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 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 making "the unhappy" happy - Part 1/2

One thing that took me a while to understand when I was younger is that “love”, or having a romantic relationship, doesn’t cure everything. In fairy tales, people fall in love and love rids you of physical “ugliness”, of having an evil heart, of disease and death, of financial poverty, of social oppression, of emotional and physical abuse, of low self-esteem, of disability, and of every negative thing that can happen to a human being. And don’t get me wrong, I like those stories as much as anyone else, and I'm also aware they are often metaphors for what love can actually achieve. Essentially love, being in love, being loved, loving, discovering love, etc. has the effect of giving human beings courage to believe in their own strength and to take risks. The greatest motivator for positive change and the strength to bring about that change is love. Love can conquer all…

The second most difficult thing for a human being to do is to bring about change in this world. The single most difficult thing in this life for us to do is to bring about change in ourselves. Love is supposed to make all things possible, right? That’s what the fairy tales tell us. That is what we have learnt personally from life. I still believe this is true. But there is one scenario unique to human beings I find particularly interesting when considering all that love can do.

Depression and post-traumatic stress disorder (PTSD) result in unique states of mind where the “enemy” and the “villain” that we fight everyday lives exclusively within our hearts and minds. He may have been created by exposure to psychologically trauma or neurobiochemical imbalances or social oppression and abuse, or any of a myriad of negative human experiences. Yet the outcome of these situations are so common that someone has been able to make lists of the cognitive effects that result. They are described commonly in books and medical and scientific literature and classified into categories that receive the names of “mood disorders”. Depression, anxiety, and PTSD are very common diagnoses given to the people who suffer the effects of having these internal enemies to fight; the low mood, the lack of self-esteem, the sense of worthlessness, the compulsion to self-harm, the feelings of inability to better one’s own situation, and the inability to envision a future different to the inner world they seem trapped in.

I have seen many patients with PTSD, mainly war veterans, but all survivors of some sort of abuse or extremes of human experience. These people have lived through horrible things – and survived! If anybody can be called strong and honorable, it is them. Yet, they often are the first to believe they don’t deserve to be alive or to have good things in life. Bullets kill many soldiers in combat; depression and PTSD kills way too many survivors. People don’t choose to suffer depression, anxiety, or PTSD, the same way none of us choose to voluntarily suffer. And the worst part is that with these psychiatric complaints, you also can’t choose to “just snap out of it”. The goals of treatment in these disorders are not aimed at cure, but at managing symptoms, learning new ways to process information to help stop triggering these inner beasts, and minimizing the number of exacerbations. Of course, there are many ways we go about doing this (medication, psychotherapy, self-directed education, meditation, etc.), but generally there’s no way to completely cure these problems.

But wait, what about love? Doesn’t love “conquer ALL? Doesn’t love give you strength, courage, motivation, hope, etc. to achieve anything in life – even to change the world? The thing with depression, PTSD, and other psychiatric complaints is that the thing to conquer lies within. But love should be able to help you achieve even that, right? Isn’t love also able to change a human being? I used to believe just that.

On what I've been doing

Mexibunny and me :)

I’ve been a bit erratic in my postings the last few weeks and I’d like to take this time for a confession-type activity. Writing, and especially this blog, is my passion. Self-expression, more rightly, is what drives me, and writing is the tool I feel most able at using. So when I write, I write because it makes me feel good to express myself. In the last few weeks there have been some things that have interrupted my usual weekly spiel. Basically, here’s a list of the things that have been taking up my time (and this I am sharing for my own selfish benefit in that it helps me sort through my priorities:

Exams

Oh gosh, there are only two things you need to study any field in life: time and memory. Really, that is all. They tell you that ability to reason is the key, but the truth is that at the end of the day our knowledge is evaluated not by someone inspecting our brains and seeing the cognitive connections we make when problem-solving, but by exams. A question for which an answer has already been assigned as right is asked. You want to pass an exam, you have to know the answer to the questions. That’s it. That’s life. How you memorize or acquire that knowledge is not important when it comes to assessments; answers, results are. Ha!

I have been studying for RACGP exams. I don’t know whether I passed or not, but right now in my life it makes little difference. In a few weeks when I know my results it will matter, but then even then, it won’t for too long. If I pass, well, I just move on with the next step. If I fail, well, I just move on with the next step, which is to study some more to take the exam again. That’s it. Everything else makes little difference. Whether I am excited or disappointed, expectant or nonchalant, makes no difference at all.

Trying my hand at new relationships

So the RACGP exams were the biggest exams of my life so far, no doubt about it. On the morning of this exam, at 3am, someone who I thought may be a worthy person in my life calls to ask a favour. Can I give them a ride to the airport? Yes, some people are considerate; others only know how to take from those of us “too nice” to let ourselves get walked on. This relationship made me realise that perhaps I am too accepting of others, that I do settle for too little, that as long as I allow others to be ok with only taking and taking from me, they will continue to do so. I have never thought that we waste our time with other people, but this relationship truly pushed me to almost believe this. I guess I can only call it not a waste of time by realising that it taught me that people like this exist  - and that I want to stay away from them.

Friends

Making friends is hard; keeping friends is even harder. When we were children all we needed to make a friend is to have them be in the same vicinity as us, and all we needed for them to remain our friends is to do the things they like, avoid things they dislike, and to apologize when we got it wrong. It’s harder as an adult. But it is so rewarding. When a friend wants to spend time with me, at my insistence or theirs, I always oblige to make it happen. It’s always a rewarding experience.

New nephew

What is it about babies? For the first few days they all look the same and do (and don’t do) the same things. You see one baby picture and you’ve seen them all, right? And yet, we can all find something about these little beings to love. Love? Yes, this is the amazing thing about humanity! We love those who offer us nothing in return, those whose only take and take and give essentially nothing in return, those about whom there is nothing “special”. And yet we all have a sense that they are unique and special human beings, full of potential, innocent, charming, entertaining, and worthy of our love, care, and protection. That’s it, that’s why babies give us that warm, fuzzy feeling.

I have a baby nephew, one of thousands born on the same day as him. What’s special about him? He does all the things that human babies do. What’s special about him is that he doesn’t need to be special, all he has to do is be the recipient to our affection and love. He asks no questions and he sets no conditions, if you want to love him he will not stop you from doing so. That’s his gift, that’s what he gives us. The bible rightly said that there is more joy is giving than receiving. It’d be good if my little nephew could love me, but the fact that I’m allowed to love him and shower him with affection is a gift to myself.

My “daughter” being sick

Mexibunny, my little pet, has been destroying my house. More recently, she has also hurt her ear so I’ve had to pay her a little more attention. She’ll be ok and it’s only minor, but I am just like the worried mothers I see every day coming in to my consulting room with their mildly-ill children terrified that they’re suffering something graver.

Family

It’s strange, they’re always there, and yet there is just something about family that makes us aware that we can’t relegate them to second place. We could skip or pass up on anything, even once-in-a-lifetime opportunities, if the alternative is to see to your family. Nothing else can justify if, not work, possibly not even our own problems; when family must be seen they must be seen. At least, that is how it is in my family.

On racism in Australia

Dr. Charlie Teo, an Australian-born neurosurgeon of Asian descent, recently gave a speech on being Australian. He addressed the common denial of certain politicians, and in fact of a large segment of Australia’s population, that there is in fact a lot of racism in Australia. He pointed out that you cannot believably state that there is no racism in Australian unless you are of Indian or Arab appearance. I would add to that list Asian or African or Indigenous appearance at the very least too. That is because people of these backgrounds, with phenotypically prominent features in their face, skin colour, clothing, etc. are the ones that are often the recipients of the racism that occurs in Australia. But Australians in general aren’t racist, are they? Australians in general think they can make “non-racist” racist remarks by prefacing a racist statement by the words “I’m not being racist, but…” then following that up with an overgeneralisation or stereotype about a cultural group of people. It is such a common phrase in Australian parlance, really, but the preface doesn’t exonerate the content of the message.

The population of El Salvador is said to be over 99% ‘mestizo’, that is to say there are less than 1% “indigenous” Salvadorians or Mayan and/or pipils. Who in El Salvador does this matter to? No one! Because almost completely the people of El Salvador consider themselves Salvadorians rather than part Mayan with part Spanish ancestry – yet all of us, in varying proportions, are exactly that. You see it in the skin colour and physical features of the people. In terms of identity and culture, however, they call themselves Salvadorians only. Isn’t that a better method?... And yet maybe it isn’t about one method being better or another being worse, but perhaps it’s a cultural thing to think this way.

I remember when I was in Peru for the first time with some Australian-born girls and they were surprised by the way people describe each other in Latin American countries: skin colour, stature, hair colour, eye colours, nose length, personality, and other physical features – mostly in that exact same order! We were often trying to find people within a local hospital we were undertaking a medical school elective in. The oncologist was the white, tall guy, a bit chubby, with black hair, brown eyes, big nose, and was such a lovely man. The gynaecologist was the dark, short guy, who was overweight, had black hair and eyes, and was an arrogant prick. Found these guys in no time with those descriptions! Maybe our culture hasn’t been too marred by “political-correctness” and that’s why we can communicate so freely, but what else is the point of communicating if not to get a clear message across? I don’t know.

A few months ago I attended an indigenous culture awareness course, of which I’ve written about before. Before us non-Australian-indigenous folk was a man of Australian Aboriginal descent teaching us things about the differences between certain aspects of indigenous and non-indigenous culture. One of the rules of the course was that there were no “stupid” or “offensive” questions; all discussion and questions were allowed. As tends to happen in these kind of conversations, people soon start talking about “them” and “us”. The speaker at the front kept speaking about “us”, so a student of the course asked him a question: does he consider himself Australian at all? The question was based on the fact that we all, the speaker included, were living in Australia and sharing the experience of what living in Australia is. The speaker answered, “I consider myself an Aboriginal man”. Well, yes, but did he identify as both Australian and as an Australian-Aboriginal? The speaker laughed mockingly and said, “There is no Australian culture! What is Australian culture? Eating sausages and drinking beer?” There was an all-round “Ooh!” heard from around the room… I guess no-one likes to be stereotyped.

Is racism rife in Australia? Probably. Is this surprising? No; why should it be? Because suddenly it’s no longer acceptable to acknowledge flaws of the past (or present). What this reminds me of is of certain oppressive governments that seek to rewrite the history books that retell of their defeats or of their gross inhumane mistreatment of masses of people. If those histories or those actions are so reprehensible, then the wisest thing may not be to deny its existence, but to admit it and accept it as a challenge, to set it as the target away from which we must aim our future. If we are lucky enough not be part of a minority group, then what we can do is to personally not discriminate minority groups. But if we are part of a minority group, we must recognise also that this does not entitle us to be racist in return to “the oppressor”. We may not be able to change Australia, a whole country, but if we each make a commitment to change… 

On the dobber's (/victim's) dilemma

I have previously mentioned the difficulty faced by victims of childhood sexual abuse as children and adolescents in telling someone of their predicament. They hesitate due to embarrassment, unwarranted guilt, fear, lack of understanding that they are victims to a terrible sin, and being unaware of the process, etc. Recently I’ve encountered a similar scenario, but in the adult victims of past sexual abuse.

Victims of childhood sexual abuse eventually grow up to become adults. Some become very capable adults, and a lot become crippled by the emotional and psychological scars of trauma. A lot of the people we encounter on a day to day basis have been past victims of this worst of crimes, most have never told a soul of their experiences. I want now to discuss a composite of this person, let’s call her Elisabeth.

An Unpleasant Story 

Elizabeth was sexually abused by Josef between the ages of 10 and 14. Josef was Elisabeth’s stepfather, who joined the family just before Elisabeth’s 10^th birthday. Elisabeth told Rosemarie, her mother, of Josef’s behaviour towards her, the fondling, etc. She did this when she was 14 and then the abuse stopped. Rosemarie had some “stern” words with Josef, but eventually she was a woman in love and they decided to put this “episode” behind them and move forward with family life. The “episode” was never discussed with police or counsellors or anyone else who may have cared. Rosemarie and Josef remain together to this day. Elisabeth, somehow, finally managed to escape the rape dungeon she called a home.

Elisabeth became a woman of her own, independent, self-sufficient, struggled with some things but succeeded in others; she was just a normal woman with a past most of us would never wish on our worst enemies. But the past was in the past and the past can’t hurt you, right? I don’t know that that is right. Elisabeth had managed to move ahead with her life, leaving the past behind, until one day the past came back to find her. Sounds clichéd, right? Yes, but it also sounds horrible and unfair.

One day Elisabeth found out that Josef was accused of doing some things she knew he was capable of, things she had witnessed at one time when she had been the victim of such things. But this was a separate incident, separate incidentS, things not related to her at all, but it brought to her consciousness something that she had suspected all along: that she was not Josef’s only ever victim. There had been others, there probably would be more… And whenever we read this scenario the answer seems so simple: tell. Elisabeth should tell her story, right? Elisabeth should do the right thing for the greater good, right?

Imagine yourself in Elisabeth’s shoes. In the movies and episodes of Law & Order: SVU what happens is that the Elisabeth-character tells her story, feels good about herself, saves the day, the baddie goes to prison forever, and everyone has a perfect life thereafter. Reality is not like the movies. Elisabeth knows this.

Elisabeth asks some people for advice; should she “assist” the potential case against Josef? This isn’t about her life or the things that happened to her, this is about doing the allegedly right thing. Everyone tells her, ‘yes, of course, you HAVE to tell your story’, it’s her duty. The thing is Elisabeth has a life now. She has left that past behind and she owes no-one anything for getting where she is. Who does she owe? Josef’s other victims? The “general public”? Why? She suffered too, but how does that make her anything other than a victim? And will she really feel better to tell her story, to become the hero that saves the fate of children she’s never met and owes nothing to? Doing good things makes everyone feel good, we’re told… And yet I feel that no one should feel coerced to re-live any pain except for their own self.

How do we convince Elisabeth to do the “right” thing? What is the right thing to do? This is the dilemma of knowing something that incriminates someone, but that also inadvertedly incriminates you too. I know you’re thinking ‘but how does that incriminate her if she tells her story?’ Josef maybe or maybe doesn’t get prison time. Elisabeth is punished by having to re-live pain of her story, the humiliation and embarrassment of discussing the very personal and degrading things done to her, she is faced by the well-meaning but hurtful murmurs that if she had told earlier none of those other victims should have had to suffer what they did. Is it worth it? Is the sacrifice worth it for Elisabeth? Forget for a second the “general public”, the “greater good”, is all this worth it to Elisabeth? What will she gain by telling her story?... It’s easy to answer that, but not if you’re truly only thinking of Elisabeth. The only person thinking of Elisabeth – and for a long time – has only being Elisabeth.

And if Elisabeth doesn’t tell her story and Josef goes on to abuse other children, is it Elisabeth’s fault or is it Josef’s? Elisabeth was a victim. Before we judge her, we have to understand her dilemma. Sometimes it’s enough to be a survivor without being a hero.

On addictions... and my dating challenges

When I was studying psychology, one of the areas that most interested me was the field of study into addiction. It interested because a lot of human behaviour can be thought of as addictions. A lot of the things that hurt us, the very human psychological things that hurt us, we are also ironically addicted to. Hold on, but no ones like to hurt – how can we be addicted to it? Quite simply because often it is all we know how to do well. If there is one thing that is more unpleasant to humans than pain, it is change.

Think of the common scenario of a person who smokes cigarettes. Why do they smoke? Because smoking feels good! The nicotine gives you a rush, triggers off the pleasure centres of the brain, etc. Basically we smoke because psychologically we experience it as something pleasant. Why should we not smoke? Well, there’s that whole thing about lung cancer, heart disease, stroke, bladder cancers, etc. etc. But what would happen if a person who smokes stops smoking? Seriously, what will happen to that person psychologically? The truth is that the smoker can’t answer that so easily, if at all. What to do next time you’re bored or in a crowd where everyone else is drinking and smoking? What does emotion feel like without the nicotine? How to relax? How to motivate yourself? All these things that we once were reliant on the nicotine and the simple act of putting a lit cigarette to your mouth for is now so full of unknowns. The unknown is incredibly frightening, no matter how tough you are! So why face this really scary thing? Why?..

There are very few smokers out there who don’t know about lung cancer and cardiovascular disease, but there are a lot more who do know about this and yet fear something greater. But what could potentially be worse than respiratory or vascular disease? Change! The unknown! Mental anxiety! Us humans will do almost anything to avoid these most horrible of things. This is why it’s so hard to quit smoking or using any other mind-altering drug or quit just about any behaviour we engage in repetitively. Everyone has their list of things they’re addicted to. We call them addictions because they are things we engage in repetitively despite the negative consequences (physically or mentally) of engaging in these things.

I keep getting into these relationships that don’t seem to last. I want them to last. I think I try my best. I date different sorts of people to see if that helps, but it’s still the same consequence: Vanessa is almost always single. But why? Is everyone out there defective? No! That’s the reason I think I want to date these people in the first place; they seem OK. So the common factor in all the people I date is me. Woah! Yes, my ego has just taken quite a blow in admitting that, but it’s worthwhile to discuss this even if it hurts. And I had to admit this because I want to change, to end this cycle of constant rejection…

There’s a great book I read in my undergraduate years called ‘Excessive appetites: a psychological view on addictions’ by Jim Orford. It quoted this other author in something which I took very much to heart:

“… in the acquisition of a new habit or the leaving off of an old one, we must take care to launch ourselves with as strong and decided initiative as possible. Accumulate all the possible circumstances which shall re-enforce the right motives; put yourself assiduously in conditions that encourage the new way; make engagements incompatible with the old; take a public pledge, if the case allows; in short, envelop your resolution with every aid you know” (James, 1891)

I made my resolution: when I saw something I wanted, I would go in 100%. It worked marvelously in some things in my life. When I finished off my science degree and didn’t immediately get accepted into medical school, I enrolled in an honours course. It wasn’t what I wanted but I thought I’d give it a try. Everyone kept telling me it’s ok, medical research isn’t that different to clinical medicine, etc. They told me to pursue it, even. I knew it wasn’t what I wanted and instead of pursuing plan B or C or D, I decided to burn all my bridges so that in fact all I had left was plan A. That quote “make engagements incompatible with the old” really stuck with me. I quit my honours course, lost a scholarship, annoyed my supervisors and the university, and risked losing the grades I had worked so hard to attain. There was no way back and no other way than ahead with Plan A: to somehow, but eventually, get into medical school. The gamble paid off; it had to. I would have probably died trying if it hadn't...

Things get a little more complicated, though, when your plans are dependent on another human being. Recently I started to see someone new. I had met someone a little while before them, and they were a good person too. Gee, life is like that, hey! You go through droughts, then you go through floods. I made my decision; I would go in 100%. I ‘made engagements incompatible with the old’. I burnt all my bridges so I’d be left with just the one bridge that lead to the destination I wanted to go. You know what happened? Nothing. I’m still single.

So back to the drawing board I go and I’m starting to realize something about myself. Maybe I’m not a bad person; maybe I’m even what you may call a “good” person, but I am also someone who doesn’t like plans B, C, D, or any other one that isn’t A. And what I hate most is being other people’s plan B, C, or D, etc… But what is it I’m addicted to that keeps me in the position that isn’t foremost in other’s list? That is something I’ve been giving a lot of thought to. I’m not there yet, but I won’t accept this latest challenge as defeat :)

-Dedicated to R.V.... and thanks for the feedback :)