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 "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 "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 Jews"

I'm on holidays at the moment so here's just a few lines on things I've been thinking about recently.

I just finished reading a book called "Outliers" by Malcolm Gladwell, which I at first thought was about the absolute opposite of what my core beliefs about success are: that everyone has the same innate capacity. And, yes, at first glance it appears to be saying that you can expect to be in low-skill service jobs if you're Latino, you can expect to be good at maths if you're Asian, and you'll probably be a doctor or a lawyer if you're Jewish. And if you're of African descent you'll probably want to kill and physically hurt others for minor slights. Generalizations? Stereotypes? Actually, it deals more on examining the roots of why people turn out to be the way they are based on specific things that happened to the ancestors of their culture, and that for the most part continue to imprint on their futures. An interesting note was made of New York's Jewish community.

In the last week I made my mum visit the Museum of Jewish Heritage in New York with me. Now, she's a very humble woman with a primary school education who can barely pick out the location of countries on a map of the world (e.g. not long ago she was surprised to find out that Spain is in Europe and not in South America like she assumed for a long time). You get my point: she's a humble woman with not a lot of knowledge of what is not essential to her survival. At the Jewish museum while we were looking at concentration camp uniforms and learning about the disgusting things that happened to so many people during WW2, mum asked me, "why did all this happen to the Jews?" I thought it was an excellent question! There's probably no single answer why that did, and there's definitely nothing in this universe to justify it.

What I find even more fascinating, though, is how a great majority of the Jewish community post-WW2 became so prosperous. They were always an oppressed and abused people. They were workers and they had to learn skills. Since thousands of years they've been working (even under slavery conditions) - they had to learn! So the theory goes that around the time of WW2 when dislike of the Jews was quite overt and common, even in the new lands they settled in they were discriminated against for many reasons. So to escape this oppressive environment, Jews after some time used the skills hey had learnt previously, textile and garment industry, for example, and started up their own operations. They hired other Jews. They taught their children the importance of work to better yourself and aiming to equalize opportunity (I maintain that this is the true value of education). The story goes that the children of garment workers went on to become lawyers and doctors and business people at the insistence of their parents - but after they became lawyers (for example) their gentile counterparts still discriminated against them. They ended up working the legal cases nobody wanted, working the medical fields nobody else considered worthy at the time (things like psychiatry and neuroscience, for example). And then, something happened: the Jews had created niches of industry for themselves - which as fate or history would have it, soon became the most sought out niches in industry.

Why did the holocaust happen? I guess there's no valid or all-exhaustive answer to that. But you know what, I believe the best thing the Jewish people ever did was 1) acknowledge their position as others viewed them, and 2) used it not as an excuse to become victims of oppression but to motivate forward action. They were people who once they left the concentration camps, they left the concentration camps. They didn't sit down and feel sorry for themselves for their dreadful pasts and suffering. They began to build instead their prosperous futures. Can't we all learn from that? Once the suffering is done with, let's stop suffering and start building a future we desire.

On birthing - part 2

I once met an obstetrician who told me “a healthy baby lives, a sick baby dies”. That was his approach to that time around the birth of a child and also to prenatal care. At the time, I was quite shocked! I thought, then what is the point of medical advances in technology, of medical research, and basically of “medicine” in general? We have studied disease, pathophysiology, human anatomy, microbiology, biotechnology, and devised all sorts of theories and methods to try to keep people alive and healthy. What’s the point of medicine if not that? Well, the obstetrician’s theory was that we may have studied too much, devised too many new things, and medicalised too many things that would (and should, apparently) be just thought of as part of human life: things like childbirth and pregnancy.

I admit that it does concern me when you consider the massive amounts of money spent in neonatal intensive care wards and the number of chronic health problems suffered by those born prematurely. Over the past few decades, the gestational age at with a child could be born safely and with the best chance of survival has drastically lowered. At one point in history, a child born 6 weeks before its due date had little chance of survival. Then someone decided that this should not just be accepted as fact and the chance of survival could be increased by some or another medical intervention. Gradually, newer and newer methods have been devised to support the survival of increasingly more premature (younger) babies. However, the issues has become one not just about supporting a premature baby to survive its first few months of life, but these babies go on to become infants, adolescents, and even adults. The earlier than anticipated a child is born, the greater his chance of dying. The medical efforts needed to keep these babies alive costs a lot of money. Then after ensuring the baby will survive into infanthood, the fact is the younger that child was born, the greater the risk that he will suffer chronic, sometimes lifelong, health problems. The management of chronic health problems of children and adults again costs a fortune. The life of a person who is prematurely-born is, therefore, very draining of resources, economically speaking.

Would it be better if we made health care decisions based solely on economics? Or would it be better if we based them based solely on “nature”, and ‘let nature take its course’ when a woman goes into labour prematurely? Why do we find it so repulsive to accept that “a healthy baby lives, a sick baby dies”? The truth is that the majority of us human beings couldn’t sleep at night if we made decisions like this. If you ask the women who have given birth to premature babies, even extremely premature ones, if the life-saving efforts to keep their children alive into adulthood were worth it (even if that life went on to be marked by chronic illness), do you know what almost all of them would say? They’d say “Yes, of course it was worth it!” And that is because you are talking about a person to whom they have a profoundly close connection, and also because it is a small “innocent” child, apparently deserving of all our best intentions, efforts, love, money, protection, etc. etc. It is also another human being, a person. You could summarise it by saying that we are humane towards other human beings; we are human. That is why we act so many times against logic, against “nature”, against economic viability, and against the greater majority’s good.

For the majority of persons, our instinct is to promote the survival of ourselves and other people; but when it comes to fetuses, there has always been a discussion into whether or when they can be considered a “person”. Now, I’m not about to go into a philosophical, theological, or bioethical discussion about abortion because frankly I think that is a discussion an individual can only have with themselves and come to their own conclusions; I only care to discuss an interesting scenario that was recently raised. Some Australian philosophers made an argument that newborn children are no different to fetuses because they do not understand or yet know what life is, let alone appreciate it. They don’t know what it is to be human, they don’t identify themselves as persons, therefore, they are not persons with the usual “standard” human rights, including a right to be alive. In theory at least, then, you could extend the arguments raised about fetal abortion to “post-natal abortions”, i.e. a newborn child being considered no different to a fetus. If is right or wrong to carry out a procedure to procure the destruction of a fetus with no known congenital defect, so it should be right or wrong to destroy a full-term newly born healthy child... Before I digress, let me just ask if a child has rights? If so, when do those rights come into effect?

Now, I wanted to discuss birthing and not actually “abortion”. Ms. Janet Fraser, whom I spoke about earlier, claims to have incorporated into the coroner’s investigation into her daughter’s death, a stance to defend “women’s rights”. Specifically, she wants acknowledgement of a right of a woman to decide the birthing method of her unborn child, independent from any right owed to the child (or potential child). That’s ok, right? Legally, a cognitively competent person has a right to make decisions over her own body and any intervention to it, medically or otherwise. That legal right overrides the fact of whether an intervention is actually good for you or not. For example, I can refuse to have any surgery being performed upon me, even if that surgery can save my life and without it I will undoubtedly and precipitously die. But not just life-saving surgery, I have a legal right to refuse any medical intervention at all… What about epidural anesthesia at the time of birthing, is it ok to refuse that? What about antenatal care? I mean, pregnancy is not illness, so why should a person be forced to see a medical person, right?.. And what about fetal monitoring? No woman in labour particularly wants to be touched by anyone else. What about wanting to deliver a child traditionally at home and not in a modern hospital, particularly if you are scared of hospitals? And what about assisted delivery, I mean that is rarely to help the woman, is it? What about refusing a caesarian section, that’s a type of surgery so why should a person not have a right to refuse that?...

Why are these questions interesting? Because we accept that a person has a right to make decisions about their own body and their healthcare, but we are also aware that the decisions of this person affect another human being (even if we don’t consider them an independent person yet). Though we are unsure whether this “person” or “potential person” is owed any rights, we have this niggling little feeling that they deserve at least a chance or some consideration in the whole argument. What is the answer? Should a hierarchy be legally set up to nominate whose rights are or whose life is more important at the time of birthing? I don't claim to know what the right answer is, but unfortunately in the world we live in, people tend to be motivated more by laws and potential for punishment (or material reward) than the things that moved us in the past. I guess we can’t expect all people to reason that they will sacrifice something, anything, to ensure the safety and health of their child as a priority to their own personal preferences.

(I will not be donating any of my money to Ms. Fraser’s ‘fight for the rights of all women’, mostly because I appreciate and encourage more people [and not just women] to consider at least in some situations, that other fellow human’s lives are at least as worthy as their lifestyle preferences.)

On birthing - part 1

I recently read a blog post by Janet Fraser where she asked for donations to help fund a legal battle she’s involved in. There is an ongoing coroner’s inquest into the death of her baby so it’s hard to comment on what still has a large number of unknown facts. Briefly, the allegations are that around late 2008, Janet Fraser became pregnant with her third child and decided that her child would be birthed at home without the involvement of any medical or nursing staff. There were apparently no medical antenatal checks during her pregnancy. In March 2009, she went into labour and as she and her partner had planned, they prepared for the birth of their child in their home. At the end of the labour, she delivered a full-term baby that was dead. Resuscitation attempts were made by the child’s father, and then an ambulance was called to take the child to hospital. The baby was not able to be resuscitated. Janet Fraser is not on trial for murder of a child; she is involved in a legal fight to establish her (and, as she claims, all “women’s”) rights to be able to opt to give birth at home, unassisted by medical staff.

Janet Fraser has delivered 3 children, the first of which was born in hospital. In 2003, Ms. Fraser was admitted to hospital for delivery of her first child. The whole interaction of this visit was experienced as a very negative, indeed “traumatic”, experience for her. The physical (aka vaginal) examination was unpleasant, the medical and nursing staff made medical and nursing decisions (apparently for and about her and not in conjunction with her), and her right to a vaginal delivery was denied. A caesarean section was performed for delivery of this child, as deemed medically necessary for either mother and/or child. Ms. Fraser felt that this “medical need” should have been no reason to overlook her right to make health care decisions (i.e. whether to have surgery or not), and a result of this she felt personally violated by the hospital system when the caesarean section was performed on her. This hospital birthing experience came to be interpreted by her as akin to rape. She never wanted to experience this ever again.

For delivery of her second child in 2006, Ms. Fraser wanted to avoid all possibility of having a caesarean section performed upon her (presumably against her will) and so decided to deliver this child at home. She eventually went into labour and this lasted 50 hours. After the birth of the child, she suffered a severe haemorrhage and was taken to hospital. Upon admission to hospital, she reported to hospital staff that she had only being in labour 3 hours so as to avoid potential reporting to policing authorities for child neglect or abuse (from willingly submitting the child to a prolonged labour). I wonder if she herself considered that this whole thing could be called child neglect or abuse had the possibility of prosecution not been raised…

Delivery of her third child in 2009 was attempted in the same way that of the second child was, at home. I guess Ms. Fraser considered that the risk of having another difficult birth after 2 previously difficult births did not warrant the greater medical care that may be offered in hospital. Everyone takes risks in life, right? There is always the chance that mum and/or baby could die during birth, regardless of where it takes place. There was always also the chance that Ms. Fraser could have delivered her third child healthily and so smoothly at her home that none of us would ever have heard of her. She must have weighed up those possibilities, the consequences of their potential outcomes, and then made the decision to deliver her child at home. The outcome was a dead baby; the consequence is that that outcome is final.

On money and healthcare: Rights & Priorities - Part 3/3

As a doctor you often see people in a very vulnerable state of health walk into your room. Your job is to provide some sort of health care to that person. It is a paid job just like anyone else’s job for which they trained and invested time, effort, and money. Why any of us decided to become doctors and not hairdressers, teachers, politicians, carpenters, etc., is different for everyone and that is not the point. The point is we are workers same as anyone else doing any job. You do the job for a certain amount of hours, you get paid for doing that job, and then the money is yours to do as you wish. That’s the essence of working in a capitalist, democratic country like Australia and the U.S.A. regardless of what your job actually entails, right?

The doctor is a bit like a hairdresser or an accountant or a lawyer or a politician in that he doesn’t physically sell you a product, but rather a service. A patient walks in, you carry out an assessment, work out what he needs, and advice or give that treatment required. Patients don’t leave the room with a new bag filled with products they’ve purchased, but the same thing happens once you leave your hairdresser or accountant – and yet you are aware you need to pay for the service provided to you. And yet you could say that the service provided to you is at least a little more essential than a haircut or advice about things other than your health. One of these things could potentially be the difference between life and death. I have never heard of anyone who risked death by having long or unkempt hair…

So here is the dilemma I wanted to get to: health, or the access to health care is an essential human right; it is a right every human being regardless of who they are or what they possess deserves for the simple act of having being born human. In countries where there is widespread poverty and having no money really means having no money (i.e. none to spare on food or clothing or housing, and not just meaning poor as in having no money for a tv, a car, a haircut, a holiday, or entertainment, etc.), having a right to free access to health care is one of the great achievements of humanity.

So why am I singling out ‘poor’ countries as separate to developed countries like Australia? Because in developed countries like Australia, we believe that if we can’t afford a holiday or a car or costly entertainment that we are poor. And we don’t want to miss out on these things! To a person in a wealthy country like this, we believe that these things are our rights too - and God forbid that we miss out on these things to pay for what we now consider non-essentials, such as our health care. And that is the cause of the dilemma in wealthy countries: we have for the most part changed our priorities as to what is considered essential and non-essential. Yet we all have a sense of what our human rights are. I will tell you that in Australia we see time and time again people who hesitate and complain about having to pay an out-of-pocket fee to have their health tended to, but will without hesitation hand over large amounts of money for haircuts, for manicures, for holidays, for fancy cars, for video games, movies, etc. And yet, only one of these things could potentially be the difference between life and death…

I don’t know what the right answer is. And I don’t know what the best system of health care is. Surely everyone deserves the right to access health care regardless of what they have or who they are or what they do with their lives. Yet, surely, we have also come to some concerning conclusions when tending to our health is considered less of a priority than funding our non-essential commodities. Personally, I have only ever considered the doctor’s role as equivalent to the mechanic’s, to fix the machine so the machine can go where it chooses and do what it chooses. Doing our job doesn’t make us special people, we just do a special task. But it is a job same as being a mechanic is a job - and in this society, a job implies compensation. Doctors eat too and pharmaceutical companies are not charities, so the reality of it is that health care has become a business. It’s not ideal, but it is the reality.

On money and healthcare: Rights & Systems - Part 1/3

Rights

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services”  (Article 25, The Universal Declaration of Human Rights). The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. Of course, to the majority of the world’s population, complete attainment of our human rights and of health are only ideals and not reality. Nevertheless, they are ideals worthy of our consideration.

Ideals

In an ideal world every time someone fell into an unhealthy situation (physically, mentally, or socially), he should be able to access medical health care, mental health care, or social care and have his “health” restored. He should be able to access these things regardless of the amount of money he has, his sex or age, his political or religious affiliation, his ethnicity or language, his sexual identity or practice, his birthplace or site of residence, his employment status, etc. Basically, his right to health care is universal and his human right. That’s the ideal; reality is very different for a lot of reasons.

Reality

Every country has different health care systems, which impact on the way patients access health care. Some countries will have a health care system that is exclusively government-funded and all you may need to access it is proof of citizenship to that country. Usually that means that there is no cost to the patient for an “encounter” (i.e. every time you access health care) as funds are usually derived from a portion of pooled taxes payed by that country’s citizens. Other countries may have a system where accessing health care requires payment to a private health care facility or a private company that coordinates provision of health care (e.g. supplying and paying for the medical staff’s wages, the medical equipment, the facility fees, etc.). A lot of developed countries, Australia included, operate both of these public and private health systems concurrently where the public system is the default for all citizens unable to afford private health care. The private system exists and thrives because it promises certain perks and advantages like your choice of health care provider, faster access to elective surgery, more ready access to specialist medical reviews and allied health services, and often newer premises, medical equipment, and technologies. And yet other countries have a third system, like a lot in South and Central America, a “worker’s” health care system that provides health care services exclusively to that country’s citizens whose employers pay for access to this service. The worker’s health system is closer (or equivalent) to the private health care system than to the public system. I don’t intend to argue which system is better or which worse or which country does it best, but it’s interesting to consider what’s out there.

Australia

Australia has a dual system of public and private healthcare, the public system funded from federal money and managed (for the most part) at a state level. Medicare can be considered a pool of federal monies reserved for funding certain medical services (including surgical fees and the payment for medical staff), medicines, medical aids, etc. All citizens have access to those Medicare funds provided certain criteria are met, but generally it is a default system for everyone.

An often misunderstood peculiarity of the Australian government’s Medicare system has to do with the way a doctor bills his or her patients. The Australian government decides which medical services are worthy of a Medicare rebate, the amount of money allocated to it, and the conditions under which a service qualifies for a rebate. For example, anybody may approach a general practitioner for medical care and Medicare will provide a certain benefit to the patient to pay for that consultation. The patient may also approach a specialist doctor and pay for the full cost of seeing him in his private clinic; or he may present to his GP first and obtain a written referral to the same specialist and then become eligible for a rebate from Medicare to help pay for his medical specialist appointment. (A patient not wishing to access the private medical system at all for any reason may also be referred to a specialist in one of the state’s hospitals where it is available and obtain medical specialist review free of charge.) Importantly, the Australian government decides which medical services qualify for a Medicare rebate and how much money it allocates to each service – however, how much money Medicare allocates to a service does not always reflect how much money a service actually costs to provide. Medicare in fact operates as a rebate, a subsidy to the total cost of health care, not (at least not always) as the absolute cost to cover the service. Think of it as a discount voucher, not as a voucher for a “free” service.

On euthanasia

Jack Kevorkian served 8 years in prison for second-degree murder, that is murder that is not “premeditated”, or what you may also describe as murder that is not ill-intentioned. Essentially, he was a doctor that assisted many ill patients to die; what we commonly call euthanasia. He argued that he was imprisoned for being merciful, and that his merciful acts were to procure or hasten the death of other human beings. They were merciful because he aimed through his actions to liberate the person from suffering due to illness – when this person had indicated that they wanted or needed his assistance to do just this. The law said that regardless of the intent, procuring or hastening someone’s the death equates to murder and this is illegal even if the other party consents and requests it.

Now, a lot of the issues surrounding euthanasia and death legislation are about semantics, and to a lesser degree also intent. I remember first learning about euthanasia in a bioethics class, and I will describe it briefly now as I was taught it. There were four categories of “euthanasia” described:

1) voluntary active euthanasia (where the patient voluntarily requested help in dying and another person actively helped him achieve this) – E.g. a person asking someone else to inject a fatal substance into them.

2) voluntary inactive euthanasia (where the patient voluntarily requests help in dying and another person acts by withdrawing or ceasing an action that is helping the patient stay alive),  - E.g. a person asking someone else to pull out all tubes providing life-saving support like oxygen or fluids, etc.

3) non-voluntary active euthanasia (where the patient does not actually request or oppose help in dying and he is acted upon so as to hasten his death), - E.g. a non-communicative or possibly brain-dead patient who has made no prior indication of his wishes in this situation being given a fatal substance to hasten their death.

and  4) non-voluntary inactive euthanasia (where the patient does not request or oppose help in dying but another person acts by withdrawing or ceasing an action that is helping the patient stay alive). - E.g. a non-communicative or possibly brain-dead patient who has made no prior indication of his wishes in this situation having all life-supporting measures like oxygen or fluids withdrawn.

“Non-voluntary” is used as opposed to “involuntary” because involuntary implies that it is against the person’s wishes whereas non-voluntary simply that it is not opposed nor is it specifically desired. For example, involuntary active euthanasia could be thought of as common first-degree murder where a person does not want to die but he is purposely killed. Involuntary inactive euthanasia could be akin to a person actively asking for my help to avoid death (which I can presumably prevent by some action) but I withhold from providing this life-saving thing. This is a crime similar to murder in many countries too.

In most countries in the world what the law forbids are active forms of euthanasia, and in fact inactive forms of euthanasia are quite readily accepted – and legal. Every day in intensive care units patients are non-voluntarily actively euthanized, when their treatment is deemed futile by someone other than the patient themselves. And our right to “voluntary inactive euthanasia” is hailed one of the great achievements in medical ethics when doctors were disrobed of the expectation of paternalism to have that same power handed back to the alert, competent patient, in the form of autonomy. Any patient in the world can refuse any treatment in the world even if that treatment is considered life-saving. You can even write down your wishes when you’re still able to communicate them for future reference, for those times when you are non-communicative or no longer medically-competent. But I am digressing here, I could go on for hours on medical ethics, but what I really wanted to discuss is active forms of euthanasia.

Take religion and law away from the argument for a moment and try to discuss why euthanasia is “wrong”. Well, they tell us, it’s inherently bad because it has the potential for abuse and you run the risk of evil people wanting to just kill whoever for whatever trivial reason. Reasons such as, maybe, “he’s no good to society anyway”, “I don’t like him”, “he is of this race or culture”, “he’s poor”, or “he has no family”, or “he will cost more than I am willing to spend to keep alive”, etc. etc. There are many things in medicine with potential for abuse. We often hospitalize and treat the mentally ill; we force-feed those with eating disorders; we prescribe medications with known side-effects; we terminate the lives of foetuses for whom we can’t prove either way whether they are “persons” with an independent right to life or not, etc. I even heard it once said that one of the biggest mistakes in medicine was the idea to try to keep premature babies alive at all costs. Many of these babies will have chronic health problems, and the expenditure on neonatal intensive care units is massive. Some would say we have abused the technology in life-sustaining measures by trying to apply it to each and every patient, even these tiny babies which we are potentially setting up for terrible lives. My point isn’t to argue if these tiny babies are worth it or not worth it; my point is that we do entrust health professionals with many life and death situations all the time. And we do this because we have assumed they won’t abuse their powers just to see a new technology or treatment work without thinking of the consequences.

So then, why else is euthanasia “wrong”? They say because we could make a mistake – and the consequences of that mistake is not reversible. Again, doctors face this potential every day! I think that if you were to filter it down, the real controversies with euthanasia are 1) religion, 2) law, and 3) an expectation (or perhaps misconception?) that the overriding aim of medicine is to prolong an individual’s lifespan (as opposed to other aims like preserving their dignity, ensuring quality of life, and having a social responsibility to the rest of our fellow humans). Unfortunately, like many things in life, when you use one rule to apply to everyone in every situation, you will often get it wrong. Many people do not like to think that their doctor could have the knowledge or ability to perform euthanasia, because they assume doctors are special and, like I mentioned, should only want to prolong a person’s life. However, I believe that keeping euthanasia from the scope of medicine isn’t keeping us from any evil we aren’t already at risk of committing. I also don’t support allowing the scope of euthanasia to evolve without the input of medical professionals. If you’re going to do something, do it right. This is called harm minimization, and is not a new concept to medicine at all.

But why do I personally believe that euthanasia isn’t bad (if it were able to delivered effectively and without inflicting further harm or pain)? Because I believe that every person is free and free to choose to live their life how they choose. I also think it is cruel to deny someone something, especially their freedom of choice, simply because they need someone else’s assistance to achieve their goal. Imagine being denied access to the top floor of a building because you are a paraplegic in a wheelchair and the building isn’t equipped with elevators or ramps. Now, imagine that the reason you want to get to the top floor is because on the ground level where you are there is a fire that keeps intensifying. Don’t you wish someone could help you? But no-one can because then they will be arrested and they would rather not go to prison, even if they’re your friend or relative and they love you. So you’re left to fend for yourself. No-one bans you from going to the top floor, it’s simply a shame you can’t get yourself up there – and that is your only option! Oh well, better just wait for the fire to intensify, your skin to burn, and to watch yourself helplessly, and probably painfully, die. You knew all along that upon going to the top floor you’d only fall asleep and die up there, but hey, wouldn’t it have been nicer? Apparently not. Apparently it is nicer to allow our much-esteemed friends and family members to die in pain and helplessness.

And yet, having said all this, I have to clarify one thing for fear of being called out on my inconsistencies. Fortunately or unfortunately, I am Christian first and foremost, so no, I personally would not help a patient in this way. But I have tremendous respect for people like Jack Kevorkian who were/are courageous enough to serve their patients at all stages of life. Death is simply another stage of life.

On courageous conversations

Last week I attended an education session on Aboriginal and Torres Strait Islander cultural awareness. The intent was to help health professionals engage better with this subset of the Australian population, and as such “close the gap” between the health of non-indigenous and indigenous peoples (who fair terribly worse in morbidity and mortality). The session was run by a man who identified himself as an aboriginal man and he explained various aspects of what is culture from a psychosocial and semantic perspective. It was interesting and he spoke of a thing called “courageous conversations” – you know, all those touchy subjects on elements of our society which if we comment on we’ll be called racist or bigoted or misogynist or otherwise prejudiced. Racism and the history of Australia (or the U.S.A or South Africa or so many other nations) is one of those touchy subjects. So we all listened to the discussion he presented and he played Professor Michael McDaniel’sreconciliation speech and made passing reference to Kevin Rudd’s “Sorry”speech. The things spoken by these two men are along the same vein, but stated quite differently.

On the 13th of February, 2008, Kevin Rudd, the then Prime Minister of Australia gave a speech to acknowledge the past evils that had been afflicted systematically on the indigenous peoples of this nation. The other purpose of the speech was to apologize to aboriginal peoples of past, present, and future who had been (or will be) disadvantaged or hurt as a consequence of the shameful government policies that existed to purposely suppress aboriginal peoples. The speech was symbolic and groundbreaking, intent on paving the way to improving things in future and learning from past mistakes. This very loud gesture was meant to benefit not only the Australian indigenous people who for decades had had their history and rights suppressed, but also of benefit non-indigenous peoples by empowering them with knowledge and freeing them from the guilt of knowing that their ancestors had done something wrong but they now had the chance to right their wrongs. It was by all accounts a very admirable gesture by the leader of a nation.

Professor Michael McDaniel, an aboriginal man who is also Dean of Indigenous education at the University of Western Sydney, also gave a speech related to the reconciliation process that was occurring in Australia. He told one story of a non-indigenous solicitor who met some elders of an indigenous community and tried to tell them that he was aware of the unfairness and mistreatment indigenous peoples had suffered and he had a plan to propose some “reconciliation”, in this case something akin to acknowledging the land rights of the indigenous first occupants of that land. The aboriginal elders when he had finished his courteous and respectful talk, retold him the history of the Aboriginal people. They told him how his ancestors had raped, stolen, killed, desecrated, abused, and hurt their people in previous generations and how the current generation of their people is still suffering because of his people. The young solicitor was taken aback, surprised, and feeling blamed! What do you say to that? You say sorry. And when you say sorry the better man forgives, right? Right. That’s what we do in our culture, but not everyone’s culture is apparently the same in this respect.

Now, I have varying notions of what a sense of responsibility is, but for a while you have to consider yourself in the young solicitor’s shoes also. Prof. McDaniel explains that to the elders they were simply telling their story in their way, that they needed to do this, to vent, if you will. And at that second when the elders meet this young successful non-indigenous man, “For that moment you are Captain Cook. You are Arthur Phillip. You are the Mission Manager. You are the representative of everyone who did those things”. But you may wonder, why should he be designated the “representative of everyone who did these things”? The logic goes that it is because it is as an acknowledgement that the system and society we currently live in was built to ensure the success, exactly as he has, of a non-indigenous person like him and not of an indigenous person like the elders. So is he at fault because he is successful? Prof. McDaniel doesn’t state it quite like this, but he states that the systems that exist are at fault, they’re the “bad” ones. And yet in the middle of all this is a young man trying to do the right thing given what he has. Prof. McDaniel states he just has to “cop it, because it’s part of the healing process”. I know, I was outraged at his logic too. But you know what? Apparently it's hard for us to understand, he says, because (and I am paraphrasing here) ‘as a young non-Indigenous person, we’ve never had a sense of belonging to a society. We’ve never had “a collective sense of responsibility”’.

Honestly, I liked Kevin Rudd’s speech better. I liked it better for two reasons. As a Christian I always remember that scripture in Ezekiel 18:20 that says, “The one who sins is the one who will die. The child will not share the guilt of the parent, nor will the parent share the guilt of the child. The righteousness of the righteous will be credited to them, and the wickedness of the wicked will be charged against them”. Acknowledging our ancestors sins is one thing, we can even apologize for them and regret it on their behalf, but as for being “punished” or held accountable for it, I believe is a bit rich. My second reason can be summarised in this quote by Antoine de Saint-Exupery: “To be a man is to be responsible. It is to feel shame at the sight of what seems to be unmerited misery. It is to take pride in a victory won by one's comrades. It is to feel, when setting one's stone, that one is contributing to the building of the world”. Guilt is a useless thing unless it motivates forward action. It is honourable to take responsibility for righting wrongs even if they weren’t committed by us. It is not honourable to use punishment unless your aim is for retraining. If your camel is already walking to where you want it to go, it is only cruel to continue to beat 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.

On pride and prejudice... (not the book)

I have previously discussed aspects of the discrimination against people with mental illness. Specifically, I have spoken about it in the context of romantic relationships, how remaining together “in sickness and in health” means in health and in most other illnesses expect psychiatric ones. And of course, intimate relationships are not the only context this occurs in. Even in the health industry there is a deep-seated contempt of those coming into hospital medical departments with wounds that are related to a psychiatric disturbance. But what I find even more bizarre is how people can discriminate against themselves, often denying themselves a better existence, because of a connotation to mental illness!

In my job I meet a lot of people, people who we as medical professional often create. Almost every health professional can tell you a story about “some junkie”, a person with a substance addiction that they met along the way. But there’s a particular sort of person that we at times encounter and we don’t immediately think of as “a junkie” but we know that they’re addicted to prescription medication. In my experience, it’s usually the benzodiazepines class of drugs, the Valium-type medications. There’s a few main reasons why benzos are particularly good to get yourself hooked on: 1) they work, 2) gives you immediate ‘results’, and 3) doctors have fewer qualms about prescribing it than other dependence-forming drugs.

A scenario I see very often, and which I admit frustrates me to my core every time, is the young man coming in to see me for his repeat valium (diazepam) prescription. I ask why he’s on it. He says anxiety. I ask how long he’s been on it. He says years. I ask why. He says for anxiety; it’s really “good” at “treating” it. I ask how much he takes. He takes it “only” 2-3 times a day. I do the sums – he is taking huge amounts of it! I ask why he never had his “anxiety” treated, why he didn’t get proper treatment, why he never had counselling, why he isn’t on more appropriate medication. He says it’s because he doesn’t get “anxiety” that often or that it is not very severe; he only uses the tablets every 5 or 6 of the 7 days in a week, 2-3 times a day.

Usually at this stage my heart sinks because the next part of the conversation is also very predictable. I ask does he know it is very addictive. Yes, he knows, but he only takes it when he needs it, those 2-3 times a day on those 5-6 days a week. Again I ask why he takes it (yes, I always pray the patient will have an epiphany – and no, they never do). He takes it for anxiety, of course. I tell him that it must be pretty devastating to be feeling anxious to the point of needing external relief 2-3 times a day almost everyday; surely that would be very uncomfortable. Yes, he tells me, it is pretty unfortunate – but luckily the drugs are so good at “treating” it that as soon as he takes one, within minutes he feels better. I offer a friendly suggestion: wouldn’t it be better to be able to function without having to feel so anxious almost all the time, wouldn’t it be great to be free of the anxiety? Yes, he concedes. Good, I am relieved he agrees! I say ‘ok, let’s get rid of the anxiety then’ (usually I’ll have figured out by this stage that this guy has no time or patience for psychotherapy, he prefers a pill, even a bandaid if that would do it). I suggest this tablet, you take it only once a day, it’s safe, not addictive, and it has a longer time of action so you need only take it once and you won’t have those flare ups of anxiety at random times during the day or week. He doesn’t believe that’s possible. I assure him, it is; in fact if he takes it everyday he won’t even need the valium for those random daily attacks of anxiety because he just won’t be having them anymore!

He has a question for me now: is the medication I am talking about also called an antidepressant? I say, well, it is an SSRI medication which are classed as such, but has a mode of action that will relieve him of his symptoms. At this point he says No!.. But, but, why? He tells me the story again about his anxiety not being that bad, he doesn’t get the symptoms that often (only 3 times a day, 6 days a week), he’s not depressed, he doesn’t need an antidepressant tablet, he’s not crazy, why change what is working, etc., etc. I explain in vain that what he is taking currently, the valium, isn’t working because if it was he wouldn’t need it everyday, multiple times a day. He assures me it does work, because he takes it and he feels better… and eventually I realize that no-one has ever made a person addicted to a substance rationalise about their dependency. It’s the very nature of addiction, there are no great epiphanies – at least not about why ‘feeling good’ is bad. And it breaks my heart that this person would rather take a tablet with much less stigma amongst prescription pills, almost with the status that alcohol has compared to illegal substances, than take the one he really needs. And he makes his choice because of the association this other medication has to “bad things”: a mental illness such as depression. Apparently it’s a matter of shame to have ANY association to mental illness.

Let me now tell you of another class of patient. He also doesn’t want to be thought of as mentally ill. Luckily for him, he isn’t! He has this condition, a complex pain syndrome, a condition that is very difficult to treat. I met a man once who had been diagnosed as having fibromyalgia. The poor guy, was such a shame to see him; he was in discomfort and pain all the time. He had seen a lot of GPs, a few specialists, spent hundreds on natural remedies and iridologists, spoke to anyone that might be interested and asked for help. Eventually one medical specialist got him started on a medication he hadn’t tried before. He didn’t get his hopes up because he had tried many many medications with no relief. But, amazingly, this one worked! He was free from pain; it’d been months, maybe years since he felt so ‘normal’. And then one day he picked up his tablets from the pharmacy and started to read the consumer information page in the pack. And then he read in there that this drug was a TCA – and that the A in that means antidepressant! He was furious, disgusted, so angry at the doctor that told him to take it. It didn’t matter that the tablet alleviated his symptoms; what was intolerable about it was its name, its association. He stopped taking it immediately and attended his doctor to express his disgust.

I spoke to him a few months afterwards, his face was all cringed and he seemed in a lot of pain. He told me the story of what had happened and about how disgusted he was that the doctor had offended him by giving him an antidepressant for his fibromyalgia. He imagined that the doctor thought he was “crazy”, that he was only pretending to be in pain, etc. I let him speak and then I asked it the medication had worked, though. Yes, he said it had – but that was not the point. My heart again sank a little and I explained to him (gently, not trying to tell him what to do), that the TCA type of drugs are commonly used for some types of pain, and that they are very effective. I said they are called tricyclic antidepressants because their original purpose was to be used as an antidepressant but this new use for them had been found and it was great for pain of that particular sort. Yep, good story, Vanessa; he believed me because he knew I have a medical degree, but pride isn’t always about having rational or accurate information. Poor guy, I still see him in so much pain.

Now I’m going to deflect a little to tell you about something I initially thought about when I was at university. There was a ‘gay rights’ rally and in response to someone’s judgement that homosexuality is a disease and a social evil etc., someone had made a banner saying “homophobia is a disease”. It was like the perfect comeback. Only I’m a nerd who probably overthinks things and I was at the time studying medical microbiology and infectious diseases, so I immediately thought: cancer is a disease too. The point is no-one chooses to suddenly grow a cancer because they want to endanger their life or a limb or organ, or because they like to suffer. Most of us can at least empathize on seeing a person sick with cancer, ravaged either by disease or chemotherapy. I have never met anyone who would discriminate negatively against someone with cancer, someone with a disease they did not ask for, a disease that is beyond their control. Mental illnesses are a disease also, something no-one asks for or can internally control. Why should we accept that it is OK to discriminate against those suffering an illness? It’s sad that almost any reference to mental illness, whether people, disease processes, and even the medications used to treat it, still attract such great discrimination. Maybe the time for a new human rights movement is arriving.