my patients about these troubled army troops that keep attacking benign enemies and end up causing themselves greater harm than the "enemy" ever could. Do you think these troops might benefit from some retraining to help them better evaluate the enemy and launch and adequate response when it's due? Yes? I'd like to do the same for you, and I know just the person to help you with some retraining. This person's role is called a psychologist. Seeing him is not a sign of weakness but rather about redirecting your strengths where they're actually needed.

It is always such a shame to see people walk away with gynaecological cancers, thyroid cancers, valvular heart disease, severe renal failure, etc. who keep telling me that they'd rather die than see another horrible specialist. What I hear is 'I'd rather die than deal with my anxiety'. It's such a shame.

On "the boat people"

Someone asked me the other day what I think about refugees, specifically the illegal immigrants that enter Australia on boats and are intercepted by Australian authorities. These last specifiers are important because they make this situation particularly unique. It’s no secret, and I consider this absolutely nothing to be ashamed about, that I entered Australia as a refugee from a war-torn country. I, however, find it difficult to form an opinion about the so-called “boat people” given that my family and I all entered the country legally on a comfortable passenger plane, were granted permanent resident status immediately on arrival, were escorted from the airport to a furnished and fully-stocked home in inner-city Brisbane, and received so much governmental support with negotiating a new country and a new language. The illegal immigrants I was asked about, although both refugees, are in a such completely different scenario that I find it personally hard to put myself in their shoes… And yet, so many people who are so much less qualified than even myself find it too easy to comment on “the boat people”.

A colleague once asked ‘why don’t illegal refugees from south-east Asia and other countries do what people from wealthier countries do?’ You know, just buy a plane ticket and come to Australia on tourist visas which they can then overstay and support themselves and escape the authorities however best they can. She suggested this would solve the issue of the Australian government having to process these illegal immigrants’ after-arrival applications to remain in Australia as refugees. Then Australian taxpayer’s money also wouldn’t be “wasted” on arresting and then housing refugees in detention centres, etc. Well, if you’re a citizen of certain countries, it’s actually quite difficult to get a tourist visa to Australia to overstay, and thus getting on a boat for illegal migration is much cheaper and easier despite all its inherent dangers. Well, this colleague suggested, why don’t the boats filled with illegal immigrants just get turned away or their passengers put on planes back to their own countries of origin before their stories/reasons for migration are heard. The reason for that is that would give the Australian government a bad human rights record… Oh yeah, it might actually be a violation of human rights.

So what do I know about refugees? I know that it must be a difficult decision to make to migrate to a country where the only certainty is that it’s not your own country (ideally for the better). When my family lived in El Salvador, people were migrating illegally into the surrounding countries, mostly northbound to the U.S.A. Around the time we left for Australia, the majority of people migrating illegally into the U.S.A. were leaving for the same reasons we were: seeking refuge from the hardships of war, the threats of death, and the intense poverty. Only a very very small minority were leaving “just for the hell of it”, and I believe perhaps no-one migrated illegally with the intention of hurting North-American citizens on their arrival. I also believe these broad categories/reasons remain true of all people who choose to migrate into another country. Why did my family migrate legally when others chose to do it illegally? Because we could. Why did others do it illegally when they could have done what my family did? Fear, lack of knowledge, I don’t know. I just don’t know. And I think that that’s the thing, that it is extremely hard to even imagine what it takes a human being to go through to make the choice where they consider it a lesser danger to hand over non-refundable money to an illegal human trafficker in order to board a shabby boat for a rough sea journey to a place you’ve never been to that speaks a language you don’t understand. How horrible must the other options have been?!

How do I feel about the “boat people”? A great curiosity to know their stories. And a wish that no person in this world had to suffer the hardships that lead most people to seek refuge in another country.

On the things we think about

When I was a kid (truthfully, until recently), I sometimes asked my mum what she was thinking about. I always thought she was lying when she’d say “nothing in particular” or “what I need to buy from the store” or “what I will cook for dinner”, etc. The thing is that I would always be preoccupied with thinking about other things, things with little direct connection to my life, things like what it must it have been like to describe and name a new illness such a AIDS or (even tuberculosis if you were Robert Koch), why does it matter so much to people whether their religious beliefs will be proven right or wrong after death if they’re dead anyway when they see the definitive truth, etc. I wondered why mum never told me that she would think of things like this. Surely, I thought, everyone has abstract thought they dedicate time to. Why would mum not tell me what her “other” non-mundane thoughts were about? Surely a person has more than everyday-survival thoughts, right?

In the last few weeks, due to some difficulties that have affected my family, I have ended up becoming a guardian for my teenage nephew. And you know what? I have finally come to understand that my mum was not lying to me; she was just too busy being a parent to me and my four siblings to have time for non-mundane thought! I have in the last few weeks found myself actually thinking about and planning things that I would normally have left until the last minute, the boring stuff, the mundane stuff: what would be appropriate meals, what would be appropriate discipline, what are appropriate expectations, etc. It really does take up time to be thinking, more so because of my inexperience at this. Yet in a way it is also, I think, a blessing because having someone depend on you forces you to return the centre of Urie Bronfenbrenner’s ecological systems theory of human development. Sometimes a person can spend so much time thinking about how to change the world, how to change the future, about how things of the world should be, that you can forget that changing the world starts at home, with families, with ourselves. 

On saying the right thing

Just a very quick blog today on things I’ve realised over the years about what to say in certain situations. The times I’m talking about are when someone is crying or sad; when someone is mourning; when someone is in trouble and worried; and pretty much any other time you’ve thought “I don’t know what to say”. The problem is that though we think there is a ‘right’ thing to say, the real answer is that these are the times when we don’t need to say anything at all. The only thing you need to be doing when you find yourself in a situation where you don’t know what to say is to not say anything at all and just listen. Yes, really listen. Pay attention, become interested, and if you must say anything, then say that which you feel, “I don’t know what to say”.

On excuses, reasons, and choice

I met someone some time ago who had some personality features I didn’t quite like. We were close for a time and so I told her that some of the things she did bothered and sometimes even hurt me. She told me that it was all because that’s just how she was, that that’s how she had turned out after been raped as a teenager by her father. Of course, that is a terrible thing to happen to anyone and I know it takes a lot of courage to tell your own story. And, of course, I also realise that childhood sexual abuse really does mess you up in so many ways! The strangeness of this particular situation was that this friend said to me fairly often “that’s just how I am” and reminded me about her father. I knew; I wasn’t going to forget what she had told me – it was something deeply serious! However, after so many times that she told me that that’s how she is and it’s due to the childhood sexual abuse she had suffered, I remembered that she wasn’t the only person this had happened to. Don’t get me wrong, it’s a very sad and disturbing thing and every single person this happens to will experience it differently and will be affected differently by it in the long-term. However, I felt that with me she was using it as an excuse for her behaviour so as to avoid apology, or – God forbid – change.

I have known a very many people who have been sexually abused as children and not everyone was as mean as this ‘friend’ was to me; they weren’t obligated to be mean by reason of their terrible experiences. When I remembered this, and at the last straw with this friend, I walked away from it all. Yes, I know that people with histories of abuse in childhood are more likely to have a personality disorder in adulthood than those who never had those experiences. And yet I also believe in the human potential for change. I know that you can take away every choice from a child when he is abused. I also know that at some point a child becomes and adult and all adults have the choice to continue to be victims to the past or to progress from there. It’s a choice. My friend wasn’t without awareness of how her personality and the things she said and did hurt others (myself included), and she was a very smart woman academically and creatively. When I told her that something she did or said hurt me, she didn’t say “I’m sorry. I will try not to do it again”. No, she would say, “that’s just how I am. You know with what my dad did to me”. Yes, I knew that. I also knew he wasn’t currently doing that her; she was no longer a victim, she was just choosing to continue to wear the victim cloak as an excuse not to alter her adult behaviour. Finally, it hurt me too much to continue to be her friend when she found it easier to say “this is how I am” than to alter her behaviour to prevent hurting those that were simply trying to be a good friend to her.

On religion and mental illness

Karl Marx, a 19th century philosopher, told us that religion “is the opium of the people”. He meant not that it makes you believe things that aren’t real and see things that aren’t there, but that it has the soothing and calming effects opium has on the human mind in amongst the turbulence of what goes on in the real world. So then the question becomes, what is real? Is God real? Actually, it’s not what I intend on discussing here, but rather an anecdotal relationship I have noted between those with mental illness and their religious beliefs.

I may have discussed it earlier, but there was the story that was told to me by a neuroscience professor: There was once a very devout Christian religious minister who developed a brain tumour. The tumour affected this man’s thinking capacity, his cognitive function, and interestingly it made him unable to understand or believe in a non-physical, abstract, concept such as God. He lost his faith not because he was disappointed in God, but because the part of his brain related to religious faith was damaged! My professor took this as hard evidence that God and religious faith is nothing more than a human cognitive construct and in fact there is no God out there in wherever a person believes he is. Now, that is a pretty good deduction, but perhaps a bit premature. For example, if the antenna broke on my TV and I could no longer receive the signals that transmit my favourite shows, would I be right in concluding that in fact the television channels never existed in the first place or even that they have stopped transmitting the moment my antenna broke?

The opposite to the scenario proposed by my university professor could also happen. Some people with epilepsy and even those with migraines can experience an “aura” before an attack. The aura is different for everyone and some will suddenly experience a particular taste on their tongue, a music in their ears, a vision in their sight, a smell in their nose, etc. – yet these sensations are all originating from brain activity, not the organs they appear to be coming from. There are the rare people who experience very complex auras, things like seeing a halo-like figure of a person who resembles how a religious figure is depicted in art, or who hear a voice like that of a relative who is now dead. Of course, in the medical world we may call them auras or a sign of temporal lobe epilepsy or aberrant brain activity, but then other people may call them religious experiences. I won’t even try to conclude anything from that for anyone, but it is an interesting thought.

A quote often attributed to Robert M. Pirsig, a writer and philosopher, is “When one person suffers from a delusion it is called insanity. When many people suffer from a delusion it is called Religion”. As a medical student doing a post in a psychiatric ward, I first started to notice how a large number of patients’ delusions revolved around God and other religious concepts. As an example, a person might believe that electricity is controlled by the devil and every time you plug in an appliance to a powerpoint then that lets the devil into your house. Or she may be obsessed with keeping her clothes clean all the time and protects them from being invaded by others and germs and other such things because she has read some scripture in the bible about guarding your heart and wearing the armour (of faith) and has taken her armour to be her clothes and she guards it by standing in the same spot for hours on end watching out that no one or nothing gets to it. Others have believed they are carrying the devil’s child in their pregnant bellies as foretold by some scripture they have read/misread somewhere. Or that the people putting thoughts in their heads are either angels or demons or God himself and that they must heed their ministry of whatever they’re been instructed to do… These people, however, have ended up in mental hospitals because what they’ve done or attempted to do has posed a threat of physical damage to themselves or others. Generally that is why they’re considered “crazy” and not just a founder (or follower) of a religion with those beliefs.

Now, I will very openly admit to being a Christian; one who believes things about God and other divine creatures that neither I or anyone anywhere on Earth currently has ever seen with human eyes. Yet I also remain curious about the relationship between religious belief and mental illness, especially when it comes to psychosis. Consider a person who has never had any religious inclination at all; perhaps someone the opposite of the religious minister of my neuroscience professor’s story. Suddenly, and I mean within a space of a few days, this person starts to believe that he can speak in a language new to him but that isn’t a language of this world or of a fictional book or film and can be understood by no one of this world. To all human ears he appears to just be making sounds with his mouth. Along with this “speaking in tongues”, he believes that God is giving him dreams that have special meaning about the past, present, and future. He also believes that he has been chosen by God and can exert God’s will of healing by merely touching the infirm of body and/or spirit. Unfortunately, due to his unique position before God, he believes that the devil (God’s enemy) is trying to hurt him. To minimize the hurt from the devil, he may engage in ritualistic behaviours such as rocking back and forth in his chair, hitting his head against the wall, or cutting himself to let out the bad energies. His new life revolves around speaking and singing about God and his newfound faith whenever he can and to whomever is around, sometimes even when no one is around… A psychiatrist may diagnose this man with a delusional disorder. Someone else may say ‘here’s a new member of the Pentecostal church who has reached enlightenment’.

Lastly, I will leave you with a comical quote by George Carlin that I found amusing:

“Religion has convinced people that there's an invisible man living in the sky, who watches everything you do every minute of every day. And the invisible man has a list of ten specific things he doesn't want you to do. And if you do any of these things, he will send you to a special place, of burning and fire and smoke and torture and anguish for you to live forever, and suffer, and suffer, and burn, and scream, until the end of time. But he loves you. He loves you. He loves you and he needs money.”