On my religion

For many many years people have been telling me that I belong to a cult. My response has always been the same: an emphatic “It’s NOT a cult!” But in the last few weeks, someone else's reasoning has really lead me to question myself if I truly do belong to a cult. Now, I had always prior to this maintained that I could not possibly belong to a cult given that so many people belong to my religion, and besides, even if my religion is not perfect, it is not as bad as others out there (e.g. it does not force me to hand over 10% of my wages to “the church” out of every paycheck; or it doesn't ask that I call another random human being in a robe “father” in direct opposition to biblical scripture, etc. etc.) This kind of reasoning may not be enough, though, after what I've been challenged to think about.

I thought I knew pretty well what a cult was but just for the sake of being well-informed, I looked it up in the dictionary: “a small religious group that is not part of a larger and more accepted religion and that has beliefs regarded by many people as extreme or dangerous”. Well, my religion is certainly not a small group, it has over 7 million members (though small perhaps in comparison to Catholicism, Judaism, and Islam). Are the beliefs of my religion extreme or dangerous, though? No, I always told myself, other religions believe and practice even crazier things!... Well, I think they do. However, if I am honest here, there are many times I have suffered due to the doctrines of my own religion. I have suffered and hurt as a result of some doctrines that I personally find it hard to fathom are truly anything more than man-derived rules rather than true Godly-inspired interpretations of the scriptures. If I am honest - and I want to be - I have to share some of these incidents. Here is a list of some of the things that have come of my religion that have hurt me personally:

• As a kid, after the first few bible meetings, I was told that there was a code on how I should dress to attend meetings. Men must dress “like men”, and women like women. That’s not based on bible principles, I believe, but on what’s tradition. That meant not wearing what I felt most comfortable in (didn't God want me to be me or feel comfortable while rendering him worship?), but wearing what is “traditional”. Tradition? That’s exactly one of the issues I had with my catholic upbringing, doing things for tradition and not because you understand them. So, ever since I have been unable to relax in any meeting or feel like myself. Is that what God’s wants? Does he want my sincere heart and sincere prayer or does he want me distracted by my discomfort while I am meant to be worshiping him in a group? Well, I comply for “tradition”, but one day it would be great to be free of such absurdity again. 

• When I was a teenager and had been attending bible meetings for a few years, I was asked by the elders of the congregation to abstain from doing some things that seemed kind of “wrong”, let’s say. And you know what these ungodly things were? Holding my mother’s hand during prayer and putting my arm around her in an embrace during hymn-time or while we read the scriptures. My whole life I have been very affectionate towards the people I love and I had come to the conclusion that love was a good thing, especially love for your family. No, I was told this was not the case, that I was setting a bad example as my behaviour towards my own mother could be perceived as homosexual… I let that clearly twisted and perverted judgement go because of a scripture that was read to me about not (deliberately) causing other people to think badly of the people in God’s service.

• The most soul-shaking thing to have happened to me within my religion came shortly after that first incident, when I committed what I was told was a very very serious violation of God’s law. I cut my hair short. I am not exaggerating, that was the extent of my “sin”. Again I was pulled up by the elders of the congregation (though I still was not a baptized member of the congregation) and told that I had done wrong. I thought it was a joke and I initially laughed. No, no, this was extremely serious, I was told. The tone changed completely in a few seconds when I was told that (not asked whether) cutting my hair was a vanity-driven act of rebelliousness. Me vain? Me rebellious? Never in my life have those been things that have motivated anything in me. In fact, my whole life is quite the opposite as I am a very shy person. And as one of the elders spoke to me about my evil sin, I must have sat there with my mouth wide open in disbelief since his wife had shorter hair than me! I didn't at the time know what the word hypocrisy even meant, but injustice I was becoming familiar with. Again, I let this slide because at the time I wasn't yet baptized and I was told that had I been, I would most likely have been ex-communicated from the church. I took comfort in this; I thought at least they’re not kicking me out so things could be worse.

• Things did get worse. When I had first become interested in learning more about what I believed to be “true Christianity” and left the catholic faith, I had asked this member of the congregation to help me learn more about the bible and its message. I regarded this girl very highly and eventually (I studied the bible with her some years) I came to think of her as my confidante and friend. What happened was that that same week that I was told that I was evil for cutting my hair short (‘like a man, and unbefitting of a female Christian’), the girl who I thought was my friend came and told me that she would no longer be helping me study the bible anymore. I felt betrayed and like I was kicked in the guts while I was down. I asked why. She said that it was because I essentially was a lost cause. Yes, the blows kept coming. I imagined Jesus was incapable to do this to anyone, even the greatest of murderers and sinners, and yet here I was being judged and told by other humans that I was too far gone. This whole incident triggered what was my first and still most severe episode of depression yet. I was about 19 and I wanted to die.

• Now, eventually after some time, an older lady from the congregation took pity on me and spoke to me again about the bible. I studied with her for some years and she taught me that God’s people may not be perfect and they don’t always get it right but that sometimes you just have to believe, accept, and try to do better. She said it’s not like “blind faith”, though to me it sure did sound a lot like it. I guess I was just very grateful to no longer be so ostracized from people I thought to be good and nice people. I tried even harder this time to things exactly as I was told and not let my own thoughts and questions get the better of me. I did as I was told and not what I truly believed. I really did hesitate for many years on whether to become a baptized member of the congregation (since I had had so little luck even as an un-committed one) but I eventually took the plunge. I convinced myself by this reasoning (which at the time I thought was great): God doesn't care what religion I belong to or whether I am a “full” member or not, he will still judge me if I refrain from doing what is good or knowingly break one of his commandments. It was a literal case of ‘you’re dammed if you do; you’re damned if you don’t’! So I did… I am ashamed now to admit that I "joined up" not because of the benefits I thought having a loving God in my life would bring me, but out of fear of not pleasing this scary God who would just me harshly and punish me by withholding grace from me. And now I wish things I dare not express.

• You’d think that as a full member of my Christian congregation, I would have felt finally like I was in the in-crowd. In fact, the opposite happened. I soon learnt that it’s not judgement by God that I must fear (after all he’s a very forgiving and understanding being), but rather that of my so-called Christian brothers and sisters. When I still attended meetings regularly and strove really hard to do all the things that a good Christian apparently should do, I had managed to make what I thought was a good friend within the congregation. I would visit this girl, hang out and do things together with her, talk all sorts of things, and I’d even spend time with her family, especially her mum who is also a member of the congregation. I thought of this girl as a friend and both she and her mum would encourage me to do more Christian things. I liked this interaction and I thought of it as really uplifting… until they tried to encourage me and instruct me in other ways too.

 I can’t even remember how our conversations started but I figured that as a 20-something year old, one day you will talk about relationships and such. However I started to receive advice I did not ask for and that was delivered not in the most tactful of manners. One particular day, my friend and I had been out on a walk by a lake and were talking about relationships. Then my friend started to say that I don’t dress like someone who is serious about looking for a relationship (well, I actually also wasn't wanting one, but that’s beside the point). I said, well, I thought with this sort of thing, shouldn't you look for someone with whom you share similar ways of thinking etc? No, she said, I needed to wear “prettier” clothes and pants that fit better and a bra that doesn't make my ‘tits look like you’re fifty’. Wow! If she wasn't my friend, she would have made a very hurtful enemy. I felt offended by her comment, and in my mind the question popped up “is this girl really my friend or does she just like driving to the city and bringing her kids to my pool?” I was uneasy the rest of the walk to her house. When we arrived at her house, as if by relay, my alleged-friend’s mother brought a bottle of perfume out to me and sprayed it. She said I should wear it to get men’s attention. She said I should wear make-up too. And wear pants to make my bum stick out so that men get aroused. Really? That’s what I thought, ‘Really? I should wear clothes to make men think about fucking me like the good little Christian we’re all pretending we are here?’ I gave a very polite thank you for all the (unwanted) advice on how to seduce a male member of my congregation. Then I drove home knowing I never could think the same of these people ever again and that I’d never so much as waste a word on them. I must say, I have been so much happier since I got rid of all my so-called Christian “friends”.

• The most recent turn of events was receiving some very nice text messages from another of my Christian “friends”. Gee, she had some very nice and uplifting words to say. She was glad I was OK, that my family was well, that I still attended bible meetings (though only every now and again), and that I was healthy. She in turn was well and she thought it was such a shame that we couldn't hang out anymore because she had moved interstate, etc. etc. It was a very pleasant back-and-forth text conversation. Then to say goodbye she told me explicitly that she had contacted me ONLY to do her Christian duty of encouraging me to go to bible meetings regularly. I said she shouldn't have bothered. I meant that. I have decided after all these years, that I have no patience and no tolerance left for hypocrisy – and that is also the reason I don’t often go to bible meetings anymore.

Back to my original thought of 'do I belong to a cult?' Well, it’s certainly not a small religious group I belong to. However, my religion’s beliefs have been extreme at times, and dangerous and hurtful to me personally too. But the final clincher of the discussion with a (non-Christian) fried on whether I belong to a cult or not came when she asked me “how easy is it to get out?” Wow, that took me aback! I know typically so-called cults are difficult to get out of – well, to put it one way, my religion isn't one that is easy to leave. Don’t get me wrong, I mean it is extremely easy to get yourself kicked out of it, all you have to do is cut your hair short or talk to someone you’re not supposed to, and you’re out. But leaving voluntarily by any other way is extremely difficult. Let me take you through a scenario; let’s all pretend it’s hypothetical too:

There’s a very nice and devoted lady who loves God and loves her family. She is in an emotionally abusive marriage to a man who is not a member of her religion. She, naturally, wants to leave him. Her religion, however, says that it is a sin to divorce her husband unless he has been unfaithful to her with someone else. In other words, emotional abuse is not a valid reason to leave a marriage; and if she were to leave for this reason, she is deemed to be sinning. As a result of her sin, she would be ex-communicated from the church. She doesn't want to be ex-communicated from her church as she believes that she would then forfeit out of benefiting from eternal afterlife in a paradise. Losing this would shatter her life and crush her. She really does not want to lose this. So she stays in her emotionally-abusive marriage suffering every day. She’s trapped!

Now, this lady has five adult children. One of her children is a member of the same church as her mother, but the other four aren't. The lady loves all her children and treats them all with love and kindness, which comes naturally to her. Now, the child who is a member of her church also, her daughter, really wants to have a child of her own. The problem is that the daughter doesn't have and doesn't want a husband to have her child with, as their church mandates. The church says that if the daughter has a child on her own, she will be deemed to have sinned and subsequently will be ex-communicated from the church. The daughter doesn't really care about this. The daughter is at peace with and wants God’s approval only, not those of imperfect men who are elders of the church and at times act as if they were God to pass judgement as if they truly understood the mind and heart of God.  However, the mother doesn't want her daughter to be ex-communicated. You’d think why would she care? Because if this lady’s daughter is ex-communicated, the church will either 1) ex-communicate her also and call her an accomplice to the daughter (you know, for that sin of wanting to have a child), or 2) forbid the mother for life from interacting with her daughter (or that child she may one day have). The daughter does not want to “lose” her mother, she does not want to lose the great relationship they have and that beautiful warm feeling of being loved by a mother. She is petrified to lose this. And she is so regretful to have joined a church that dictates to her mother that if she were to leave, the daughter does not become again like the lady's other 4 children who never were members of the church - but that demands she treat specifically as the worst of the worst sinners. No one wants to be thought of that way to her own mother. The daughter is trapped!

And here I realise I've just described two people trapped in this religion of mine. It’s not small. It has been very hurtful to me. And it has people trapped inside it, trapped by fear of ‘missing out’ or invoking punishment from God. Maybe I do belong to a cult. Maybe God does not approve of this wholly. Maybe God wishes it was better. Maybe what God actually wants is for people to be happy and knows this oppressive religious doctrine is not the way to go about it.

On making "the unhappy" happy - Part 2/2

Of the war veterans I meet with post-traumatic stress disorder (PTSD) and depression, do you know what they value most in their lives? Not finding a “cure” for PTSD and depression, but just appreciating and being able to be with the people in their lives. They accept very courageously – not cowardly – the goals of treatment of these disorders: minimizing symptoms, moving forward from the last exacerbation, and decreasing the number of further exacerbations. They don’t seek a cure, though of course if it were feasible, they’d pay any price to have it. But why fight futile battles? So, I say again that they very courageously choose to expend their energies on the things that matter instead: love, productivity, enjoyment. But before you assume that I am making a claim such as “there is no cure for depression”, let me clarify that that is not the broad statement that I am making.

I used to think, naively, that once I fell in love, once someone loved me and I had someone to share my life with, I’d be happy. I wondered why the people I met who had the things that I thought would bring me happiness weren’t happy. How could they be depressed when they had a partner, children, a job they didn’t hate, generally good physical health, etc.? Why hadn’t the love they had in their loves not cured their depression? Because lack of love didn’t bring about the depression, nothing that was correctable did. Yes, they had love; but completely unrelatedly they also had a mental disorder. Finally I realized why people give flowers to sick relatives in hospital: the flower isn’t meant to “cure” the illness, just make it more tolerable by giving you that warm feeling inside that you’re not alone and reminding you that people care about you.

In persons who have become depressed or suffering PTSD as a result of some psychological social trauma, there is nothing in this world that can erase the memories and/or the cognitive processes that get programmed into your brain. Remarkably, though, a human being can go about their lives being perfectly functional and socially involved despite these demons we carry around in our head. When you have a chronic depression or PTSD of this kind, the best you can wish for is not being “cured”, but having people around you who understand you and stick with you on the journey. Not even “love” can erase the inner hell we experience with these mental disorders, but love can motivate the people around us to give us the all vital support and understanding. Conversely, if you find yourself in a relationship with a person who has depression or PTSD or a similar complaint, you will only hurt yourself by believing that your role is to bring about “cure”; it’s not. Your role is no different to that of anyone else who ever loved: to love, to give (including understanding), to receive, and to share life together.

On the Eminem thing

People think I’m trying to be purposely funny when I describe myself in the “About Me” section as being like Eminem. I’ll be the first to admit I’ve never met Marshall Mathers III, and I’ve never even had the good fortune of being to an Eminem concert. I identify a lot with most of the lyrics of Eminem’s songs, though. A lot of people must; he sells records in the millions of copies. Personally I believe he is a great expressionist, and not only that, he has a very common human story.

There is an Eminem song (Same song & dance) where he is considering different ways to tell his crush how he feels about her (he’s a shy, socially-awkward person like so many of us) and he postulates: "Should I cut off one of my ears and mail it to her? Send her pictures of my collections of skeletons? Or footage of me impaling myself on an elephant's tusk?" This kind of strategy may not occur to everyone, but it does to Eminem because he is he and he thinks the way he does… I keep a small collection of animal skeletons and to me Eminem’s proposition of sharing something dear to him does not seem strange.

I won’t go try to analyse Eminem’s lyrics for anyone, but I would like to share some of them which are the reason I identify with him so much. I guess, the way Jorge Luis Borge’s words always come to mind: ‘each man is every man’ and each man’s story is shared by every man. I have been the “dark phase” Eminem, as much as I have been the Eminem who rejoices in his blessings. We all have to different degrees, I think J

I'm not afraid /To take a stand

Everybody /Come take my hand

We'll walk this road together, through the storm

Whatever weather, cold or warm

Just lettin’ you know that you're not alone

Holla if you feel like you've been down the same road…

****

I got some skeletons in my closet /and I don't know if no one knows it /So before they thrown me inside my coffin and close it /I'm-a expose it... (Cleaning Out my Closet)

Well since age twelve, I've felt like I'm someone else /’Cause I hung my original self from the top bunk with a belt...

And by the way, when you see my dad, /Tell him that I slit his throat in this dream I had. (My Name is)

All I know is I don't want to follow in the footsteps of my dad /’cause I hate him so bad /The worst fear that I had /was growing up to be like his f*ckin’ ass /Man if you could understand /why I am the way that I am... I never dreamt I'd get to the level that I'm at /This is whack! This is more than I ever could have asked... (Saying Goodbye to Hollywood)

Yo, never was a thug, just infatuated with guns...

/I'm a soldier, these shoulders hold up so much /They won't budge, I'll never fall or fold up... (Soldier)

My thoughts are sporadic /I act like I'm an addict /I rap like I'm addicted to smack... (‘Til I Collapse)

Sometimes I feel so alone /I just don't know /feels like I been down this road before /So lonely and cold /it's like something takes over me /Soon as I go home and close the door. (Deja Vu)

I'm just so f*ckin' depressed /I just can seem to get out this slump... I think I'm starting to lose my sense of humour /Everything is so tense and gloom... (Beautiful)

Sometimes I even cut myself to see how much it bleeds /It's like adrenaline, the pain is such a sudden rush for me...

But what's this sh*t you said about you like to cut your wrists too? /I say that sh*t just clownin’, dog /C'mon, how f*cked up is you? /You got some issues, Stan. I think you need some counselling... (Stan)

If I, were to die murdered in cold blood tomorrow /Would you feel sorrow or show love, or would it matter?...

But there's way too much at stake for me to be fake /There's too much on my plate, I’ve come way /too far in this game to turn and walk away...

The only way I'm leavin’ this bitch is suicide... I'm not what ya think /I appear to be f*cked up, mentally endangered /I can't stay away from a razor...

 It hurts when you see your friends turn their back on you, dog /And you ain't got nothing’ left but your word and your balls /And you're stressed from the calls of your new friends /Begging with their hands out...

Death itself can hurt me /Just the thought of dyin’ alone that really irks me (When the Music Stops)

Sometimes I think, there's nothing to live for /I almost break down and cry /Sometimes I think I'm crazy; I'm crazy, oh so crazy! /Why am I here? Am I just wastin’ my time?..

People make jokes, cos they don't understand me /They just don't see my real side /I act like shit don't phase me /Inside it drives me crazy /My insecurities could eat me alive... Sometimes it feels like the world's on my shoulders /Everyone's leanin’ on me /Sometimes it feels like the world's almost over... (Hailie’s Song)

I never would have dreamed in a million years I'd see /so many motherf*ckin’ people, who feel like me /Who share the same views and the same exact beliefs /It's like a f*ckin ARMY marching in back of me (White America)

Yet everybody just feels like they can relate /I guess words are a motherf*cker, they can be great /or they can degrade. Or even worse, they can teach hate /It's like these kids hang on every single statement we make /like they worship us... They say music can alter moods and talk to you /Well can it load a gun up for you and cock it too?... That's why we sing for these kids who don't have a thing /except for a dream and a f*ckin’ rap magazine /Who post pin-up pictures on they walls all day long /Idolize they favourite rappers and know all they songs /Or for anyone who's ever been through sh*t in they lives /'Til they sit and they cry at night wishin’ they'd die /'Til they throw on a rap record and they sit and they vibe /We're nothin to you - but we're the f*ckin’ sh*t in they eyes /That's why we seize the moment, try to freeze it and own it /Squeeze it and hold it, cause we consider these minutes golden /And maybe they'll admit it when we're gone, just let our spirits live on /through our lyrics that you hear in our songs... (Sing For the Moment)

(If it looks like you’ve seen this before, I have posted most of it on my facebook notes before.)

On logical suicide

I was at an internal medicine grand rounds talk one day when a colleague started speaking about “logical suicide”; as in suicide that does not seem like the irrational choice we all have come to believe it is. Experience, philosophy, or science, have taught us that a human being’s overriding desire in life is to live. If we deviate from this, if a person wants not to live, then that human being must be ill or evil. But are there ever situations when suicide can actually be thought of as logical? It takes a little bit of tearing down of our usual norms to even contemplate this, but I was curious to explore this further.

A life worth living

In medical ethics circles you’ll often hear the terms “a life worth living” and “quality of life” banded around. What is a life worth living? Most of our lives. We have our basic physiological needs met; we have freedom to think, decide, and act accordingly; and we have (most of us, I mean) the physical capabilities to transform our desires into acts. But, then, just what is a life not worth living? You could say that it is a life that lacks those things we spoke about before, but that’s not true. You may lack any, a few, a lot, most, or all of your physical abilities and yet still consider your life worth living. The important thing is that decision on the ‘worthiness’ of your life is made by you, the owner of that life and body.

A life not worth living

The medical profession and some societal groups, though, have decided on certain broad aspects of a human being’s existence which, if lacking, deem that person’s life a “life not worth living”.  Things like if a person’s brain lacks measurable electrophysiological activity, or if the person requires constant support in their nutrition, hydration, breathing, etc. Of course, the problem with a third party deciding which life is worthy and which not worthy of living is a very fearful one. The Nazis, for example, conceived a concept of “a lifeunworthy of life”. Initially, they considered it a socially useful tact to destroy peoples who were brain dead, brain impaired, mentally retarded, or psychiatrically ill to the extent that they could not survive without the assistance of others. It was considered that these people weren’t worthy of life and in fact were unaware of what life meant, therefore, eliminating them from society (by purposely killing them) was totally acceptable. We are now all very aware that the Nazis’ category of “life unworthy of life” eventually extended to some very broad groups of people and resulted in mass killings without a logical rationale. I, am, however, now digressing…

Suicide

Why do people suicide? That is a question psychologists, scientists, doctors, religious people, and a lot of us ask every day! What do people who suicide tell us (in their last writings or after a “near miss”)? That they did it to end to the pain, that they could see no other options in their life, that they no longer wanted the mundanity of life, that they had failed beyond what they considered remediable, that they had succeeded enough that anything further would be a downhill decline which they didn’t want to face, that they had nothing left to live for, that they had more to gain in death and the afterlife, that they didn’t want to be a burden on others around them that supported them in their existence, etc., etc. People’s reasons for dying are as complex as those we live for. And yet, for most of us, living just seems like the right thing to do. Most of us don’t even question it. And when we become ill or our life is threatened in any other way, our instinct is to try to preserve it. Then what is wrong with people who want to die? People will often quote you that up to 95% of people who commit suicide have a mental illness, for example, depression. But I’ve always wondered about the other 5%. OK, OK, 4% didn’t have a diagnosed mental illness but were intoxicated with drugs or alcohol, acted impulsively after a sudden change in life circumstance, or suicided “accidentally”. But what about the remaining 1%?

Logical Suicide

I’ll start by acknowledging that I’m playing devil’s advocate here just to explore this question further. My colleague who spoke of logical suicide was in fact speaking of one of our patients. It’s not that he disliked this patient and wanted him to die, he was just saying that if this patient decided to suicide, it wouldn’t be considered a totally irrational thing to do. Of course, there were a gasps of disbelief in the room and a few chuckles thinking he was purposely trying to bring up a taboo for a few laughs. How could he speak such preposterous ideas? Because he knew the patient was very aware of his own conditions. The patient did not suffer an intellectual impairment and he knew what he had been through with his condition and that it was only going to get much worse for him. He was in constant pain and discomfort. He was still physically able to act so as to procure his own death and he was not depressed or suffering any other mental illness. Would he want to face further suffering and physical deterioration? If he didn’t, would his opinion be irrational? If he suicided, could you consider his decision illogical? What happened in that room with our colleague having raised this, is that the conversation quickly changed topic. It is still taboo to speak of these things, apparently.

Now, consider a person who, like most of us, has set an agenda for his life, something he would like to achieve and this is what motivates him day to day to keep living. For some of us this is doing a particular job, helping others, marrying the person you love, competing in a sporting race, raising your children, making music, self-expression, visiting a particular place on earth, caring for your parents, etc. These are things worth living for, for you, at least. Now, let’s consider, for example, a person whose sole motivating thing in life is to get married and have children. He wants that more than anything else in life, and that would make his life happy and complete. He is not unhappy without it, however, but he is just existing with the purpose of achieving his dream. What if he was born with a physical impairment that meant he was completely dependent on someone else to care for him and as a result wasn’t able to meet any women to have potentially fall in love with him, marry him, or have his children? He reaches 20 and hasn’t met anyone yet, online or in person. He reaches 30 and he is still in the same predicament. He reaches 40 and his parents, who are his only source of real meaningful love (but not of romantic love, which he desires), are becoming elderly and still his predicament hasn’t changed or improved. He isn’t any more likely now to a) become free of his illness, b) prevent his own physical deterioration, c) find a new overwhelming desire/purpose for his life, or d) fulfil his own self-designated mission in life. What is he living for? How does he answer that question to himself if he isn’t a religious man? Is he living to wait for his death one day?... Well, if this man suicides thinking he has nothing of value to him to live for, could you honestly say his suicide was not logical?

Living

When someone speaks of suicide, of contemplating it, we often see ourselves come up in defence of “life”. We tell the person that they should seek treatment for a mental illness, or we “remind” them how wonderful life is, or we tell them how missed they will be and how many people love and care for them, or we say that perhaps soon medical science will come up with a solution to what discourages them from life, or we tell them to think of how much they will hurt others if they go through with what they’re contemplating… We’re actually pretty good advocates for life! However, perhaps what we should be doing instead of telling others how to feel or what to think, is ask some questions of how they’ve reached their conclusions. The person most likely to convince you of something, even living, is yourself. And hearing back your own arguments for life vs. death is perhaps the only way to have a person change their minds on suicide.

Until recently we still spoke a lot on suicide prevention, but that lead to a lot of people (family, friends, religious ministers, health professionals, etc.) feeling guilty. They were feeling guilty because suicide was being discussed as purely “preventable”, which mainly implied that it could and should be prevented, and if a person succeeded in suiciding then it meant that someone (or everyone) had failed this person. The emphasis is now shifting to raising ‘suicide awareness’, to be able to recognise those at risk of suicide. Most of these people can be helped. The others we may not be able to prevent from suiciding, but we can equally help while they’re living. You don’t need to be anyone special or especially-trained to do this, all you have to do is be a human being and engage the attention of another human being. Who knows, they may just help you too.

On teen suicide... and living

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

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

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

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

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

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

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

On depression and V-Tech

You're going to have to forgive me for reposting from my facebook notes, but I just really want this story shared:


Remembering V-Tech
On April 16, 2007 a guy called Seung-Hui Cho killed 32 people at Virginia Polytechnic Institute and State University. None of this is news, the media called it “the V-Tech massacre” and compared it to the “Columbine shootings”. Why does this interest me? Because Seung-Hui Cho interests me. Many people hate him; others tag him with as many psychiatric diagnoses as possible in order to fathom him as a human being. I think it’s also important to have a listen to how he thought of himself, or what he thought, in general. Here are some non-contiguous excerpts of things he said prior to the massacre/suicide: 

“You had everything you wanted. Your Mercedes wasn't enough, you brats? Your golden necklaces weren't enough, you snobs? Your trust funds wasn't enough? Your vodka and cognac weren’t enough? All your debaucheries weren't enough? Those weren't enough to fulfil your hedonistic needs? You had everything.” 

“Do you know what it feels to be spit on your face and to have trash shoved down your throat? Do you know what it feels like to dig your own grave? Do you know what it feels like to have your throat slashed from ear to ear? Do you know what it feels like to be torched alive? Do you know what it feels like to be humiliated and be impaled on a cross and left to bleed to death for your amusement?
You have never felt a single ounce of pain your whole life. Did you want to inject as much misery in our lives as you can just because you can?”
“You have vandalized my heart, raped my soul and torched my conscience. You thought it was one pathetic boy's life you were extinguishing. Thanks to you, I die like Jesus Christ, to inspire generations of the weak and the defenceless people.”
“I didn't have to do this. I could have left. I could have fled. But no, I will no longer run. If not for me, for my children; for my brothers and sisters that you fucked. I did it for them.”
“When the time came I did it. I had to. “

Now everyone points out the obvious things about these words: 1) He resented those that were wealthier or better off than him, 2) He had something like a grandiose delusion comparing himself to Jesus Christ, 3) He denies responsibility to his actions by saying he “had to” do what he did. And those things may be true, but there’s something else about him that interests me. What if he really was just a normal human being reacting like how any other human being would react in the same situation? There’s this segment in the Bible where someone asks why all the “bad” people seem to get everything that they want and he who tried to live a noble and decent life, didn’t seem to get the same benefits, the same riches. What I’m saying is that the feeling of injustice or unfairness is not a new thing, the Bible is thousands of years old. But beyond a common feeling of experiencing frustration, disappointment, resentment, sadness, or anger at injustice, is something else that then enables or empowers you to act. Could this be mental illness? Could these be the immature coping mechanisms they talk about? Maybe. I’m not an expert. I know about something, though, and some people call it depression. 

What I know about depression is that it’s not the same thing as sadness. Sadness is what you feel when you experience loss or disappointment. Everyone has known sadness. Depression is like when there is nothing left to be sad about. There’s just nothing. No companions, no love, no words that could bring comfort. It’s like having this dark being by your side—always—that follows you around and fills your space. It’s what gives you the courage to fear nothing because nothing outside of it exists. Sadness is almost beauty, a romantic ideal you wish you could at least aspire to. In depression there is no love, no beauty—no sadness, even. It’s a void; a dark space with nothing inside and no walls you could even break through. Therein lies the frustration, and when you have no battles left to fight, you cry. Everyone cries, and most people cry at the moment they realize their defeat. 

You know when you have those dreams that you’re falling into a black hole, but then you wake up and you’re still in your bed? Imagine this, but you keep falling for hours, days, months – and you can’t get used to it. There’s no sense of direction or orientation; nothing you can grasp at and no sensible motion, so although you’re moving and falling, you can’t even feel it. You don’t feel a thing. Nothing. Pretty soon you realize you can’t leave, you can’t scream, you can’t see or experience anything other than complete overwhelment at the nothingness that is your life. You can’t feel and so you stop wanting to. That’s the worst part: when desire finally leaves your soul. Nothing hurts and nothing feels pleasurable; nothing you could care about exists. There is you and outside of you there is only darkness and the void. You can’t touch or be touched. You can’t feel or want to feel. There is nothing to be sad about and you’re not. You’re not sad—you’re dead already. You’re not content or satisfied; those things describe nothing known to you—but you’re not sad, either. To be sad one has to be alive, to long for something. When you’re depressed, you’re no longer alive or wanting. Depressed people don’t commit suicide; they commit euthanasia by physiologically killing what on the inside is already dead. 

That’s one side of the story of why someone could react the way Seung-Hui Cho did (and I am using him only as an example). That argument could explain suicide, but what could possibly explain homicide on such a large scale? I believe it’s not such a large leap. When nothing matters, when you realize you have nothing to lose because the future has already being decided and there are no consequences to fear because you won’t be living with them, then you are the most powerful being around. In this line of thought, it’s quite easy to believe you are a God, with the ability to do as you want, to decide who lives and who dies, to act with ultimate freedom. The knowledge of your power is what allows you to explore all your options, things you may never have even considered before, things like actually hurting random strangers “just because you can”. 

I’m not trying to justify Seung-Hui Cho’s behaviour at the end of his life. But I do believe it’s important to remember “the V-Tech massacre” if only for the reason of trying to understand. George Santayana said “those who cannot remember the past are condemned to repeat it”. So lest we forget. 

—11/04/2009

On the human factor... and the risks of work

As anyone who has ever done a job that involves interacting with another human being will tell you, it's often the human factor that ruins most things. In fact it can ruin it so much you can start to lose your will to live. Let me describe one scenario that is all too familiar for anyone who’s ever worked a junior doctor job in a hospital:

Say the procedure is: patient is 1 year old and has a tumour, patient needs pre-op MRI, patient needs surgery, patient then needs post-op MRI. The actual procedure becomes: need to talk to the patient’s parents about the surgery, risks, etc. You then have to organise the pre-op MRI, which is absolutely necessary for surgical planning – and everyone knows this – but either way someone will have a go at you about because you’re requesting it be done today or tomorrow because the surgery is to be done tomorrow and the boss only told you about it today and the patient did not ask for their tumour to be diagnosed only yesterday. Then you have to discuss the case with the anaesthetist who tells you that you need to put an IV cannula in this child before he gets to theatre, although you tell him that the only accessible vein in this child is in his neck and it took another consultant anaesthetist 2 hours to get a cannula in him last time. Somehow, he tells you, the patient’s poor venous access is your fault and you’re incompetent for not being able to cannulate the child. Eventually the kid gets the surgery (after the 2 hours it took the anaesthetist to find a vein in the child) and you have to talk to the parents again because they're worried something went wrong, they think someone somewhere stuffed up and it's someone's fault, and they get all unpleasant towards you even though you're trying to explain to them that their child is just post-op and they'll improve or that it was a risk you had discussed with them previously, etc. Then you try to organise a post-op MRI and the radiologist decides to pick this occasion to tell you how surgical teams do too many scans, that they don't plan them right, that they order unnecessary investigations, that you personally are a crap clinician, that you don't understand how the MRI machine works, that you are wrong and your patient doesn't need the scan... but they'll do it anyway. So by this stage everything that needs getting done IS getting done BUT all these people have in the meantime made you feel so negative about yourself that you start to wonder if it was all worth it. Like, really, why must it be you that cops the abuse? Your role could easily be filled by someone else who knows how to fill in the forms and talk to people (aka the majority of the tasks the junior doctor job actually involves). So why must it be you? Why? Seriously. Hopefully the kid gets better, and maybe you had something to do with it, but you'll never think of it that way, and the family or the patient will never thank you, so all you remember from the interaction is the abuse everyone laid on you and how small you felt afterwards. Was it worth it? Was removing that child's tumour worth you self-esteem? Was it worth losing your self-worth? Was it worth losing your passion for your job, the big picture? And maybe, just in some, the question becomes ‘was it worth losing your will to live’?

Okay, so maybe the final statement was a bit of an exaggeration but it is not describing a new phenomenon. I always remember that story from ‘House of God’ about the medical intern that suicides and how every year a certain percentage of doctors do. But the phenomenon, of course, isn’t limited to health professionals. Cliff Baxter, one of the executives of Enron Corporation (the U.S. energy company that went bust in 2001), suicided after he was indicted to court for his role in the Enron bankruptcy case. In his suicide letter he wrote, “where there was once great pride, now it’s gone”. As an executive of a corporation like Enron was, Cliff Baxter wasn’t a weak or stupid man, but to me at least, his story warns about the risk of defining yourself by your job. I find it sad to think that having a wife and children, he saw his life as not worth living because he could no longer live with pride for his work. What about living for his wife or his child? What about living because there are other things in life besides work? I can’t help but feel that if you have to rely on your job to make you feel satisfied, to make your life feel like it is worth living, to make you happy, then you’re probably lacking something very important and beautiful in your life.

They say that doctors are especially prone to what is commonly called “burnout”, in general, for the same reasons that they have chosen to become doctors: they are often perfectionists and have a high sense of responsibility. In the workplace these are exactly the things patients and their relatives appreciate and expect. Other co-workers also expect the same thing from them. And what’s more, eventually the doctor comes to expect this of himself. So then he starts going home late to make sure everything is OK (a.k.a. “stable”) before he leaves. He’ll work all the ridiculous shifts and hours he is told to because he’s expected to and no-one before him has been able to change the system so he just has to submit. Of course, with all the time (and let’s not forget effort) dedicated to work and career progression, he spends less and less time with family, socializing, relaxing, and essentially doing all those things that truly enrich human life. It’s then easy to imagine how with work consuming so much of your life, a person could come to define themselves solely by their work. You start to associate success exclusively with occupational achievements and less with the attainment of personal, family, or social goals. Proverbially, you come to ‘live to work’ not ‘work to live’. And once you come to do that, it is not so far-fetched to imagine guys like Cliff Baxter who, having lost his ability to work, come to believe that he has also lost the ability to live.

On priorities

There’s this incident from when I was in medical school that always stuck in my mind. It’s about this patient I saw in a breast screening clinic who wanted to die, and she wanted to die before she even knew that she had breast cancer and could possibly die. It stuck in my mind because it resonated with something I had experienced personally – and something that I am only now beginning to understand.

In the movie (and book) ‘Fight Club’ the main character has terrible insomnia, works a mundane job he doesn’t find motivating but keeps him busy, and leads a fairly lonely life with little friends or satisfaction. To break up his day he starts wishing for something to happen, anything. He wishes his plane would crash, the world would end, anything to end the routine of his unsatisfying life. Of course, he could do something about changing his life (couldn’t we all?), but it’s all so ego-dystonic that many of us would rather wish that things would just change.

Lately I’ve been thinking about this incongruence we have with acknowledging that we are dissatisfied and acting in accordance to enhance our satisfaction. I think one of our main problems is prioritising.

I am someone who is very prone to becoming overwhelmed. As with many people, when I become overwhelmed I often enter this phase of what others might call depression. Sometimes people who find themselves in this state start to wish things would change, for better or for worse but just change. Recently I noticed how I had all these deadlines, things to do, money to pay, people to please, and I started to feel so low. Physiologically there was probably little wrong with me, but I started feeling so down. And so I started to wish again that something would happen. And I wanted something to happen so I wouldn’t have to deal with all these things I had pending. I’d heard Tony Robbins (the motivational speaker) before refer to this persistently low mood as overwhelment rather than depression – and I start to see now how true this may be. But what exactly about wishing for negative outcomes is it that seems so appealing when you’re feeling overwhelmed? I think it has something to do with putting things back in perspective.

Say something bad happens, maybe you’re in a serious car accident or a family member becomes really sick. Suddenly you notice that you can (and should) take the day off work, that that document can be handed in late, that that person won’t hate you forever if you fail to make the party, and that if all these things that were overwhelming you don’t get fulfilled the world won’t end. That’s right, these things aren’t essential! It’s incredibly liberating to realise this. And you realise that all these things have been prioritised incorrectly – or not at all. At the end of the day, the things that keep us alive and satisfied are always the really basic things, things that rarely have deadlines, people who won’t judge you, and things that you probably already have. When life forces us into a place that perhaps physically impedes you from completing the tasks of life that were overwhelming you, only then do we start seeing what our priorities really need to be.

The Story About The Breast Clinic

Yesterday I saw a woman at the breast screening clinic who had just been diagnosed with breast cancer. She seemed like the kind of person you’d usually expect to be the one cheering up other people. Yesterday, though, she was just human like the rest of us. The thing that stuck with me most is that she said she was actually happy (even though she was crying profusely) that she was going to die. In her mind she’d already made up her mind that cancer equals death, no other alternative but death. And she was happy that she was going to die because she had wanted to die for some time, before the breast scan had ever been an issue. She wanted to die because her life, she felt, was out of control and she wanted an escape or a change.

Gosh, gosh, gosh. I remember having felt like this before. My life felt remote from what I felt I had been—and I felt powerless, cowardly, and like my life was out of control and without a purpose. And because I wanted to die and at the same time too weak and cowardly to do it, I just wanted something, anything, to happen to me. I fantasized about road accidents, strokes, cancer—anything fatal. At one point I didn’t even mind if it happened to me or to someone else, just something needed to happen to change the direction of my life because I had no direction or purpose to my life. And I felt too weak to bring about change myself. I was so low.

This, I imagine, is how this woman at the breast clinic had been feeling, and how unfortunate that something like this did happen for her. I’m not even sure that it is also what happened to me (or similar) or if it is the opposite.
— 5/05/2007