On abortion

The rape of the Sabine women, Giambologna

Recently someone asked me to express my views on ‘abortion’, specifically as it relates to my role at work, my personal religious views, and my experience with medical ethics. I found it an interesting little exercise because it made me think about the different roles we play in different social spheres and also the cognitive schemas which we keep constant across these spheres. For example, the religious group to which I belong and whose view I share (or at the very least accept) has a view on abortions that is easily summarised as “it is never indicated”. Now, in my role as a doctor I am at times confronted by people enquiring about termination of pregnancy services. In this scenario you could say that I am paid to educate, to assist, and to aim for the best health outcome for my patient. But I am the same human being doing both roles of Christian and doctor. The other thing to realise is that I represent only myself, not my religion or my profession – and yet to another fellow human, I am both!

I have summarised perfectly my religion’s views on abortion as “it’s never indicated”. Before I summarise my profession’s view on abortion, I must summarise my profession’s role. Doctors have sets of clinical standards and legal standards by which we must exercise our jobs. It is not just about using the best clinical method or doing things legally, it is about using the best clinical method to do legal things that are in the patient’s best interests – as dictated by the patient himself (or a substitute decision maker on his behalf). So my profession’s view of abortion you could say has to do with the performing of legal abortions in a clinically safe manner. Of course, this is given that it is requested by the patient, and is in keeping with the general direction to minimise harm to her or to improve her wellbeing. You could very generally summarise my profession’s views on abortion as “it is indicated when the patient wants it, it is the best thing for her mental and/or physical health, and it is able to be performed in a clinically safe manner”. Now, does everyone in my religion believe exactly the same thing? No! Does everyone in my profession believe the same things as each other? No, of course not. Some of us differ even in antibiotic prescribing!

Personally, I believe whether or not a thing is bad has to be decided by the person to whom the decision directly affects. For example, if my religious belief is that eating a certain food is a sin, then it IS a sin if I personally ate that food. However, if someone else doesn’t believe it is a sin and eats this particular food, then to me that person is not guilty of a sin either in his own view or mine, and I can hold no negative judgement towards that person. The question of MY view on ‘abortion: good or bad?’ for me is redundant. To me what is of relevance is what I do in one or another context. I am both a Christian and a paid medical professional, but I am above all things, a human being. Every human being approaches life with the same basic aim: to do the thing that is best for me and minimize my discomfort (physical and/or mental). No one likes to feel guilty of not doing their job adequately, and no one likes to feel that special type of guilt our religious beliefs can make us feel. Things get even more complicated when you throw in having to act in situations that will directly (and indirectly) affect at least one other human being.

I have reached a position in my life where I don’t want to change anyone’s view to that of my religion, or to change the views of my religious associates to that of my own. I have also been lucky enough to realize that my work is just that: work. So what has all this stuff on religion have to do with my discussion here on abortion? Medically, in my job, it is never my choice to decide on a patient’s medical care if he is competent to make that choice himself, regardless of their or my personal religious or personal views. My job would be to inform accurately and with scientific fact, to ensure that the person has access to adequate psychosocial support, and to aim to protect the patient from mental and psychological harm. None of these tasks have anything at all to do with my own personal religious views on anything.

You can’t discuss abortion, though, without discussing legality. I was asked whether I believed that termination of pregnancy services should be deemed “illegal”. I believe that the main reason that the concept of legality is still introduced into discussions about intentional abortions is that it is contended on some many levels that have little at all to do with either medicine or the law. The way our society deals with such “ethical” or “moral” dilemmas is to pass strict laws or rules to dictate what should be done and where and by whom. For example, a statement could be made that an unborn person has the same human and legal rights to a person who is already born. However as a society a statement like that is not very practical because there are too many things to consider, e.g. at what age or weight is a foetus a ‘person’, what anatomical or biological parts entitle a person to be called a person, etc. So we come up with laws and rules instead, saying for example that a foetus after 24 weeks of gestational age is a person and has this and that other human right but not these other ones yet, etc. This is, you’ll notice, similar in concept to Christian ideology that says “it is never indicated’.

Personally, I believe that health professionals should not be criminally prosecuted for performing abortions that are performed safely and using standard practices when a person has consented to the procedure after being adequately counselled about it. I believe it should also be legal for patients who are intellectually competent to make health care decisions to seek adequate help from health professionals for discussion and possible subsequent performing of an abortion. I also believe that it should remain illegal to perform abortions that are not medically supervised or on people who are not capable of consenting or refusing to the procedure (unless in conjunction with a substitute decision-maker that has the person’s best interests at the forefront). I am glad that termination of pregnancy techniques have been developed in a medical context. For example, it’s better that a doctor with appropriate tools and knowledge perform an abortion than a woman attempt to have one done by someone with no specialized training. To believe that outlawing something which has such a long history of occurring is going to stop it from being done, I think is quite naive.

I do have one problem with our society’s current high rate of abortion, though, and it has nothing (or everything?) to do with either religion or law or ethics. I find it concerning that the high use rate of termination of pregnancy services, and its widespread acceptance, has led to the trivialization of what is essentially (and I think, rightly so) a big decision to be made in a person’s life. It saddens me that some people are coming to think of an abortion as an option for contraception or that it is a common/simple thing like getting a mole removed from the skin. The true and often undiscussed fact is that a lot of women do not understand the psychological impact of their decisions, and the potential for negative psychological sequelae in the years to come. Ideally, no woman should opt for an abortion without having full explanation of the medical or surgical techniques and the potential risks associated. The discussion should include explanations of the changes to be expected in her body, an understanding of the foetus’ current stage of development, an exploration of her own spiritual views, and consideration of her mental and physical health. Now, I am not saying ‘don’t have an abortion because you’ll get depression or other mental problems in the future’. I am simply saying that a patient needs to be given adequate and complete information to help them form their own decisions.

On an environmentalist

A monkey masturbating!

There is one man I credit with helping me lose the respect I once had for environmentalists. I won’t say his name, but he was a lecturer I once had for a bioethics class at university. Now, this man’s great passion was protecting animal rights, especially as they related to scientific research. He spoke of it all so passionately and realistically. He enjoyed the work of philosopher Peter Singer and he was also a vegetarian. Why do I mention that? Because it means he was a knowledgeable and “true to his cause” environmentalist. Anyhow, it was well understood knowledge that he was a very well accomplished ethicist and so he had the attention of all of us students. And then he let me down.

He, like many scientists and philosophers, admitted he was an atheist. Is that wrong? No; a person believes what they choose to believe and as long as it’s not coerced or misinformed, then there is nothing wrong with what they choose to believe. I in fact believe that there are few true atheists, but I’ll discuss that at a later stage. To this man, a “good” man I was lead to believe at that stage (he was an ethicist and an environmentalist, to say the least), the protection of nature, earth, and living creatures on, above, or beneath it was very very important. Wow, there’s a good human being! However, as the lecture moved on, he for some reason I can no longer recall, moved on to the subject of discussing religion. Ok, so he had already made it well known that he didn’t believe in “God” or that religion wasn’t of his preference. But he started to discuss a neighbour of his, a man he didn’t like: a man who was a Jehovah’s Witness in Christian belief.

So let me frame this for you so you understand why I found what he said so offensive and despicable. Firstly, he comes in with a reputation that he knows inspires respect and influence. Secondly, his reputation is that of a “good” man: one who cares about and defends defenceless animals and the natural environment. Thirdly, he is put in a position to educate very keen and suggestible young adults. It would be a great and excellent platform to incite some passion or at least enthusiasm for a good cause. He could have chosen to inspire us to defend the environment, to protest, to petition higher authorities for change and justice, to be kind to animals, to support the defenceless, to acknowledge the inherent power of a human being who is passionate in his pursuit of a definitive goal, etc.

What did he do instead? He told a story of his neighbour who is a Jehovah’s Witness. Now, the neighbour was a “bad” neighbour because he insisted on greeting him pleasantly over the fence between their properties, was always so jolly, and always wanted to make friendly conversation about anything at all. You know, the kind of guy like Ned Flanders from ‘The Simpsons’ who irritates because of his good nature. Similarly, this Jehovah’s Witness was a ‘bad’ man, he had us believe, for doing just that. So then this guy, this great ethicist, disclosed a fantasy of his: he said he would love to collect a whole bunch of leeches and set them free onto his neighbour until the leeches had sucked away all his blood, and given that he was a Jehovah’s Witness, watch him then die as he refused a blood transfusion. He laughed after telling this story. He laughed and then after a short awkward silence, the whole auditorium laughed with him. And then he continued the lecture on how a good person must ensure to promote the wellbeing of the environment and animals.

I was not at that stage a fully convinced Christian so I wasn’t offended for that reason, but I found his behaviour to be almost an abuse of power. Sure, in the right context it could have been considered a funny joke, but what was disturbing is that he was in a position of teaching, and we all learn best by example whether we believe it or not. Knowing he was an influential man in front of an impressionable crowd, he chose to spread disdain and hatred instead of promoting a humanitarian cause, or even just doing what he was being paid to do and teach us about the ethical use/care of animals in science. And what further aggravated me was the hypocrisy of claiming to be for the very humanitarian causes of protecting the environment and non-human species, and at the same time being capable of such great non-humanitarian discrimination, if not hatred, of a group of people. I say a group of people because he never said his neighbour’s name, he referred to him as “a Jehovah’sWitness”. I lost all respect for that man that day. I still consider it a shame that he is allowed such an awarded role in the university and still exposing impressionable students to his dichotomous, and somewhat concerning, views of the world and the creatures on it.

How is it possible that a person be able to love animals, to want to preserve and protect them from harm, and yet be so careless about the dominant animal species: humanity? If I wanted to keep a mouse alive, wouldn’t I consider it an equally respectable aim to keep a human being alive? If I considered it wrong to cruelly beat an animal, then why would I support or even promote the discrimination and abuse of a group of people? A lot of people who are passionate about the environment tell me their passion is because these animals, these trees and lakes and oceans, can’t protect themselves. And not only that, they do no harm to anyone. A human being, on the other hand, can not only defend himself but also launch an offence / attack towards other humans, towards animals, and towards even the very environment that keeps us alive. Yes, human beings are capable of evil, no doubt, but to admit that a person can be imperfect and to say he warrants death is a massive leap. 

^^^ Hilarious tattoo! - why you should think twice aboout what you put out there :P ^^^

On god, nature, and spirituality

Recently I was doing a bit of reading about Australian indigenous identity, and one of the things I found very interesting is this culture's view of spirituality. In fact, the interesting thing is that a lot of indigenous cultures from vastly different places seem to have a similar belief system: sharing a deep spiritual connection to the land.

Now, I live in Australia, a westernized and largely Christian (if not by majority agnostic or atheist) country. To say that a culture has a deep connection to the land conjures up images of politics, of land ownership laws, and of a broad concept we’ll called ‘justice’. No, no, what I’m trying to discuss here is not those socio-political issues, but rather one of spirituality and culture. I admit that this new understanding is only new to me as a result of my natural curiosity and some research I had to do as part of coursework for a developmental psychology class. I would, however, like to share what I have come to comprehend from this – which may in fact be completely off track - but is probably closer to the true track to understanding these concepts.

I, like a lot of Judaeo-Christian adherents, couldn't understand before much about how a connection to the land equalled a spiritual connection. And in the Andes region, for the Incas for example, connection to the mountains meant a spiritual connection. The conclusion I’ve reached as to the reason it's hard for the traditional Jewish/Christian person to understand a connection to a land and equate it to a connection to God is because our tradition teaches us that God is in heaven, or “out there”.

So a common belief in Western culture is that God, who is creator of man and earth and everything, is in heaven, above us, in the sky somewhere. When we worship we direct our spiritual attention to this ether out there where God is. Now, the aboriginal man, for example, believes that all life comes from the earth, the soil and the ground on which we're all dependent on. And science will tell you that this is true: life on this planet requires air, water, sunlight, and nutrient and sustenance from the ground. Eukaryotic life, of which mammals and other animals like us are, depend on plants for nutrients. Plants emanate from the earth. Therefore it’s not a huge leap to assume that what keeps us alive is in the earth, or IS the earth. This is not a new observation, thousands of years ago, before pastoral times, and before mass colonization, the indigenous peoples of the land saw this basic relationship. He would see the plants and trees grow out of the soil, which fed the animals, which fed us, which kept us alive.

Keeping this in mind, consider now the human concept of god or creation. Until very recently, most traditional cultures had a basic belief that life, the universe, human beings and every other thing above, on, and below the earth, including the substance that is earth, was created by one if not many other external being/s or forces. For brevity, let’s call these beings or forces God. Extrapolate the line of thinking previously established, that if all life essentially originates from the earth, and God is creator of everything, then earth must be this being we decided to call God. It is now also easier to understand why so many native cultures speak of a 'Mother Earth' or Pachamama.

Now, the most common Judeo/Christian/Islamic traditions are monotheist and believe in a god that created the universe and everything in it, and who we in turn worship or have a spiritual connection or relationship with. To worship a creator is mostly a sign of gratitude and sustaining interconnectedness between ourselves and others (including wildlife, the earth, space, etc. as our specific faith dictates). To worship god or gods, a creator or co-creators, is a very ancient concept common to most cultures. Now consider the aboriginal man to whom God is or is in the earth. For an aboriginal man to worship God is to worship the land, to cherish and honour it, to direct his prayers and rituals to it. Christians, Jews, Islamists, etc. do the same: we pay respect to the place we think God inhabits, the heavens. We direct our prayers to this place. As an example of just this concept we have the very old traditional Christian cathedrals with high arched ceilings, ceilings decorated with images of heavenly creatures and the sun, the skies, etc. Going to the temples and cathedrals to offer our prayers and sacrifices we'd contemplate the heavens, conjure them up in mind and spirit to give our worship to God. The indigenous man does the same thing, except he believes God is in the earth. So making physical/skin contact with the soil is very important. The earth is what connects one man to God, and that which connects him to other men and all other creatures in this planet.

When Judaeo-Christians meet in their churches and synagogues and temples, etc, they also seek not only to connect and share with their god but also those whom they consider their spiritual brothers and sisters, co-worshippers in a common belief, people and creatures with whom they believe they share a common origin. It is the same also with the indigenous man, worshipping with those who are related to him via God, Mother Nature, earth. To worship together means often to worship in a specific place on earth, not just with specific people or within a specific but man-made structure such as a temple.

The indigenous man also shares a deep connection with other creatures, animals that also walk or otherwise inhabit the earth, not only with his fellow humans. That's why when the indigenous man speaks of the wolf or the kangaroo he calls him his brother, sharing a common origin and connection with the land. That's why killing animals for nutrition, especially to the aboriginal man who is not of a pastoral nature but hunts only what he will consume and absolutely needs that day, is a sacrifice and a spiritually-filled occasion, as it would be if a person of a Western culture would eat his siblings or friends. In times of crises, humans from non-traditionally cannibalistic cultures have had to do exactly this for survival, and they will tell you of their suffering in making these decisions and going through with them. You could say the indigenous man does this a little less freely, consuming his brother animals because he has acknowledged the sacrifice and has certain rituals by which these activities take place and they are often so ingrained that they are incorporated into the cultural practice itself rather than as a distinct spiritual ceremony.

Western culture’s spiritual worship rituals and our belief as to the location of God, in heaven or some other intangible place, is exactly what (I believe) makes it difficult for so many of us to understand the spiritual connection many indigenous peoples, not just native Australians, have with the land. But understanding this also helps to understand why place and movement, physical relocation, to aboriginal peoples is so important. Imagine it being like kicking someone out of a temple or cathedral, out to the cold and unknown, and asking them to continue about their lives, including their worship, without the places and things they believe to be sacred and secure.

On 'what's going on' with me

'The Thinker', on top of 'The Gates of Hell'. Auguste Rodin.

O.J. Simpson once said, "They say people don't change, but I say they're wrong. People change, but it's usually for the worst". He may be a man that doesn't always speak the truth, but he wasn't too wrong in saying that. Or maybe he was. I've always believed that in life change is inevitable, but qualitatively neither good or bad, just inevitable.

Recently I've had some well-meaning people ask me "what's wrong", "what's going on with you". Now, to the majority of the non-family, non-religiously-affiliated of my friends this question may seem a little odd so allow me to provide a little background. Who is Vanessa? Some people that know me may answer this differently to other people who know me. Which is the right version? Both! All angles, probably. I'm no different to anyone in this respect. But a lot of people who know me from either being family or a religious peer will describe me as shy, non-engaging, quiet, and abiding. They see me that way because I was that way for such a long time. I am not the perfect Christian or the perfect relative, but I am presumed to be pretty close to it. Worse than being presumed to be perfect is to buy into the belief that you have to be. Even worse than that is knowing you are being evaluated at every encounter to ensure you still meet the same criteria. What can I tell you about me? I can tell you I am human.... And let's consider humans for a little while.

A human is born a small dependent child that needs the basic things we need thoughout our lives: nutrition, hydration, protection, sensory stimulation, social contact, and what we broadly call love. The difference between a child and a grown adult is that the child is initially dependent on others for all these basic needs. As he enters adolescence the social contact he needs becomes more than that of his parents and immediate family members; he seeks and needs the interaction with other peers. Later, maybe into puberty, he comes to crave a sexual relationship (whether that be physically or emotionally intimate or both). As adults we don't stop developing; our physical, social, and psychological needs change and the tasks we have to achieve to meet these needs change too. We are a constantly growing being.

Have I changed? I hope to God I have! I'd hate to still be thought of that defenceless child lying in a cot with only a cry to communicate my needs, and then waiting and needing someone to come help me meet them. Everyone changes. It's human to. It's inevitable in this skin and body to stop being human without killing yourself and hoping that those things we believe in about the afterlife are true, whatever they may be.

What's going on with me? The same thing that is going on with every other human being: living, experience, change. I can narrow one thing down, though. I was always an insecure, shy, quiet girl when I was younger. Gradually, and very very slowly I must add, I became a bit more and more confident. And by confidence in my sense I mean more at ease at accepting that I am also human, and at the same time that it is okay to be and feel different to others. I became confident to form my own identity. A long time ago Erikson, a psychologist, described a series of psychosocial stages of development that a human being transgresses as he grows chronologically older. Everyone ages; everyone equally and inevitably must grow psychologically. I guess where I am different from a lot of other people is that because of my pathological shyness, the formation of my own identity didn't happen when it does in most people: puberty / adolescence. Me, as I've mentioned in a previous post, I couldn't even look at my own body comfortably until I was 26 years old. 26! I couldn't believe or accept that that body I had to look at only because I couldn't get away from it, belonged to and was me. And that was the external aspect; I can't even begin to explain what the psychological experience I struggled with, these feelings of depersonilization and unreality, were like. I reached 26 years without yet fully defining and deciding who Vanessa was. And I'm 29 now... There are those that are intellectually retarded, I guess I prove that you can also be psychosocially retarded :)

On doctors... Part 2

Just as I thought I’d finished this post, I remembered what exactly I set out to do: provide a dual view of people’s experience of health care. Now, it may seem that above I was just taking a defensive stance to explain what is experienced by the doctor himself compared to what the non-medical population, our patients, expect. But it must be acknowledged that a lot of patients do have these, perhaps out of date, perception of doctors – and doctors would be callous for overlooking this!

It’s already established that a doctor has a very specialized knowledge, access to which you can ‘buy’ for the cost of a consultation fee. However, this knowledge is of value to every human being because it deals with something that affects you directly and in the flesh. Access to this knowledge, the service the doctor provides, could potentially save your very life – there are very few services this could be said of! Patients know this and that is why they seek them. Doctors have to equally acknowledge this, so as to fulfil our duties (for which we are being paid for). Generally, people do not present to a doctor just to hand over some money for the consult fee and waste some time. Generally, they pay their fees in order that the doctor provides advice and or treatment for a sub-optimal machine fragment. That is an important thing for an ethical doctor to realise. Now, I say ethical speaking of work ethic more so than moral or philosophical ethic. If you paid a mechanic to fix the gearbox in your car and he dismissed your concern about it because he doesn’t feel motivated to work currently, and he did nothing to repair or investigate the problem in your gearbox, then charged you his mechanic’s fee, what would you think? You would think he has a poor work ethic, not necessarily that he’s an immoral person or that he’s not a good mechanic; quite simply he has not done what he was paid to do.

Patients don’t go to see their doctors when they are happy and healthy and life is grand. They seek the doctors when they are in need. And that to me is one of the biggest realisations a lot of doctors fail to make. Even the patients that abuse us, that blame us, that threaten and disrespect us, did not come to us without a need. Perhaps it may even be that they need treatment for their abusive behaviours and just haven’t realised it. But patients don’t present to us to waste our time. They perhaps have expectations of us that are above reality, but they do have basic needs that are not being met – and sometimes the cheapest treatment we can offer them is to acknowledge and validate their concerns.

Having said that, I can only emphasize that medicine as an industry does not always obey your standard commercial industry rule to give the client exactly what he asks for. You may ask someone to sell you a plank of wood of a particular length and he will gladly comply and bill you accordingly, but from a doctor you buy a service, not a product on its own. For example, if a patient attends a new doctor demanding a script for a drug of dependence, that doctor is not obliged to hand over a script at the end of the consultation. He is required to perform a consultation and apply his special skills to determine what the treatment indicated is, which may or may not be to provide a script for a drug. And in that, the medical profession differs because we do have a duty to both aim to improve the patient’s health and also to prevent negative health effects. A doctor does not sell prescriptions, investigation requests, or referrals to other health professionals in exchange for your consult fee. No, he sells his time and specialized knowledge, which may require referral, investigation, or medicinal or surgical treatment.

I suppose if I have to summarize this whole two-part rant I’d say I was trying to make two points: 1) Doctors are normal people doing special jobs, and 2) Doctors would be silly not to acknowledge that the non-medical public does attribute some beyond-human qualities to them. People do the jobs they do for different reasons. Medicine is also a job, but a special one in the personal and direct nature of it. As human beings engaging in human-human relations, both doctor and patient in the relationship need to acknowledge the fact that we are all deserving of the same respect and care owed to each human being aside from our duty in the transaction.

On doctors... Part 1

I particularly hate labels because of the stereotypes, often negative, associated with them. But today I will discuss doctors, as a label, just like the non-medical world sees/believes it. Now, I am during the hours of 8am-6pm, Monday to Friday, also one of these doctors so I will aim to give you some insight into what this is actually about.

Traditionally medicine as a field of study (science or art, as you choose to see it) was something that was practiced by a select, if not elite group of people. Guys from the times of Hippocrates were taught by apprenticeship. They had a code of practice, and they were taught by and from the knowledge others before them had acquired. Those chosen to partake in the training to practice medicine were children of the wealthy, of other doctors, and other persons who excelled academically or otherwise, etc. It was an elite group acquiring a very specialized knowledge. Their superior knowledge and skills on which others from the village depended on placed them in greater standing in their communities. They were people to be respected, protected, renumerated, and admired for their service to the community. Such behaviour was totally understandable when it’s considered how many people in a village one physician was entrusted with caring for (often for a fee because these were rarely men of religion or charity).

Fast track to modern times and a lot of people still have the belief that doctors are special people. They believe they are smart, inherently “good”, of high moral standing, wealthy, caring, and just somehow different to other human beings. Now let me consider a few of these points. Actually, first let me consider what it means in modern times to be a functional human being. A man or woman living in modern times needs nutrition, shelter, psychosocial support (usually family and friends), industry, recreation, self-efficacy and satisfaction, and the money to be able to afford a lot of these things. Doctors are human beings too. Doctors also need these things. Doctors are human beings who are practitioners of a particular profession – but they are first and foremost human beings born of other human beings and of the same substance of every other human being on this planet.

I will start by discussing first the most banal of subjects, because it is a subject neither doctors or non-doctors like to associate to the profession: money. A doctor is a person whose job it is to deal with other human beings in order to improve their health or wellbeing. Note first that he is a human being doing a job. Jobs are done for money. A doctor needs money the same way everyone else needs money. You can’t walk into a supermarket and grab your groceries and tell the checkout personnel that you won’t be handing over money for your items because you are a doctor. No! It’s absurd. Money is demanded of doctors the same way and for the same things it is demanded of any other human being. What makes people uneasy about this discussion is no-one likes to think that a monetary value can be placed on preserving or improving the wellbeing of another person – but try doing it without it! How without money can you buy the equipment you need to exercise your profession, to feed and clothe yourself, and to enjoy the recreation all human beings are entitled to? A doctor provides a service, a product if you will, a specialized service; in return a fee is charged for this service. There is nothing abnormal about this. Teachers, engineers, shop assistants (not shop owners), prostitutes, psychologists, and even a lot of clerics, do it. Are they bad people for practising a human profession? No. They are workers employed to render a service for compensation. To deny that doctors don’t think about money and how to make it is like to deny that they eat and breathe and defecate just like any other person on this planet. Interestingly enough, unlike the nursing profession, medicine was never so inherently related to charity and religious servitude. A medical man was always separate to the concept of providing charity; he always provided a service for which material reward was often gifted/charged/expected.

The other common misconception is that doctors are somehow different, or better people, than others. Well, what kind of people go into the medical field these days? All kinds of persons. People of wealthy families, people of poorer families, people who are religious, people who are atheist, people who are accepting and welcoming, people who have prejudices, people with high academic scores, and people of not so high academic scores. At the end of your medical school training all these people are awarded (or earn) medical degrees. The prejudiced guy’s degree and that of the religious girl are both equal – and they both are now doctors. The medical schools teach you medicine, not how to be a “good” human being. Therefore, post-graduation the only thing in common of the graduands is their medical degree not their moral standing or wealth or religious views or any other societal variable. A person with a medical degree is still just that, a person. To say “doctors are special” is like saying “children like birds”. Some children like them, others hate them, some of them don’t even notice them, some wouldn’t even know a bird if one stood on its head. What am I trying to say? There are as many “good” doctors proportionately as there are “good” people in this Earth.

Lastly, I want to consider the concept of the ‘caring’ professions. One complaint patients sometimes make of doctors is that they don’t care. Now, remembering what I just discussed about how different sorts of people enter the medical profession, we have to consider that the reasons that people do go into medicine are also varied. For example, a person may go into medicine for some perceived social higher standing, because it is a profession in which continual education is inescapable, because they find biology and science fascinating, because they want to be of assistance to other human beings, because they enjoy certain technical aspects of surgery or procedural medicine, because they enjoy interacting with other human beings, because science and biology was something they were good at academically at school so they may as well use it in their work… the list is endless. Of course, most members of the non-medical community assume all doctors have gone into work in the medical field because they ‘want to help others’ or because they care about human beings to the devout (and also sacrificial) extent a religious minister might. These patients are often disappointed by the doctor who treats them as a client receiving a service (which they are) and not as a saint tending to his disciples’ every need. Medicine is a health care profession, not a ‘caring’ one that implies caring for things other than the person’s health. Your fees pay for a doctor to render a health care service, his specialized knowledge.

Of course, I am not saying all doctors are uncaring, money-hungry, immoral people who care only about themselves. No. Neither am I encouraging the general belief that doctors are superior, all-knowing, all-caring angels of God sent here to heal people of all their woes, health-related or otherwise. What I am saying is doctors are human beings. Human beings doing special jobs, but they are just human beings no more special than any of their patients.

On mental illness / addiction

Recently I went to a show by comedian Wil Anderson and he spoke of what we commonly call addiction and mental illness. Now, I don’t mean to spoil the show for anyone, but I thought some points he made were very valid (and hilarious).

Last week I wrote about the strain mental illness places on relationships and about having more tolerance for the mentally ill. The point arose about certain people then using their illness as an excuse to any and all misbehaviour. I suggested that the person whose behaviour is really a result of their mental illness and not just personality traits will often lack insight into what it is they are doing or saying, but upon being confronted will often be apologetic of their behaviour and try to change. The person who is simply someone acting wrongly and then not apologizing for their behaviour but rather suggesting it is all part of their illness and you are in fact wrong for judging them negatively – that person is most probably just a person will a bad attitude who happens to also have a mental illness. Of course, it’s not always that simple and the lines are often very blurry between what is intentional misbehaviour and what is sequelae to the condition. Now, let me raise another scenario (which Wil Anderson raised in the show): what about those people that don’t have a mental illness diagnosis misbehaving?

What I mean is people who are not known to be suffering any mental illness suddenly noted to be doing something wrong and then identifying themselves as mentally ill and thus not responsible for their misbehaviour. As an example suggested by Wil is someone like Tiger Woods who as far as everyone (even his partner) knew was just a normal guy doing extraordinary things on the golf course. Then it became widely known that he was engaging in sex with a lot of women outside of his marriage, and without the knowledge of his spouse. He didn’t deny what was reported, but he did then claim to have a sexual addiction which no-one not even close family and friends had ever known he had. Not having ever met Mr. Woods, I can’t comment on his specific case but the questions that arises are: Isn’t that suspect timing for a diagnosis? And is there such a thing as sexual addiction?

Diagnostically a mental disorder implies that there is interference in a person’s social and or psychological functioning due to the behaviour, for example loss of jobs or relationships, etc. Substance abuse / addiction implies that a ‘substance’, which can be anywhere from alcohol, heroin, or a behaviour such as gambling, continues to be used/repeated despite negative sequelae from it. For example, a person who uses intravenous heroin on the weekends for recreation and the rest of the week holds down a job and has a good relationship with friends and relatives and is not in financial strife isn’t a “heroin addict”, simply a heroin user. If as a result of his heroin use he came to lose his job, money, relationships, housing, etc. and still continued to use heroin despite this, then that person could be said to have an addiction. The interesting thing about celebrities claiming sexual addictions (or other mental illnesses for that matter) to account for their misbehaviour is that they do often lose out financially and psychosocially after their misbehaviour is uncovered. The usual course of the story is that they then enter an addiction rehab centre and they’re “cured”. Suspect? Maybe. Real? You could anecdotally note that celebrities seem to have a much lower relapse rate after rehab than your traditional addict entering a rehab program… or maybe they have better support systems as a result of money and/or fame or family and friends… or some would say maybe they were never sick in the first place. It’s easier to cure a paraplegic who can walk than one with a severed spinal cord.

What about sexual addiction? If it meets the criteria of interfering negatively on a person’s psychosocial functioning and the person continues to engage in it despite these negative effects, then a person can be addicted to almost any substance or behaviour. A person with a sexual addiction, for example, may continue to engage in repeated sexual activity until the extent that it impacts on their ability to hold down a job because they ‘need’/want sexual stimulation at regular times, they may struggle to keep stable romantic or even family/friend types of relationships because of promiscuity and perhaps even indiscrimination as to sexual partners or context; it may cause legal problems, and it may cause physical health complaints such as sexually-transmitted infections. The short answer is yes, there is such a thing as sexual addiction. Is everyone who cheats on their partner a ‘sex addict’, though? No, of course not. If he/she manages the rest of their life well and just happens to be very adept at concealing sexual encounters with other people from their partner, then they’re probably not ill, just claiming to be so as to deny responsibility for their behaviour. Which raises another concept Wil Anderson spoke about, you can’t be “a little” addicted, or “a little” mentally ill. Psychiatry makes it really easy, actually: you either meet the criteria for a mental disorder or you don’t.

And one last topical mention: Charlie Sheen. When he started shooting off his mouth, behaving differently to the ‘good boy’ Charlie Sheen we all for some reason thought we knew, people started branding him as “bipolar”. Now, Mr. Sheen himself denied ever being diagnosed with bipolar disorder and reported drug and alcohol use which he was not ashamed of. Was he lacking insight into the manic phase of a bipolar disorder? Could be. Or maybe he just wasn’t sick at all and is one of a few celebrities who is honest enough not to use a mental disorder as an excuse for general human misbehaviour.