On poor us

I’ll start by acknowledging that I’ve recently finished reading the book ‘Affluenza’ by Clive Hamilton and Richard Denniss and so I’m not even trying to pass off any of these ideas as things I’ve discovered myself. One aspect of the book I found particularly interesting is not so much the “outing” of our obsession with ourselves and with money, but rather the way we see ourselves as deprived.

I wasn’t raised in a wealthy family (or in a rich country, for that matter). When my family moved to Australia (and my mum still describes it this way), it was like entering paradise. There was no immediate threat of death from warfare, no real struggle to put food on the table or pay the rent, nothing but encouragement to pursue our education, and besides readjusting to a new culture, a new language, and missing friends and relatives, there basically was nothing to complain about. My family was one of the very lucky ones where a large proportion of our family immigrated to Australia also, so in fact after the first year or so there were few of us to miss. We soon learnt the language (we were actively taught it!) and we made new friends. To describe some aspects of our lives in Australia to people back in El Salvador for them is incomprehensible. Things like, for example, free (and high-standard) basic healthcare, housing assistance, and government co-payments for students, disabled persons, the unemployed, single parents, etc. We are fortunate amongst our family and amongst other peoples born in third world countries; and not just my family, but Australians amongst the world’s citizens are so extremely fortunate.

What’s my point? Well, the truth is that if you ask most people in affluent countries like Australia if they are content with their financial situation, the things they have, their jobs, their houses -their lives- they’ll say no!.... But wait, aren’t we so wealthy and well-off and living in ‘the lucky country’? Yes, but that’s other people, not us. We have bills we struggle to pay, things we wish we could own but can’t afford, thankless jobs that consume all our time and energy, and family and friends we have lost touch with. Collectively we are the lucky people in the lucky country, but as individuals we feel deprived. Feeling deprived and being deprived are two different things, though. The reality of it is that if you look at the pure facts, the numbers, the truth of it is the vast majority of Australians are not homeless, are not going without food, are employed, are managing to pay their bills, and most households own at least one car. You can look around you and immediately you know this is not a third world country. That is the reality of it!

What is it that we are deprived of then? We are deprived of satisfaction! And you know what the most intriguing reason of why we are so dissatisfied is? Because if we weren’t dissatisfied, then why would we keep working jobs we don’t like, for the long hours that hurt us in so many ways, just to buy the things we don’t really need? The question then becomes, well, then who is it that is keeping us dissatisfied, who makes us believe we are struggling, that we are a deprived people? In short, industry and government.

The advertising industry , the entertainment industry, the manufacturing industry, the pharmaceutical industry, etc, are all trying to sell us things. To sell us any product, you first have to convince the consumer that they are better off with it than without it. Even if there is nothing wrong with you, you could still be better off. Never mind you already having a functional car, a comfortable house, and practical clothes; no, that’s not good enough. They want us to believe that what we should have is a bigger more luxurious house, a luxury car, and the newest clothes of this season. Why? “Because you’re worth it.” There’s another thing that has been marketed heavily by industry: our deity. We deserve everything, just like the celebrities have. When you see yourself as being unable to afford the newest and most expensive of everything, of course you’ll feel deprived! And that’s good news for industry because then you’ll keep slaving away at your job to buy more and more of these things, which only keep getting more and more and newer and newer. Of course, if it all gets too much, then it’s time to make the poor pharmaceutical industry some money and invest in their pills that cure the human soul.

A people who are deprived is a woeful thing; thank God for politicians who can make it all better for us! That’s right, the other group of people interested in perpetuating the myth that we are all struggling are our governments. The benefit to them is that if we believe ourselves to be struggling and they promise to provide for ‘the battlers’, then they can secure our votes. I can’t recall a politician stating as his election plea that he will ensure that wealthy people can afford to buy a newer luxury car. He would be scorned! Instead we would rather vote for the guy who wants to help poor folks like us (who are “poor” only in the sense that our lives aren’t like those on those fictional films or because we don’t own the things that celebrities seem to).

We are sold the idea of deprivation from various levels and multiple interested parties. They sell it so well that we are unwilling then to recognize what is so clearly around us. I wish there were interested parties who thrived instead in helping us see truth, building up our self-worth and self-esteem, someone that would remind us that we are poor only when we rely on material things to define ourselves. I once read about a different sort of dissatisfaction, one I would like now to share:

On prescribing choice... and the hypocrite's spiel

There are many people who will tell you that pharmaceutical companies are the devil. I say the devil is the devil, but I also say the pharmaceutical companies are no angels. Let me first disclose something to you: I eat the lunches brought in by the pharmaceutical sales representatives (almost everyday at my work!), I give my patient’s their drug samples, I enjoy their “educational” dinners at expensive restaurants, I am grateful at their supply of products ‘directly related to my clinical practice’, and I miss the days of the free drug-stamped stationery and random gifts. I do not claim to be immune to their marketing tactics simply because I am aware of them; both they and I know that I am human and the tactics exist because they do work. There are those who directly embrace the drug companies with the attitude of ‘hey, if they want to give money away, they may as well give it to me and I will do what they want me to do’. And there are those that completely shun them, who demonize them, who accuse them of being a… a business. Aren’t we all in business? Those who claim they aren’t, aren't in business very long.

Just this past week I recognized a tactic by the sales reps I hadn’t noticed before: bullying. Now, what I mean to say is not that they wanted to humiliate or hurt me, but they sure as hell wanted to make me feel guilt. Now if I remember correctly from my industrial psychology and marketing readings, creating negative emotions in targets is one of the least effective methods to inspire change of behaviour (in this case, prescribing more of the drug they’re promoting); however, least effective doesn’t mean ineffective. The rep was telling me of some new medication; was I using it, she wanted to know? I said no, I studied a little pharmacology too and I felt more comfortable with another medication. She was horrified! Did I not know that it was the most popularly prescribed medication in its class, prescribed by the greater majority of my peers?! My mind was thinking ‘yes, and?’, but I said, ‘Oh, ok. I’ll keep that in mind. Anyways, thanks for the lunch.’ I went away thinking, wow, really, everyone but me uses it, was she implying that I am doing the wrong thing by prescribing something other than “the most popular”? Is it the most popular because it’s the most effective, because it the newest (and newest we are told is better), because they are better doctors than me and if I want to be good then I must be like them. As I walked towards my consulting room from the lunch room where I had the food brought in by the friendly drug rep, I realised it had worked. I was here second-guessing my clinical management not based on clinical data or evidence, but based on simple human emotion: everyone likes to be liked and to be like the rest. I then laughed at myself.

A few weeks ago another drug sales rep was speaking of a medication for erectile dysfunction. Of course it was about the drug, but they alway tells everyone “it’s about the patient”, thinking of what’s best for them. There’s no news or controversy in saying this; no matter what industry you work in, at the end of the day everyone must eat (and you need money to buy food, right?). Every drug rep walks in to that lunch room and comes with 1) our daily bread (or gourmet lunch), and 2) the “educational material” to impart to us that just so happens to show that the drug their company sells is better for our patients for some or another important reason. But this drug rep wanted not to tell me about why their erectile dysfunction drug was better than the other two, but wanted to know what I based my choice on. I’ll tell you what I answered but first I just want to consider another point on prescribing choice.

Now, you could have five different drug reps talk to you about five different drugs from the same class, both targeting the same “disease” (I’ll explain later why a disease is worthy of my quotation marks here), and they can all show you with ‘real clinical evidence’ and ‘scientific studies’ that their company’s drug is the best. The first rep will say their antihypertensive is the best because it, say, doesn’t have this bad side effect. The second one says theirs is better because it reduces blood pressure quicker than the others. The third one says theirs is better because the effects on reducing blood pressure last longer. The fourth one says it their drug tastes better and is in a smaller pill and that this is very important to patient compliance, therefore in fact being the best drug because patients will actually take it. The fifth one will say theirs is the newest and is so many times better than a placebo. Who wants to be associated with the old and outdated, right? Ah, the stories…

What I answered my friendly drug rep is actually not anything new to them. Why do I prescribe a certain erectile dysfunction drug versus another? Honestly, I confessed, my choice was based on whatever sample pack was in stock in our drug samples cupboard. They know this, that’s why they like to stock our cupboard, not because they like to give away “free samples”, but because it works at securing consumers. I have to clarify a little, though, I use this rather non-clinical method to guide my prescription choice only in certain conditions that in my experience the medications are only slight variations on each other with similar clinical effects, for example as in erectile dysfunction. The second reason to why I do this is because these medications are very expensive and I want my patient to try it first before he goes and spends his hard-earned money on something that may or may not be right for him. Most doctors do this, too. You give the patient the sample pack and a script to purchase the medication if they are satisfied with the effect or tolerant of its side-effects. In cases like this, I prescribe what is in the drug cupboard because I know the brand name will make little difference to the clinical effect I am trying to achieve in a patient. For some reason my honesty seemed to surprise the rep and I think it is because there must be some secret pact that we, both the pharmaceutical companies and doctors, must deny that our interactions are in fact business transactions and we should pretend they are purely “educational” and clinical.

As a medical student I did a placement at a clinic that strictly forbade pharmaceutical reps from visiting to promote their products (or should I say, educate us). It was a clinic were most of the clinicians also held academic posts at the university and they were thoroughly involved in evidence-based medicine. I remember one doctor specifically telling me about how he always prescribed the generic version of a particular drug because it was the cheapest and therefore it meant less money spent on government subsidies paid to the drug companies, and subsequently more money left in the health budget for other essential matters. It made sense to me.  Some years later I worked at another clinic where another very noble and more senior doctor advised me that I should prescribed the brand-specific version of a medication for depression that was now off patent. The reasoning was that the company that made this brand of antidepressant was highly involved in drug research and development and also at producing patient education and support materials, but they obviously can’t afford to do that unless they are making money also. It made sense. Yes, besides I also knew that once you allow for the generic version of a medication to be dispensed by the pharmacist, he incidentally happens to supply the patient by the generic version of a medication which is made by his pharmacy chain. Oh, everybody is a businessman. So my choice is then, who do I feed? The pharmaceutical company making the brand-label stuff or the pharmacy chain making the exact same but generic-labelled stuff (which in most cases cost no different to the brand-label medication). Ah, such decisions… Oh yeah, that’s right, this was mean to be about the patient!

Another thing that the pharmaceutical companies are accused of is not only of making healthcare a business (which I don’t believe they are solely responsible for), but of also creating disease. What do I mean ‘creating’? This is mostly in reference to the medicalization, the labelling, of certain human existential states as disease. Some years ago I read a story about how bad it apparently is that we have made things like pregnancy and ageing disease-states. In a similar vein, drug companies have been accused of doing either a good or bad thing, depending on your point of view. One could say that thanks to the educational and public awareness campaigns directed by our blessed pharmaceutical industry, so many people can be diagnosed and directed towards the treatment of many ails such as depression, anxiety, mood swings, hyperactivity, etc. etc. Another group of people report that the drug companies directed these campaigns as a diversion to their real campaign: increase uptake of certain medications (mostly psychotropic medications). They convinced people that their sadness, that their agitation and worry, that their child’s childish behaviour, are abnormal and required treatment – by using the drug that their company so happened to manufacture. Oh, so many coincidences…

And what have I achieved in telling you of these few tales? That I am a hypocrite? Maybe. But hopefully I have also reminded us all that we live in a capitalist society and that denying that there is a devil at our table won’t make that devil any more of a saint. Worse than being the devil’s pawn is not knowing that you are. As doctors, as human beings entrusted with the care of others weakened by disease, we must ensure that that truly is the worst thing: that we sell our own souls, and not that we trade in those of our patients for a piece of the devil’s share.

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

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

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

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

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

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

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

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

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

On friendship / giving and receiving

You know what is a good friend? A friend that is always giving (of their time, attention, efforts, etc). You know what is a bad friend? One who always seems to be taking and taking and never giving anything (usually material things) in return. What do you call a person who sometimes gives, but just doesn’t seem to take anything at all from you? I don’t know, but they’re not usually called a friend. 

I used to wonder some time ago why I was never the kind of friend my ‘friends’ called on to help get them out of a tight spot, to lend them money, or just to vent  when everything crashed to pieces. Often I would hear through other mutual friends about how their relationships had broken up, they had won an award, or they’d been in a minor car accident, etc. I was often left with this little numb wondering of ‘why didn’t they tell me?’ or ‘why didn’t they call me?’ And I would feel a little rejected and sad to have been left out of a kind of major life event. I would recede into myself and wonder: 'am I such a bad person that they wouldn’t think to tell me?, to ask for my help?; or do they not like me?, am I considered of no use?' As you can see, I was aiming these comments toward myself mostly rather than the other person. And as I thought about these things, I began to distance myself from these ‘friends’ of mine. I questioned our whole relationship, and the feeling of rejection did not do my self-esteem any good.

Still, I could never figure out why I was never the friend people sought for when people I considered friends needed “a friend”. Until one day I figured it out: I never called any of my alleged friends when things, semi-major events, happened in my life. I either receded into myself and put up the fight (or celebration) on my own, or I spoke only to my mother about it. It wasn’t that I didn’t find my friends worthy of the knowledge or of sharing my victories or defeats, it was more to do with pride, I guess. "You want to have nothing in life that you’re proud of? Let yourself be guided by your pride." Pride is like a fear of falling, so it stops you from reaching too high. Healthy pride, good pride, is probably better called gratitude and self-efficacy. Good pride is an after-the-fact quality; that’s not what I’m talking about. I mean more the pride/fear to be seen as vulnerable, as needing, as wanting, as human. One day I read that to have good friends, you have to be a good friend. I always thought I was a good friend, willing to give to others when they were in need, listening when they needed to be heard, sharing some advice, looking out for their wellbeing, etc. But my friends were never there when I needed something not because they were bad people, but because I was too proud to let them in.

There’s a bible verse that says that there is more happiness in giving than in receiving. Sure, but we all know that there is also something very pleasant in receiving!  That’s right, there is happiness in both. And what any good relationship, any friendship or partnership, needs is both giving and receiving. Sometimes we give our friends a present, something to cheer them up or make them feel good. We feel good in return, right? A happy friend means a happy me, means a healthy relationship. But how about sometime letting our friend also share in the happiness of giving, allowing them give us a gift, being grateful for their effort, validating their efforts and gesture of camaraderie? Of course, I am not talking just about material gifts. I mean allowing ourselves to be human, to admit our need and desire of friendship, of companionship, of another human being to share our load and cheers with. Trust me, if you know anything about human pride, this is actually very hard! We become proud, stern, often as a result of being hurt in the past, or disappointed. We want to convince ourselves and others that we can’t be hurt again. We want to block out the bad – and we end up blocking out the good too. We punish ourselves and others by creating a wall of perceived invincibility. But it’s actually easier to be invincible if you have an army of comrades rather than take the world on by yourself.

So what more can I say to encourage you to be a little more vulnerable, a slightly better friend? You are human, don’t be scared to be mistaken for one. And there’s a paradoxical rule with love: it’s the only known substance that the more of it you give away, the more you end up having.

On "that" year

Kingaroy, QLD

2006. I was 24 still. I was a child still. But before I tell you about that year, I’ll give you a speedy run-down on my life until then. Age -9 months: my mummy meets my daddy. Age -6 months: my mummy finds out the father of her daughter is also father to 14 other children before her. Ages 0-9 years: growing up in El Salvador, a country with low literacy amongst those of my social class, and in a single-parent family where no-one has ever finished high school even. Age 6: I “decide” to become a doctor like the “cool” guy my mum works for as a cleaner/nurse. Ages 6-22: still stubborn about wanting to be like that cool guy. Age 23: finally start medical school. Ages 23-24: study, study, study. And then 2006 came along…

Things got tough for me in 2006 and my second so-called “depressive” episode happened. I lost the joy in everything, study was a hassle, I became morbidly preoccupied with my own mortality, a great solitude and loneliness came over me, and I wanted nothing because simply wanting anything required effort. The social withdrawal and pathological shyness again set inside me. Then I got into a situation where a false accusation was made against me. I was feeling pressure from my religious peers and my internalized God concept. In essence, I felt deficient. I felt lacking. And I felt dead inside – and then the feeling to externalize what I felt inside came over me. I lacked the motivation, the energy and willpower to do even that. Fearing my own internal monsters, I chose instead to go again in search of Vanessa.

Once I left everything, I felt both a great freedom and a complete hatred and fear of that freedom. There were no friends, no company on my journey, I had some advice but which felt more like orders. I had no allies – and I didn’t want anything or anyone even if there had been such people there. At first the numbness overwhelmed me and I was as a ghost walking around (which I recognized because this was not the first time in my life I have had these “episodes”). Gradually, over the next few weeks, reality and the mundane started to creep in. I needed to eat, pay bills, move, reply to the questions that were being asked of me. I started then to formulate my own questions. Who is Vanessa? And yet, not so much who is she but who does she want to be? Why does she want to be that? Does she really want to be that? What does being that entail, the practicality of it? And what of everything else? What is important? Who is important? Who, if anyone, is my friend? And what do I do with these things I love but won’t make me any income? And what should I do about these things that keep pestering me, these things others call conscience? You’ll often hear me diss and complain about the ‘white man’s stupid concept of “finding themselves”’, but you could say that that is what I set out to do.

Specifically I had some questions to answer and that was my quest in this time without commitment to study to answer. Formulating the questions was the easy part. Even finding the answers while on the quest wasn’t that hard. Finding what you’re looking for is easier when you know what it is you’re looking for. The hardest part was making the decision to take a break from my study, my big commitment at that time, to go on my quest. I risked a lot. I risked losing my friends, my family’s belief in me, jeopardising potentially years and years of prior education (and money), and losing my credibility. But I made the choice and I then had to go exploring my questions, myself, trying out different scenarios and risk finding out that my whole life had been a sham. But sometimes not knowing is as deleterious as finding out an unpleasant truth.

The second part of my task, after walking away from it all, was easy: I had the question that needed to be answered. Did I really want to do medicine as a career or was it a childhood dream of mine that I expressed and no-one ever had the courage to shut me down about it despite all the odds being stacked against me? I was a poor kid in a third world country where tertiary education costs more than entire families need to survive. It was a nice fantasy that they let me believe for a long time – until fate and relocation made my dream a possibility. But I was always a stubborn person, did I want to go into medicine purely as a whim? To prove people wrong and that I could do it? They were questions, and I answered them fairly quickly, actually. I think that giving yourself the space to not feel judged is very empowering. People may still be judging you, and I remember a lot of “friends” and even family members discounting me as a drop-out, as someone with no stamina, as a loser. But me, I gave myself the space I needed, I didn’t need anyone’s permission to explore my own life and motivations.

Like I said, the process of answering my questions took a remarkably quick time after I let go of the restraints I allowed to be placed on me by society, by other people’s expectations, by my own pride, and by my pessimism and distorted view of ‘reality’. And in the process, I learnt not only who I in fact was, but also to no longer despise myself for not being what was ‘expected’ of me. The answer to my questions were:  yes, medicine is what I, Vanessa, want to work in; and this will be a job like any other. I came to this conclusion by considering the things I enjoy (writing, visual arts, and film and theatre) and the things that I could bear to do for income. I could not bear to do anything other than medicine as income, and I’d perhaps do it even without income if something else where somehow feeding me. At the same time I was able to explore many aspects of the medical profession, and I had no grand illusions about it like a lot of people do, illusions of ‘saving’ people or of ‘making a difference’. I came to understand a lot of the industrial and organisational psychology of the business. And I became comfortable with what I learnt.

The rest came easy. The friends elected themselves by being the only ones standing when everyone else had gone. I bit the bullet and made a religious commitment. I got a “money” job because I was already planning for my future and my dream to see the wild condors in the Andes in South America. I in fact spent the remaining months of that year killing time by working and entertaining myself until my return to uni and getting on with my task of achieving the next task on the journey. So guess what I do now for work? Medicine. And guess what I do for passion? Write. And I can now unashamedly say that my name is Vanessa and I know exactly who Vanessa is.

Condor! Colca Canyon - Arequipa, Peru

On animals and food - Part 2

Since I was a child I always found it intriguing how human beings are just animals like the are thousands of other species, but there’s just some things about us that sets us apart. And you know what I focused on as kid on how humans differ from other creatures? Food.

As animals, we can’t photosynthesise so we consume other eukaryotic matter to obtain our nutrients. Every animal, even fungus, does it. Some animals eat grass and vegetation, some eat other animals, some eat both animals and vegetation and anything else they can extract nutrients from. We are, however, perhaps the only species that has self-determination regarding the foods we eat. A person may choose to eat only plant matter to the exclusion of everything else, for example, or plant and animal matter, or even only animal matter, or any other variation in between. As a species we are regarded as omnivores but as individuals we may choose to have diets that are vegan, vegetarian, pescerian, etc.  And what further sets us apart as a species is how we can then interrelate our choice of foods and the act of eating with spirituality.

Not everyone, but a large number of people, have formed a relationship between food and spirituality, ethics, morality, and all these words that are of relevance only to humans. Personally, as part of my religious belief-system, I have few limitations on what I can or should eat. Those I don’t eat are those that if I ate would kill me, those that I find unappetising, and those my religious-belief system prohibits. My particular belief system does not prohibit me from eating animals and has only basic clauses on to how an animal has to be prepared for human consumption. In addition to that, I do also have personal beliefs on the ‘humane’ treatment of animals for science, food, and other industries. They are personal views and unrelated to my religious beliefs.

From an early age I was taught to say a prayer before meals. As a kid I dismissed this together with a lot of “social norms” that served no real purpose but looked ‘nice’ to others. I later found out that some religious belief systems have gone further and have made food preparation and consumption a religious rite in itself. I found this fascinating! Eating was not considered just meeting a basic human need like breathing or obtaining nutrients, but instead an act of religious worship. Some religions, for example, will deem a product only suitable for consumption without violating religious law if it has been prepared a certain way (think, for example, halal and kosher foods). Later when I decided to embrace a religious system of thought and incorporated prayer into my life, I understood the desire to turn every human act a direct act of worship to God.

I found the idea of making food preparation an act of worship very fascinating, but ironically I also found it a little distancing from its purpose. The thing is often adherents to religions that follow religious customs on food preparation also aren’t the same ones that say prayer prior to their meals. What does that matter, right? Well, if you don’t believe in practicing this it makes no difference who (if anyone) says the prayer or who enacts the act of worship; it can be whomever, or it can be no-one. It mattered to me because I, like many other people, who had come to interrelate food with spirituality felt it was in fact delegating my personal worship to God to someone else. I finally understood what my mum was getting at: the prayer was meant to acknowledge my gratitude to God for providing (or not denying me) that which so many other human beings lack. It was a way also to acknowledge that another living creature was being sacrificed for my benefit and its life did not leave in vain or unappreciated. That I do consider my personal duty: that if I care about something, then I must personally support it.

There are two stories Paulo Coelho tells that I find very thought-provoking. The first is about a monk or some other spiritual leader talking to his pupil. The pupil wants to know what food he can eat so as to bring him closer to God, as he is already doing everything else that in his religious system is required to gain God’s approval. His teacher tells him to eat of some grass. The student goes enthusiastically to pick it – then he realises it is a poisonous grass! He is shocked that the teacher has indicated this deadly shrub to him and asks if he realises that if he eats it he will die. The teacher says to him ‘I know of no other way through which eating something will bring you closer to God’. The second story is about a similar man who accuses someone else of being lacking spiritually because he eats a certain food. The man considers that this food is unholy, that it tarnishes the soul, that it is an offense to God to eat it. The teacher then reprimands the student for blaspheming God, for calling one of God’s creations unholy, for assuming that God is so petty as to be offended by what a person eats or doesn’t eat. He reminds him that it is not unholy what enters the mouth, but what from it emerges.

On animals and food - Part 1

Some people say we are superior to other creatures because we are “intelligent”. The truth is this intelligence is only of value to us as humans because we possess it and we know how to use it. An elephant could equally believe he is the superior species on this planet because he has a trunk – and all the great things he can do with it! He considers every other trunkless species as inferior, lacking, because we don’t share that one thing that to him his survival is dependent on. Our “intelligence” and interaction style is dependent on the arrangement of our nervous tissue, our phenotypic appearance is genetically-determined, and our behaviour is in the broadest sense survival-driven. Now, we (all animate creates) are carbon-based constructs of eukaryotic cells incapable of photosynthesising to meet our own nutritional needs. We are amazingly adaptable and very different to other species in the way we interact with our environment, but even if we were the superior species, it does not entitle us to haphazardly proceed to abuse our environment and the creatures in it to meet our own needs.

We are truly an amazingly adaptable species. Human beings have developed ways to overcome our deficiency in obtaining and forming our own nutritional needs for survival by consuming other eukaryotic matter. We have even developed systems to make this more efficient and safe for our digestive systems. We, for example, cook our food. Simple biology classes have taught us that cooking our foods, especially those derived from other animals, has effects on the quality of food itself so as to make it suitable for the human digestive tract. Heating denatures protein, makes food stuffs generally easier to transit along the gastrointestinal tract, destroys pathogenic microbes, changes the taste of most foods, and all these other things that are limiting (and thus important) factors to our ability to live off these products. We are also incredibly adaptable on the choice of foods we can live on.

I have always had an omnivorous diet except for a few years where I was a vegetarian purely as a teenage fad. It was interesting in those few years, though, what you do learn about human beings and our need to stereotype others. I openly admit I chose to have a vegetarian diet purely as a choice, not based on my views on animals or religion or anything really.  In fact you could probably say it was almost on a whim similar to any teenager who has ever dyed their hair an “odd” colour or done anything considered outside the norm just because they could. Adolescence is a time of experimentation and trying on different identities until you find one you stick to a little more permanently. My phase was vegetarianism. What I learnt was that people do have a particular relationship to food that is not like that related to fashion or hair dyes or music preferences. People generally relate food to something more akin to spirituality. Now, of course, my choice on diet was on a whim, but it is true that a great majority of people do make their dietary choices based on these things.

I grew up with what you’ll often hear me refer to as “edible pets”. This was what I was exposed to growing up. We had pets in the form of ducks, chickens, rabbits. We raised them and fed them from young and considered them as anyone else does a pet. When they got to a particular size, my mother or grandmother (or sometimes my siblings) would kill them and prepare them as food for all of us. This we all understood as the circle of life. We cared for those animals and treated them without cruelty; in fact we would play with them and be fond of them as our pets. We did not shed tears for them when their time came, though. We had known all along what the fate of these animals were to be – and yet we did not hold back from caring them as we did. To us it seemed similar to the way people love each other, siblings, parents, children, spouses, friends, etc, and don’t hold back even though we know these people will one day sooner or later leave our lives.

Growing up, our family had at one point also a dog or two as a pet that we did not consider “edible” in our culture. We kept this animal purely for company.  And we considered it okay to keep him because we could sustain him without going out of our needs to meet his (he ate scraps, inedible leftovers, and whatever he could fend for himself). Why I mention this is because still to this day I have moments where I consider it unethical to go out of our way to provide for ‘non-edible’ animals when there are starving families in the world, when money could be diverted to help other fellow humans in need… I have those days, but I have also learnt to be a little more open-minded and understand that, particularly in western-culture, people do often equate dogs and cats and whatever other pets, to family and even to being equal to human beings. A view I understand even if I still cannot say I share it.