This is an oft used phrase that people use when they are looking at issues of personal identity, career, and family. The phrase has taken on new meaning for me in having moved to another country and having been in New Zealand just over 8 weeks, now.

This morning, I got up early. I haven’t been sleeping that well because I have been stressed about trying to figure out (at a mental level, but even more importantly, at a deep internal level) how my personal ethics and professionalism will fit into the contemporary New Zealand practice of psychiatry. This gets into the whole “better, different, worse” dimension from the last blog post.

This morning, I got up early because I was thinking and troubled. I thought, that’s it – I am not going to keep worrying about all this – I am going to start working on my books, to begin with Creating a Holistic Medical Practice (which when I opened the document today, I realized it has been 2 months, to the day, since I last wrote anything on this). So, I got up and thought, I’ll just head off to the café, get a latte bowl, and do some good old writing and that will help orient me and help me to feel I have a focus and purpose in whatever it is I am doing in New Zealand. 7 am. Of course, cafés here don’t seem to open until 8 am on Sunday, which is my cultural lesson for the day. So, that is ok, I am flexible and I haven’t taken a long walk along the beach in awhile, so I headed off, the sun shining brightly on the water.

I saw a flock of Kakariki, or red crowned parakeets, about 5 or 6 of them. Amazing! I sat down along the path and watched them call to each other and dart in and out of the trees high up on the Cliffside above the road. A few NZ goldfinches, with red heads, joined in, twittering and flying in and out of the trees. After watching for awhile, I resumed my walk down the path, but decided I would head up a road winding up the hill to see if I could see the Kakariki from another angle. (Incidentally, when we went out to Tiritiri Matangi Island, the tour guide gave us each a Maori bird name to pronounce, and the one I was assigned was the Kakariki). I heard a bunch of birds calling in the trees, some of which I thought were the Kakariki. I saw a few pukeko grazing on the lawn. I couldn’t get a good view of the parakeets, so I gave up and walked on up the hill, pausing to look at some thrushes along the way. I got up to the top of the hill and sat down for awhile. Lo and behold, the Kakariki had come up the hill, one sat on a fence for a while and then a pair of them went off into a tree. I followed them and at times they seemed to follow me. They seemed kind of curious as I kept trying to get a picture with my camera phone (unsuccessfully), but it was alright, I got quite a few good views of them. Then I walked over and down the hill to the Sierra café and at 8 am got some breakfast (a very tasty plate of poached eggs, toast, boiled tomato, potatoes, and creamed mushrooms) and my latte in a bowl.

The thing I think I am struggling with is finding my place in the world, and more specifically finding my place in New Zealand, and more specifically yet, my place in Manaaki House and psychiatry at Auckland District Health Board. Some of this is adjusting to the “differentness” in the way things are done. Some of which seem “better” and some “worse” from my perspective. One of the things I am hitting, which I think is a cultural difference, is that I would like my role to be clearly defined, I would like to see the policy and procedure manual, so that I can see what the policy is for which staff are allowed to touch medication, to dispense medication, and what the rules are for how and where and under what kind of security medications are stored. I have almost learned, now, to stop asking for the written policy and procedure manuals. That doesn’t seem to be the way things are done here. I am still thinking there must be some policies on these things somewhere, but it doesn’t seem to be a simple thing for me to get them and I fear I have offended some people in my quest for written guidelines. I am trying to understand the de-emphasis on policy manuals as a more “laid back” approach to life and work in New Zealand, but it is very difficult for me to go against my orienting reflex of what are the rules, how are we supposed to be doing this? One person I spoke to mentioned that people are going to think he is “Hitler” because he wanted to update some policies. That is a pretty strong anti-policy sentiment. What I struggle with, is that from my perspective, an American who has worked in many different health care delivery systems and designed from scratch a small health care delivery model (private practice), it seems like a lack of organization and structure. For me this is a culture clash, because in my disorientation in Kiwi culture, my orientation reflex is to find the structuring and organizing principles, which creates a greater dissonance between me and the culture and the day to day work.

Another cultural difference that I am finding is that Kiwis, not just at work, but in many settings, banking and business (these being other settings that I am used to having clear cut rules, policies and guidelines) there is a tendency to avoid directly answering questions that in the US would have a very clear and direct answer. For instance, I was at the bank last week, activating my EFTPOS (electronic fund transfer point of service) card which is also a MasterCard, and I tried 3 times at the window and then back to the “ATM” machine and it wouldn’t work. Eventually, the teller asked if I would just like some money at the window. I did, but I also wanted my card to be able to work. We have already switched banks once and I keep getting in these situations where I don’t have access to money accept for using my US credit card, which costs more with currency exchange fees. So, I said yes, I’d like some money. The teller said I should just wait a little while on my card, that it was activated in the system, but that sometimes it takes the computer awhile to update. So I took my $100 and tried again at the ATM a few days later and it still didn’t work. So, I waited about 15 minutes for a teller, and then she was able to get my card activated both as an EFTPOS and a MasterCard. I asked about my balance on my credit card and there was a $3 fee for a cash advance from the day before when I got the $100. I said that I didn’t feel like that was fair, because I was in and out several times and when I got the money, I thought I was getting it from my account at the bank, not a cash advance on my credit card. ($3 isn’t a big deal, and this whole episode may seem kind of petty, but when you repeat similar interactions many times over a week on many different topics, some minor and some major, it starts to become clear that there is some kind of cultural issues at work). She said she understood, and that it was a mistake and that it was “fixed.” Having been in New Zealand for a little while now, I knew enough to ask what she meant when she said it was “fixed.” She said, it won’t happen again. I thanked her for that, and then said, I didn’t want to pay the $3. She said when I got my bill, I could address it then. I said, well, why can’t we address it right here. I am here, you are here, and we can both see the $3 on the screen and why on earth would I opt to get a cash advance and pay for that when I have money in my accounts. Yes, she could see my point, she was sorry, she said it is taken care of. I said, so I won’t have to pay the $3? She said, oh, no that fee is there, but it won’t happen again. I took a deep breath and settled in for a prolonged discussion on this. She glanced back at the ever lengthening line of customers, and said she would talk with her manager and get the $3 fee removed. We each took down each other’s details (another thing I have learned in NZ is to write down the name, date, and details of the interaction because what someone says doesn’t always turn out to be what someone does) and I went on my way.

What seems like a very positive thing in Kiwi culture is that no one in the line got angry or irritated, at least not that they showed. I observed a Fiji Indian bus driver spend what seemed like 5 minutes one day patiently working with an Asian woman who spoke minimal English to figure out where she wanted to go and to make sure she was on the correct bus. The customer behind her jumped in at some point to help as well and said that she knew the road and was travelling near there herself. The bus driver then said several times slowly and clearly, you stay with her (gesturing to the helpful woman), you stay with her and she will show you where to go. At the appropriate stop, the helpful woman got off the bus with the Asian woman and gave her some more directions. This patience and desire to help is a really great quality. I wonder sometimes if the flip side of it though, is (what appears to a hasty and restless American who always wants to make things “better”) that there is a lack of dissatisfaction with things that are not working well. It can seem almost apathetic to me sometimes, but I tell myself that it is the flip side of other positive cultural attitudes, but then I say, but when you are dealing with money, or medications that can kill someone or be mis-used, is that attitude “different” or is it “worse,” and can I go along with it or should I risk being seen as a busy-body, know-it-all, who says “where I come from, we don’t do it that way.” One thing I have read and been told is that the surest way to alienate a Kiwi is to criticize the way things are done or to compare them unfavorably to a larger country.

In moving to another country, there is probably always a prior feeling of not fitting in with your own country. I know for me, that I am often critical of the US and on many levels tend to feel like I don’t fit in. Also, I tend to drift toward the fringes and I tend to really enjoy other people who are eccentric or don’t fit in squarely into the culture. In moving to New Zealand, I think on some unconscious and maybe semi-conscious level, I think I was hoping I would find a place where I “fit in.” I think this is one the major internal issues I am working on. What if I don’t fit in here? What if then I don’t fit in back in the US? What do we do, move to a third country?

I know that many people in spiritual or psychological circles would say that everyone is an individual and that the important thing is to feel comfortable with oneself. If you fit into yourself, you will find a place in the world. I do ascribe to that view, although I don’t think that is the whole truth. At least, it sounds like a potentially lonely place without much connection to others. I have been reading some of Mason Durie’s books. He is a Maori psychiatrist who has written about Maori cultural attitudes and the lack of fit in a Westernized medical system. The Maori, he says, don’t have the sense of themselves as isolated individuals, but rather their sense of self is contextual, land, place, family, tribe, and spiritual realms and connections which also are often connected to places. He says that they have a more “holistic” view of health and identity. This is definitely different from the Westernized view of a sense of self that is “portable” and self-contained and self-referential. I see the pros and cons with both the Individualist and Collectivist orientations. I can create a narrative, as many others have, that in the West we have taken Individualism to the extreme that we no longer have a sense of connection to our environment and each other. The problem of alienation and nihilism can be traced back to the rupture of connection of the individual to self, to other, and to environment.

What is the solution? What is the problem? What are different ways that people find themselves in the world? How do people find their place in an ever changing world and human environment? Is meaning to be found in the individual’s relationship to their Self, or in the individual’s connection to the Other? Is there a way that all of this is true, that there are times that a connection to Self is most pressing and other times connection to Others is more salient? How important is it to be true to your Self and how important is it to fit in?