On being old enough to know better

Dave Chappelle, comedian, does a very funny yet thought-provoking skit on age and responsibility. The question arose about musician R. Kelly’s 2002 arrest for urinating on a girl who at the time of the alleged incident was 14 years old. The girl in question at one point is said to have consented to being peed on, but still everyone criticized Mr. Kelly because in either case the “girl” was underage and shouldn’t have been sexually involved with an adult. Poor girl, right? Didn’t realise the consequences of her consent, etc. etc.

Then another incident Dave Chappelle discusses is about Lionel Tate, who when he was 12 years old was play-wrestling with a 6 year old girl using moves similar to what he had seen TV wrestlers do. The 6 year old girl died from injuries sustained from this “game”. The boy was arrested and sentenced to life in prison without the possibility of parole. Apparently he should have known by the time he was 12 years old that his actions have consequences, etc. etc.

Finally he talks about Elizabeth Smart, a girl who when she was 14 years old was abducted from her home and taken captive by a couple who lived not very far from her own family home. According to the way Dave Chappelle tells it, she wasn’t physically restrained or locked up, but was advised by her captors not to flee. She obeyed. She remained at this site from June to August 2002 before being relocated elsewhere for a further six or seven months. But for at least two months she was situated very close to her own home, possibly within walking distance, often unsupervised at this place, not locked up or restrained – and yet she remained docile to her captors without allegedly even attempting to flee. Of course, it was unfortunate and not her fault at all that she was abducted, but shouldn’t she have known by the age of 14 years that her actions have consequences, that she could and should act, etc. etc.? Poor girl, right? Didn’t know what to do.... But wait, Lionel Tate knew exactly what to do and how to do it apparently by age 12!

The reason that these stories have come to my mind recently is because of the “poor boy” who was arrested in Indonesia and is being tried for drug-related charges. He is an Australian citizen and he is 14 years old. Those two facts are the main reasons we are enticed to have sympathy for this “boy”. He is alleged to have bought drugs while on holidays in Indonesia. Apparently he didn’t realise the gravity or consequences of his actions either because of his young age or because of his alleged addiction to the drug he sought, etc. etc.

So how old is old enough? How old is 14, really? Old enough to know better, or too young to know what you’re doing? If it’s not old enough, then let the “poor boy” in Indonesia out of prison to live his life and learn what is good and what is right and what isn’t. And let 14 year old girls decide if they want to have sex with adult men or whether they want to get peed on or not without prosecuting the adult involved. But if 14 is really too young to know better, then Lionel Tate deserves a big apology for the malice attributed to him when he was 12 and killed his 6 year old playmate. Luckily for him, this did in fact happen and he was eventually released from prison and went on to learn what is good and what is bad... (Almost a “and he lived happily ever after” story, except for the fact that when he was released from prison he went and committed other crimes  that bought him a fresh 30 years incarceration that he can no longer blame on his young age.)

The ability to make “adult” human decisions relies on the prefrontal cortex of the brain. This part of the human body does not reach its full developmental peak until you hit your early 20s. To me this has some interesting implications not only related to criminal law (as demonstrated in the examples above), but also to medical ethics, and to psychosocial development. In medicine we accept that children (by Australian law, under the age of 18 years) may competently consent to some things like taking a contraceptive tablet, having a blood test, allowing a physical examination by a health professional, etc. By the same token, the same person at the same age may be considered not competent enough to consent to, for example, reproductive sterilization or an organ transplantation / donation. It’s a matter of being competent enough, recognising that a person’s cognitive development is a dynamic thing evolving across multiple tracks until, hopefully, they all eventually reach a maximum and you reach your “adult” competence stage.

The other interesting thing about this gradual stepwise development in our ‘human nature’ relates back to the previous discussion on criminality. Maybe instead of focusing on “is 14 years old enough to be considered responsible for a crime?”, we should consider “is this person who is still in the dynamic stage of their cognitive development able  to be taught or rehabilitated to make choices that will decrease their chances of becoming further involved in criminal activity in the future?” Remember Lionel Tate? He was 12 in 1999 when he killed the six-year-old girl. In 2001 he was sentenced to life in prison without the possibility of parole. He was later released on appeal in 2004. In total he was in criminal detention from the ages of 12 until he was 17. What did Lionel Tate learn from the ages of 12 to 17? Who knows. But this would have been an amazingly opportune time to teach him exactly what the consequences to a person’s actions are, what taking responsibility means, how to get ahead in life without victimizing others for your own advancement. Would he have been a different person if this had happened? Who knows. But really, what have we got to lose?

On euthanasia

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

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

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

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

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

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

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

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

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

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

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

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

On courageous conversations

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

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

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

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

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

On being in love (...and being too good)

In 'By the River Piedra I sat Down and Wept' Paulo Coelho tells the story of a boy and a girl who grow up together, get to form a very close bond, but then grow up to have separate lives. The girl goes off to the city and studies at the university. Meantime, she learns of life by working whatever jobs young college students do, and she meets a lot of people who teach her about travel, love, sex, philosophy, etc. She becomes what you could call a very ‘worldly’ woman; a modern educated woman with no theological or philosophical constraint to limit any of her experiences. The boy grows up very differently. He enters a seminary and becomes a spiritual guru of sorts. He is respected and generally considered a very holy man. The boy and girl meet up again as man and woman and what was once an almost fraternal relationship becomes a romantic one. The girl feels inadequate because the boy’s profession requires that he travel, that he dedicate his “free” time to meditation, study, and consideration of deeper greater things, not the mundane things like being a partner in a romantic relationship. He doesn’t tell her this, but she knows it. She wouldn’t ask him either to give up his “gift”, his vocation and talent just to be her husband, boyfriend, lover, or whatever when he could be inspiration, intervention, guidance, and illumination to so many other human beings who need him too. And not to mention the fact that you may consider her a worldly, maybe even ungodly woman, and you may consider him a man truly of God.

One of the most horrible things a man has ever said to me was “you remind me of Jesus”. Now, I’m a Christian and I try to live my life as best I can so you may ask why would that be offensive to me and not a compliment? Because no-one has ever desired Jesus; no-one has ever desired to marry him, to make love to him, to kiss him softly and romantically on the cheek. Of course not. So many of us admire him, worship him, and love him with a firm spiritual belief. But you don’t fall in love with Jesus. No-one ever fell in love with me! And so this man telling me this was such an eye-opener for me; a cold glass of water across my face. Sure we all want to be good at something, but more than anything don’t we all just want to be loved? I think we do. I do.

The other very hurtful thing said to me, and it has been said to me on far too many occasions, was that I’m “too good”. Again, you could say ‘but that’s not an insult!’ No, it isn’t, but try having it said to you time and time again that “you’re too good for me”. Too good; not just good or good enough, but “too good”. Too good for this person to be with you, to love you, to take the risks we all do in love; “too good” for them to even try. There are a lot of people out there with self-esteem issues, and yet this isn’t distinctly the reason why people were telling me that I was “too good” for them. No. It had simply become the new catchphrase like ‘it’s not you, it’s me’, which was a very sensitive way to simply end a relationship you didn’t want but that exonerated you from being the “bad guy” who broke the other person’s heart. So you tell a sweet, sensitive lie like “it’s not you, it’s me” or “you’re too good for me” or “you deserve so much better than me”. Suddenly you’re the hero who is making a sacrifice for this much “better” person. Gee, they should be grateful you’ve broken their heart!  And they would be, if only we didn’t all know that these very nice reasons are just words. I must admit, I personally have used the ‘you deserve better than me’ or ‘you’re too good’ spiels too when I didn’t want to feel bad about ending a relationship I wasn’t dedicated to.

You know what happened to me one day, though? I actually did meet someone I felt was too good for me. And you know what I did? Two things: 1) I became selfish, and 2) I fell in love. Anything is worth it when you’re in love. Mark Twain tells of how when he met his future wife he was a drunkard, poor and indebted gambler. The woman he fell in love with came from a wealthy and educated family. She was too good for him, clearly! But you know what he wrote? “I wouldn't have a girl I was worthy of. She wouldn't do. She wouldn't be respectable enough." He was quite aware of his circumstance and he knew he was being selfish in trying to convince the girl’s father that, yes, he’d most likely ruin his daughter’s reputation, but that he would love her and be with her until the end of their days. Some things are just worth it. Love is worth just about everything, even selfishness. And yet in telling this story I came to understand why it had hurt me so much when people had told me I was “too good” for them. I realised that when I thought that one person was actually too good for me, because I loved them, I wanted to become a better person for them.  So I came to realise that when people had told me I was “too good”, it had hurt me because I knew they were also saying that I wasn’t worth the effort.

Is it selfish to keep on after those one we feel are “too good” for us? Maybe. But it is extremely weak also to give up because you lack something, even if in the end it is purely self-esteem. When you’re truly in love, there is no room for comparisons or measure of a person’s “goodness” or anything else. When you’re truly in love, you want a particular person regardless of who they are, how spiritual or wealthy or educated or healthy or intellectual or adventurous - or anything - they are, or how deficient of these things you personally feel. There are some things that are truly worth the effort in this life. Love, to me, is worth just about everything.

On hierarchy

One of the things that really bothered me when I was working in the public hospital system is the pronounced (and revered) hierarchy of the medical industry. In short, it is what people call “top heavy”. If you’ve ever read ‘The House of God’ by Samuel Shem, even if you know nothing about it from personal experience, you’ll realise that this is a universal system of our industry. There’s an almighty, infallible boss at the top of the pyramid who ‘makes the big bucks’ and has his name attached to the patients “in his care” – even though he may not even be aware of these patient’s existence. Then there’s the half-bosses, charged with making all the hard decisions and often physically doing some of the too-hard things. He makes reasonable money, and you see him once or twice a day, but he also rarely sleeps. Then there’s the minions, working for scraps of money, working for almost every minute of every workday, being dealt all sorts of unpredictable tasks, and who is for the majority of the time a secretary with a medical degree.

If a scenario came up where the minion has just walked across a desert fighting off bullets and helping out injured civilians; he is met at the difficult battles by the half-boss who takes an armoured vehicle from one hard battle to the next (but driving by the lesser battles); and they are met at base camp in an air-conditioned shelter by their godly boss who has been driven in by chauffeured limousine from his 5-star hotel only seconds ago – who do you think will be offered a chair and a cold glass of water? Not the dehydrated, wounded minion with blisters on his feet. No. The boss will take the chair and the glass of water and not even thank anyone for it – he is the boss, apparently he deserves it more than the others.  And that’s life. That is not just the medical industry or the military, it is probably most industries! And that is why I had to get out of the public hospital system.

There’s also another story I don’t often tell about my experiences in the hospital system, and it is related to the above concept, but also about a certain type of discrimination. See, another thing about working in a hierarchy is that you have to respect and worship the hierarchy. You have to! Otherwise how are you ever going to make it to the top if you don’t play by the hierarchy’s rules, worshipping the people above you for their pity, grace, and reward? This is where I went wrong. My mistake was choosing to be honest, and choosing to be true to my own convictions. My mistake was also to be born flawed – but I’ll get to that later.

I was working in a team that was just like any other hierarchy I just described. I was a minion, of course. One day, through no fault of my own, I got sick and couldn’t come in to work. Oh my mistake! I received a reprimand from a (half) boss for staying home sick – how dare I?! But my mistake went even further than that. My mistake was that I refused to kiss ass, or to apologize for being human, to give an excuse or apology for being unwell that day. And I told the boss quite clearly that I would not apologize for being sick. So began my downfall. The next day when I arrived at work I was “kindly invited” to a surprise evaluation of my performance, a discussion led by my boss before a panel of hospital “Gods”. Oh, what a terrible worker I was! Late in the mornings, slow, lazy, absent on so MANY occasions, time-waster, friendly with too many other staff members, too well-like by administration and ward staff, etc. etc. I guess you can’t really say “she’s an insolent b*tch who won’t kiss my ass like she should” so you have to phrase it differently, even if slanderously.

I was then politely asked my opinion to his allegations. Needless to say, I was speechless. One day I am away sick at home, and the next - without warning – I am asked in a panel if I dare to contradict the guy who grades my assessment and who can end my career right then and there if he chooses to. Yep, seven years of university training, a $70,000 student debt, and a lifetime of passionate pursuit of this career on the balance. I kept quite. Even if I could speak, I’d had no time to prepare my defence (aka, stating the truth correctly). In my silence, the man hearing the case, summarised my case based on what was said about me. Clearly I was ALWAYS late to work. Clearly I had TOO MANY days off sick. Clearly I LACKED ENTHUSIASM for my job and my team. Clearly I was SLOW. Clearly I was LAZY. Clearly it meant I was WASTING TIME becoming friends with the people I worked with every day. Clearly I was guilty, because the boss who is higher up in the hierarchy than me said so. I then made only one comment; I said “it sounds like you’ve already made up your mind”. Yes, yes, the panel had. Never mind the fact that I had been working on this team for over 3-4 months with no complaint made about me, that no complaint had ever been made of my performance ever, and that these statements were great generalisations of that one time I was away sick. Was it a coincidence that all these allegations came to light from the man I had apparently disobeyed by being human and being sick, and that they came to light the day after I had refused to kiss his ass? Apparently so.

But before the panel “discussion” was over, one final point was raised. Was it not true that I suffered what is commonly called depression? After all, this can lead to increased work absenteeism, to tardiness, to lack of enthusiasm, to general slowing down… Oh, this is when I lost it! Talk about discrimination – and coming from the same profession that should be advocating against this type of prejudice. It didn’t matter that the things that I was accused of in an act of spite, of revenge, to put me in my place, to hurt me, were false; what mattered was that I had a condition which obviously must apparently make the allegations true. And I lost it because you can’t wash these things off. Did I not suffer depression? Yes. ‘Well, then that must mean that you are slow and lazy and unenthusiastic and take a lot of days off work…’ The only thing getting in the way of that theory was that these allegations weren’t true in the first place. And I was completely symptom-free at the time this all happened. But I couldn’t say no; that would be a lie. It was to me like being asked “isn’t is true that your skin is brown?” or “isn’t it true that you’re Latin?” or “isn’t it true that your native language is Spanish?” But I won’t be ashamed of my skin or my culture or my language, I wouldn’t deny them. It seemed to me at that point that in this world it is politically incorrect to be racist, but not so to discriminate against those with a history of mental illness.

I must admit I have had times where I wish my defect was in my skin or in a spot I could just have surgically repaired and then be on my way. It’s not that easy. If you have a mole on your face that everyone stares at when they look at you, it makes you uneasy. But at least you can have that removed and be more appeasing to those that are superficial and judgemental. What so many people wouldn’t give for a solution that easy.

On being sad

I’ve been reading Fyodor Dostoevsky’s ‘The Brother Karamazov’, and having read a few others of his works I came to question the moods often associated with depression. You see, in his books I’ve always found a character that is just simply a miserable man, a man that is also spiteful despite the fact he is also often the protagonist.

“I am a spiteful man”, one story begins. Here we meet a man that is sad, miserable, unhappy. He wants for nothing because he has already accepted he is a miserable man. He has a job, he knows people, he does ‘things’. He’s not an outcast or necessarily a strange man. In fact there are probably a lot of people who feel just like him. He was sad, yes. But why? I always wondered why, but I now am starting to realise ‘how could he not be?’ I think the answer to this question lies not in looking at what he had (a job, friends, etc.), but what he didn’t have. Where was his purpose? Where was his passion? Where was his love? Where was his self-pride and self-efficacy? And who if not himself could he blame for lacking these things? You have to hate the man who deprives you of these things – and so comes the self-loathing.

In one of my most recent episodes of “depressive” thoughts I was asked why did I not seek adequate treatment once and for all. And pondering this question, I had to remember the spiteful man of Dostoevsky’s stories. Why was his misery untreatable? Because it was a matter of the human condition, not of an illness, per se. (Note, I am not making a general statement about the existence of the illness we call depression, but rather about a personal reflection based on my own experience.) And so what is a man like Dostoevsky’s protagonist to seek treatment for? “Depression”? Or the fact that so many aspects of his life are not yet in place? I remember a quote from ‘The Manual of The Warrior of Light’ by Paulo Coelho: “By now, millions of people will have given up. They don't get angry, they don't weep, they don't do anything; they merely wait for time to pass. They have lost the ability to react. You, however, are sad. That proves that your soul is still alive”. Sometimes I think a bigger sin than being sad is to not be sad at lacking that which enriches life: love, company, passion, freedom, activity, purpose, peace…

Why am I sad? Because I have a mental illness, or because my life is not yet like it should be? Don’t get me wrong, I have many things in my Iife I am very grateful for and I have had many achievements… But instead of telling you what I am lacking, let me tell you of what I am now achieving, how I am “curing” my state. I have found the love of my life and I am planning a family with children. I work a job that I don’t hate. My passion is writing, even this humble blog. And I have finally stopped being afraid of being judged for being myself. I am learning resilience, building my self-efficacy, and I take the responsibility for my own emotions. What I still lack IS worthy of my dissatisfaction. But what I have is worthy of so much joy.

-I used to think I was cyclothymic. Turns out I may just be human.

On skin

I was sitting in with a dermatologist one day learning about skin conditions of the type that are severe enough to make it into hospital. Before I went in to sit with him (as an observer) I had to wait out in the waiting room with his patients. I noticed a red man there with lots of fine scale on his blue work shirt and around his chair. There was also an older lady who I could not discern anything of note from where I was sitting. Then I went in to the dermatologist’s room to sit in the corner as any good medical student.

The man I had seen in the waiting room came in. He was quite animated and greeted both me and the specialist with a handshake and a big smile on his face. He was having another flare up of his psoriasis because he had been working out on a roof (he was a painter, I believe) and didn’t wear his usual long-sleeve shirt that in the Brisbane summer is only best described as torture. He was bright red (beyond what I had learnt the word erythema meant) and was shedding layers of skin everywhere, even as he talked and sat. He had come in his work clothes and he offered to remove it so that I, the medical student, could see and learn just how bad psoriasis can get. He was not a bit embarrassed, and he thought he owed to show me at least the worst spots of the disease, which extended literally from his feet to his face. After his treatment was sorted out and different work strategies were discussed to prevent such frequent exacerbations, he left with a smile even bigger than the one he came in with. The dermatologist explained to me afterwards that he was an extreme example, that he was the worst even he had seen, and that the man was remarkable to continue on with his employment and in such great spirits. I must admit, until that day, I had never even seen any psoriasis at all except in books – and that was not ‘typical’.

The second patient we saw was the other lady I had seen out in the waiting room. She came in, sat down, pulled her skirt up above her knees, and started crying. There were two small psoriatic plaques on her knees, about 4cm long by 1cm wide. The plaques were raised and had some scaly skin on top. There was no redness. This was devastating to her because this was the second or so time this had happened to her in the last four years. One knee, two small spots, and not inflamed. She apologized for having to show us such “disgusting” things that were on her knees; she was clearly embarrassed. The dermatologist treated her as if he had not just seen actually bad psoriasis and tried to dissipate her concerns and offer medical therapy for her skin. I was stunned to see how incredibly emotional she was and how humiliated she seemed to be!

One day I was out walking with a friend and she was telling me how she had always struggled to feel comfortable in her skin because she had a skin condition since she was very young. I had of course noted her skin appearance, but it had never occurred to me that she felt self-conscious about it. She told me how she imagined people thought of her because of her skin. They might think she is unhygienic and her skin is disgusting, that she is ugly and possibly ‘retarded’ or suffering some greater disorder. She said she imagined people would speak of her and comment on how ugly and disgusting she looked, and they would laugh and make fun of her. Just then a group of adolescents with skateboards went past us and were laughing amongst themselves. She said episodes like that made her think it was her they were laughing at. I felt at that moment not pity for her for having a skin condition, but rather offended as a human being not of what she thought people said of her, but what she thought of us, us people other than her.

I had one question to ask her: what did she think when she saw a person with a skin condition like hers? Did she think they were ugly and disgusting? Would she laugh and mock them? She responded no, of course not! I asked her then if she was special, was there something about her that meant she was a good person and the rest of humanity were judgemental, spiteful human beings? She said no, she wasn’t special. Of course she would never think she was special, her problem was one of low self-esteem not a heightened arrogant one! Well, I said, if she is not special and she would never think that way of anyone, what made her think anyone else would think that of her? Here she was accusing strangers, others, of being spiteful, judgmental, arrogant people with vicious mocking thoughts in their minds. Freud called it projecting, the act of ascribing to other attitudes and feelings you personally have. I believe no medical condition, handicap, special ability, money, or other advantage or disadvantage entitles you to cast judgement on other human beings!

There’s an early movie by Pedro Almodóvar called ‘Dark Habits’ in which a group of nuns take on the names such as Sister Manure, Sister Rat, Sister Damned, and Sister Snake. The aim is to humiliate themselves and remind people how even the “good” ones of us are despicable; they believe that “man will not be saved until he realizes he is the most despicable being ever created”. By the end of the film all the nuns have become either prostitutes, drug addicts, drug dealers, and other such “sinners” befitting of their adopted names. At the end, a higher-order cleric visits them to shut their order down and reminds them that sometimes “humility” can be the worst kind of arrogance when you wear it for a badge. Nothing that attracts pity entitles you to act carelessly or exonerates you from being responsible for what you say or do.