Considering Identity and Culture

Posted on May 1, 2011 by davidrkopacz

“Exploring the world is one of the best ways of exploring the mind, and walking travels both terrains,” (Rebecca Solnit, Wanderlust, p. 13).

I was recently talking with someone about culture and trying to figure out how to understand different challenging interactions. I was starting to realize that in any cross-cultural interaction, at least 4 different factors need to be considered, my personality, my culture, the host culture, and also the sub-culture I am interacting with (or the personality of a particular person I am interacting with).

I have driven myself crazy sometimes, trying to analyze how much each of these different factors is contributing. At other times, I have tried to change my personality to try to “fit” into the culture or sub-culture, which doesn’t really seem to work.

Realizing that there are so many different factors at play in any interaction does give me a better appreciation of how complex interpersonal and cross-cultural interactions really are, and it gives me pause to not feel as much like I need to “figure it all out,” and to try to let myself understand things as I go along.

I received a card awhile back that has the following quote on it, “We cannot discover new oceans until we have courage to lose sight of the shore.” I suppose this is kind of the dilemma of my feeling that I need to “figure things out,” that I keep trying to chart the map at the same time that I am exploring the “ocean,” and these are two contradictory things, as one really needs to get lost before one can find something new. The challenge is allowing myself to feel lost for awhile to learn, rather than at the first sense of feeling lost trying to immediately find my place on the map.

I was just reading Emerson’s “The American Scholar,” and there is a section where he talks about how when one is in the midst of an experience, and for a variable time after the experience, that one is blind to the true meaning of it, but that it is only at some undetermined later point that suddenly experience becomes clear, understandable, and also a part of one’s life story:

“The new deed is yet part of life, – remains for a time immersed in our unconscious life. In some contemplative hour, it detaches itself from life like a ripe fruit, to become a thought in the mind. Instantly, it is raised, transfigured; the corruptible has put on incorruption. Always now it is an object of beauty, however base its origins and neighborhood. Observe, too, the impossibility of antedating this act. In its grub state, it cannot fly, it cannot shine, – it is a dull grub. But suddenly, without observation, the selfsame thing unfurls beautiful wings, and is an angel of wisdom. So is there no fact, no event, in our private history, which shall not, sooner or later, lose its adhesive inert form, and astonish us by soaring from our body into the empyrean.”

I guess things will always make sense at some point, but this understanding is always a function of the past and not the present experience. What I didn’t expect in moving to New Zealand was that I would spend so much time bumping into myself and finding myself exploring “the mind,” when I really wanted a break from that for awhile and sought to go out and “explore the world.” That is Solnit’s point, and Emerson’s as well, perhaps, that to go out into the world is to explore one’ Self.

Hope

Posted on April 11, 2011 by davidrkopacz

“The kind of hope I often think about (especially in situations that are particularly hopeless, such as prison) I understand above all as a state of mind, not a state of the world. Either we have hope within us or we don’t; it is a dimension of the soul; it’s not essentially dependent on some particular observation of the world or estimate of the situation. Hope is not prognostication. It is an orientation of the spirit, an orientation of the heart; it transcends the world that is immediately experienced, and is anchored somewhere beyond its horizons. Hope in this deep and powerful sense, is not the same as joy that things are going well, or willingness to invest in enterprises that are obviously headed for success, but, rather, an ability to work for something because it is good, not just because it stands a chance to succeed,” (Vaclav Havel, Disturbing the Peace).

I love this quote by Havel. I like how it describes hope as a moral choice that is independent of the external situation. It reminds me a little of faith, but not quite the same. Havel’s description seems like more of a choice than faith does. One thing that this quote does, for me, is it preserves the right of the individual to choose what is right and what deserves to be worked for, regardless of the dimension of how likely it is to succeed.

I just finished reading Rebecca Solnit’s book, Hope in the Dark, in which she cites the above quote by Havel. The quote doesn’t appear until page 148, but it seems to inform a thread of Solnit’s argument from the very beginning. “To hope is to gamble. It’s to bet on the future, on your desires, on the possibility that an open heart and uncertainty are better than gloom and safety. To hope is dangerous, and yet it is the opposite of fear, for to live is to risk…Hope just means another world might be possible, not promised, not guaranteed. Hope calls for action; action is impossible without hope,” (Solnit, 4-5).

Another thread in Solnit’s book is of darkness, which is not necessarily the typical way that darkness is thought of. She writes that the “future is dark, with a darkness as much of the womb as of the grave,” (6). This darkness is more of the creative void than the destructive void. It is this embrace of generative uncertainty that also runs through the book. This reminds me of the dark matter of the universe, that unseen substance that physicists can measure that seems to make up all the empty space between things in the universe. I can’t remember for sure, but maybe it is something like 85% of matter in the universe is unseen matter, maybe it is even more than that. But, what is all this dark, unseen matter doing? I like to think that it is somehow invisibly guiding and shaping the tip of the iceberg of matter that we can see. We can bemoan the visible catastrophes, but all is not lost. Just like the iceberg metaphor, Solnit argues for a cognitive restructuring, do we focus on only what is going wrong in the world, or do we focus also on what is going right. Or, even do we focus on how things could have been an even bigger catastrophe than they are?

Solnit introduces the Angel of Alternate History. As compared to the Angel of History, who mostly counts bodies, the Angel of Alternate History focuses on that dark space that surrounds the actual and sees the possible. “The Angel of History says, ‘Terrible,’ but this angel says, ‘Could be worse.’ They are both right, but the latter angel gives us grounds to act,” (76).

Another way of looking at this cognitive re-structuring is that we have to count victories as well as catastrophes in our analysis of the world. Solnit provides criticism of the tendency toward pessimism and catastrophizing of many activists and the Left in the US. She describes such paradoxical victories as the role of Viagra in saving species that were previously used in for increasing sexual potency in Chinese Medicine and how some military bases have inadvertently become safe havens for endangered species.

Another critique Solnit discusses is that of the end of the need for activism, or the desire to “go home,” after the protest. In a way, this mindset looks at attention, awareness, and activism as only being necessary to re-set things or make it happily ever after, and then to turn off awareness and to let go of engagement. Rather, she sees activism as a mode of being, a moral responsibility, that is ongoing, and that one engages in regardless of the “state of the world,” or the “chance to succeed,” to refer back to Havel, again. The need for engagement never ends. “Still, I use the term activist to mean a particular kind of engagement – and a specific politic: one that seeks to democratize the world, to share power, to protect difference and complexity, human and otherwise,” (18). “For a long time, I’ve thought that the purpose of activism and art, or at least of mine, is to make a world in which people are producers of meaning, not consumers, and writing this book I now see how this is connected to the politics of hope and to those revolutionary days that are the days of creation of the world,” (115).

Solnit also quotes the Zapatista Subcommandante Marcos throughout the book, who apparently publishes manifestos over the internet. For some reason, I found these to be a kind of eloquent comic relief, not because the content wasn’t serious, maybe even because of the seriousness of the content, but with their ease and fluidity of language and the sense of spontaneity, creativity, and even joy that seems to flow through these declarations. “A new lie is being sold to us as history. The lie of the defeat of hope, the lie of the defeat of dignity, the lie of the defeat of humanity…In place of humanity, they offer us the stock market index. In place of dignity, they offer us the globalization of misery. In place of hope, they offer us emptiness. In place of life, they offer us an International of Terror. Against the International of Terror that neoliberalism represents, we must raise an International of Hope. Unity, beyond borders, languages, colors, cultures, sexes, strategies and thoughts, of all those who prefer a living humanity. The International of Hope. Not the bureaucracy of hope, not an image inverse to, and thus similar to, what is annihilating us. Not power with a new sign or new clothes. A flower, yes, that flower of hope,” (cited, 39-40).

Overall, it seems that Solnit’s argument for hope lies in looking at things differently, refusing to despair, seeking engagement in art, activism, and life, and accepting uncertainty (the darkness that obscures) rather than demanding a certain outcome. This again reminds me of this central Havel quote, which connects a human being to themselves and refuses to let external events dictate whether or not one can hope to make things better or even hope to have one’s own vision of life.

One last thing I’ll touch on here is a small way thing that I find hopeful. As someone who is concerned about the health of the environment, Solnit engages and relates to the natural world and refuses to disconnect from that. After reading Hope in the Dark, I started reading Emerson’s essay, “Nature,” which I don’t think I ever read before. A few thoughts have been coalescing for me. As I sat reading Emerson, drinking a cup of coffee at a cafe, gazing out the open window at the ocean which is right across the street from where we live, I thought, I should really get out into nature more – and it struck me that living on the ocean is perpetually being on the edge of nature, even though this is a pretty happening place, bustling, full of continuous human activity, it is in constant relationship to that great and restless body of water, constantly moving in and out. “The beauty of nature reforms itself in the mind, and not for barren contemplation, but for new creation…The production of a work of art throws a light upon the mystery of humanity,” (Emerson, p. 41, in The American Transcendentalists). Emerson argues that “words are signs of natural facts, particular facts are symbols of particular spiritual facts, and nature is the symbol of spirit,” (42). At first, I was taken aback by this, it seems he is arguing that the natural world and the internal, cognitive and spiritual world are reflections of each other. Oh, ok, that old “as above, so below” congruence between things. Maybe even more. I have read in a couple of different sources now about the finding that there is a 10 hertz electromagnetic current that pulses throughout the Earth and that 10 hertz is also the “dominant (alpha) frequency of the EEG in animals,” (Robert O. Becker, The Body Electric, p. 249, in the chapter, “Breathing with the Earth,” which discusses this concept in depth). What this seems to mean is that living beings contain within them an echo or correspondence with a common electromagnetic current of the Earth. It seems like an instance of “as above, so below,” or maybe, rather, as without, so within.

James Oschman, in Energy Medicine: The Scientific Basis, also writes about this, the Schumann resonance, which “is a unique electromagnetic phenomenon created by the sum of the lightning activity around the world,” (99). The Schumann resonance is 7-10 Hertz in frequency, just like the alpha waves of animal brains. Also, Oschman cites a study of various healers who had their brain activity recorded on EEG and when they went into a “healing state” had activity in the 7.8-8.0 Hertz range (107). Additionally, Oschman cites studies that show that have measured healers whose hands generate electromagnetic fields ranging from 0.3 – 30 Hz, which could be seen to vary around the 10 Hz frequency of alpha brain rhythms and this particular background pulse of the Earth (Oschman, 87). Oschman suggests that a mechanism of various healing modalities is a supportive “therapeutic entrainment,” in which the healer amplifies this electromagnetic rhythm of the Earth and that this is healing by resetting the natural baseline rhythm in the person being worked on. It is easy to imagine that through the daily stresses of life (or even longer term maladaptive patterns of living) that one could lose touch with the natural rhythm of one’s own body, which also corresponds to the natural rhythm of the Earth. Getting back in touch with nature, in this light, could really, truly have a healing effect on one’s biorhythms.

Maybe all this might seem far-fetched to you, but it is what sprang to my mind as I was reading Emerson and his argument that nature is a symbol of the spirit. The transcendentalists refused to buy into the split between mind and body and the individual and the natural or social environment. Another way of stating this could be that nature and spirit both share a common origin, both are in relation and communication with each other, and both enhance each other. Nature and spirit are reflections of one another. Rather than a separation between mind and body, or individual and environment, there is a resonance between all the different things that we divide from each other and with our intellects imagine as separate. Lately, when I feel particularly out of synch in my life, I have been imaging this great, pulsing rhythm of the Earth and looking for the echo of it in my self. I find this comforting, even hope-inducing.

Facing Fear

Posted on March 24, 2011 by davidrkopacz

One of my fears has been to be in a situation in which someone says, “Is there a doctor in the house?” My fear is that I will be the only medically trained person and that I will have to face embarrassment (or worse) as I find myself in a situation that I am not prepared to handle as a psychiatrist attempting to face a medical emergency.

Well, I recently faced this fear.

My parents visited recently and we went out to Tiritiri Matangi, an island in the Haurakai Gulf outside of Auckland that has been established as a bird sanctuary. We were in the gift shop when a tour guide came running in and said, “There has been an accident.” I tried to listen as he spoke in hushed tones to one of the managers of place. I stood there, wondering if I should speak up or listen more. The manager came up to me and said, “We need a doctor,” to which I said, “I am a doctor, well a psychiatrist, it has been awhile since all the blood stuff, but I’ll help if I can.” Actually, I can’t remember how much of that I thought and how much of it I said.

It turns out that she then remembered me from a conversation we had when I had been out to the island the first time about 6 months ago. We raced off in a truck and then walked a little way down a path. There an older woman was lying flat on her back where she had fallen backwards and landed, full force, on the wooden walkway. Mostly, I just talked with her and held her hand. She could move all her extremities, she had feeling in her hands and feet. She did have a burning pain along her cervical and thoracic spine and she had tried to turn her head earlier and that made the pain worse. As I said, I mostly just talked with her, encouraged her to stay calm, distracted her at times from her pain with humor or questions about her family, and stayed with her while the rest of the staff on the island arranged for a helicopter to come out with paramedics.

After about 20-30 minutes (hard to judge time in these situations), we heard the helicopter circling. I assumed that a staff member would go up to a place that seemed like a good landing site up the hill, but that turned out not to be the case (learning point if I am ever in another helicopter evacuation situation). Instead, the helicopter kept circling looking for us. Some of the staff shouted, waved things in the air, but we were sheltered under small trees. Eventually, one of the staff climbed up a tree and got the helicopter pilot’s attention. I still kept thinking they would land up the hill and walk down, as that was the plan that the staff had discussed. Instead, the helicopter seemed like it was going to land right on us! The sound got louder and louder and the wind started to pick up with dirt and leaves blowing everywhere. I just tried to keep the woman’s face covered as she couldn’t really move to do that herself. This seemed to go on forever, this buffeting wind and noise of the copter right above us. Eventually, I glanced up to see that a paramedic was rappelling down a rope to us. It was a relief for him to get there and I watched attentively as he took her blood pressure, gently checked her neck and head and then put an immobilization collar on her. Each of us took a shoulder, hip or leg and gently lifted her up and another person slid a stretcher under her. We then carried her up to where the helicopter had landed up the hill. They drove me down to the dock and I joined my parents on the ferry which was just about to depart to head back to Auckland.

The strange thing is that I felt really good about the whole thing. I really felt that the woman would be fine and the paramedic had said the same thing, that he was just immobilizing her to be cautious and on the safe side. I felt that my medical, and really even more, my psychiatric training had prepared me to just be with her and to recommend she stay still until more intensive medical help arrived. I felt like I had really helped another person in a difficult situation.

Since moving to New Zealand, I have really often wondered, “what the heck am I doing here?” Also, “are all my efforts and energy really helping anyone? And sometimes, I have even wondered, “Is the way I am responding to people and systems issues in this new country not just making not things better, but am I even making them worse?” Somehow, helping this person seemed to give me an inner sense of certainty and a conviction that I can help people and that is a worthwhile thing to do. Even if I am not sure about my own life, my own direction, I can still be with someone to provide comfort when they are in pain and suffering. I helped and I was helped in the same situation.

Oddly enough, my own back had gone out a week before this incident and I had gone to the chiropractor. It went out again, to the point that I even missed work the past couple days and I have made several trips to the chiropractor and my awesome massage therapist. Since coming to New Zealand, I have had back problems, multiple types of skin problems, knee and hip problems, ear problems, lots of stress, sleep problems, and probably some other things that I am forgetting. At my most bleak, I find myself thinking, “That is it, I am falling apart, I am getting old, I will never be healthy again.” At my best, I think, “this is all a big, physical adjustment to moving to another country and my body is trying to re-equilibrate to this new land and to living in the Southern hemisphere.”

I am starting my new job tomorrow, Monday, and will be working part-time between my new job and part-time at my old job for about a 6 week transition. This is another big change going on in my life. I feel like I need to let go of everything I have been trying to carry at my old job, I guess that is how I look at these back issues and the timing of them where I had to take off part of my last full week at my old job. I have been trying to figure out how quickly to let go of certain things that I have taken on at the old job and having these physical issues has made it pretty clear that I need to stop carrying them around sooner rather than later.

All these physical issues have brought up this other fear, “what if my body doesn’t heal?” This, in turn, compounds my bigger existential questions I keep asking myself, “What am I doing here? What is my purpose? Am I doing any good? Am I causing harm? Am I making things worse?” All these physical problems are forcing me back to basics, trying to be patient and compassionate toward myself during this challenging transition.

Moving to a different country, even one as similar as going from the States to New Zealand, breaks all the old social support and even, I have found, has broken many of the social cues that I used to get feedback about how I was doing in my job. I have realized that this was a fear that I didn’t realize I would be stirring up in coming here, “what if I cannot do a good job?” I have been reminded of how I felt during medical school, where, as students, we were tossed in to new specialties and hospitals every few month or so and there was this constant learning curve of trying to figure out what my job was, how to do it, and if I was doing it well. I hadn’t felt this feeling and its attendant fears for some time. I had gotten to the point in my professional career where I felt pretty confident in my own abilities. Sure, I knew that I always went through a period of feeling “de-skilled” when I moved to a new job and tried to figure out how things worked and how to adapt to a new system that had different ways of doing day to day things, but I knew this gradually would ease over about 6 months at the job. But, here, in New Zealand, I have experienced this at a much deeper level as I have re-evaluated even my basic personality, my cultural assumptions (some of which I wasn’t even aware of), my philosophy of psychiatry, and my day to day functioning in the job. At times I have been able to fall back and find strength and certainty in myself, but other times I have fallen back and found rickety structures that did not seem to provide support, or worse, my old nightmare fear of losing my grip and falling and not being able to find internal or external support.

In my professional work, I am frequently telling people to face their fears and I know, intellectually that fears only get stronger the more one avoids facing them. My experience of moving to another country has, at times, really tested my intellectual commitment to facing fear. It is hard work. I am hopeful after having faced this fear of being the only doctor in the house. I am also very hopeful about moving to this new job. It really is a challenging task to restructure internally and externally to create new life in which I feel like I fit, that I am relevant, and that is a good balance of meaningful work, light-hearted play, and is filled with good friends.

I remember a quote of Philip K. Dick, that I’ll paraphrase as, “How can you become that which you are not? By doing that which you would never do.” I suppose this relates to facing fear.

New Job!

Posted on February 27, 2011 by davidrkopacz

In addition to the major earthquake this week, I have a more minor shake up in my life as I am taking a new job.

The earthquake is still a major challenge in New Zealand. My sister-in-law and a friend were visiting and they were bumped off their flight this weekend because Air New Zealand was flying back 7 injured people to either the States or England. I recently heard that 4300 people have come up to Auckland from Christchurch. There was also an article in the paper about this guy who was lifting these big slabs of concrete off of some trapped people right after the quake. I saw the video and thought, wow, those must be some other material than what they look like, because he just picked up these slabs and moved them aside without seeming to exert much effort. Here is a link to the New Zealand Herald if you are interested:

My new job is at Buchanan Rehabilitation Centre, which is an inpatient/residential centre for 40 clients who live there. The model is a very positive and hope-inducing one that gives intensive support in a holistic framework. There is a gardening program there where clients can learn to grow plants that are then planted and cared for at various sites in the community. It is also very multi-disciplinary in its focus, with a lot of group work and it is aimed at helping people get back on a developmental track in their lives and to be less stigmatized and identified as “mental patients,” and encouraged to move beyond or through their illness experiences. I am really excited about working there. I’ll be starting part-time work there in March, increase my time further in April, and then I’ll be working 4 days a week there in May, one day a week I will be taking off for writing, and I will be ending my work at the community mental health centre.

I have had a really challenging time working at my current job. It has been difficult for me to sort out what are problems at the sub-culture level and what are larger issues with the practice of psychiatry in New Zealand. When I was at my interview in Christchurch as part of my credentialing for the Medical Council, I was told that over 50% of psychiatrists pracitising in New Zealand are internationally trained. That means that the norm is that a psychiatrist in New Zealand is from another country. That makes for a very interesting and diverse work environment, but it could also contribute to a degree of transience in the work force and has a number of challenges for New Zealand in structuring and operating mental health treatment.

At this point, I am really glad to be leaving my current job. I have put in a lot of time and energy and taken on various projects to work toward changing the work environment there. It is really challenging to be working in a system in which the staff are resistant to change, and negative, also, there are various administrative level challenges as well. The more I learn about Buchanan, the more of a sense of relief I feel. My own holistic approach should be very welcomed there and also seems very similar to the therapeutic approach used there. Here is a short article, from an old newsletter, that gives a brief overview of BRC. It is on page 5 of the newsletter.

I know this blog post is a little all over the place, talking about my job and the earthquake, so in honour of that all-over-the-place energy, here are a couple dolphin photos from the boat trip we took a couple weeks ago.

Fitting In and Not Fitting In (revisited)

Posted on January 22, 2011 by davidrkopacz

I just spent about an hour revising a paper that I presented at a conference a number of years ago, Learning to Save the Self (which can be now found at my Website under unpublished papers). I recently came across this paper and it really seems to summarize a lot of the issues that I have been working on in my job, teaching, and professional career over the years. Basically, how to remain fully human while going through educational programs or working in jobs that encourage dehumanization. I quite like the paper and it seems like a really nice summary of some of these ideas. It was also a lot easier for me to write than all the work I have been doing on the book, Creating A Holistic Medical Practice, which seems to be requiring endless revisions and is still has sections that I feel I have just not gotten to the essence of what I am trying to say.

So, I thought, maybe I can just do a few revisions on this old presentation and get it out there in print somewhere. I remembered a link someone had sent me about an on-line medical humanities journal. I looked up the submission requirements and it says that articles should be less than 2000 words. My paper is about 5000 words. I just did a bunch of revisions and it is now 3771 words.

I don’t think I can cut out another 1771 words and keep the spirit of the original paper. Once again, something not fitting in. I just set it aside, for now, with ideas of going back to working on the book, or maybe doing another draconian round of revisions (which would realistically mean dropping out at least one whole section of the paper, which means dropping out a whole segment of concepts that were introduced), or, maybe, just writing a piece with the aim of trying to distill the essence of the paper into 2000 words. It is frustrating, particularly as one of the themes the paper deals with is in trying to preserve the complexity of human emotion, feeling, and relating in the face of forces which try to reduce human interaction to acronyms, protocols, and procedures.

This frustration of yet another thing not fitting in is not an isolated issue. I have four computers (my work computer, an older laptop I kept at home with all my private practice clinical information backed up on it, the desktop computer I bought for my office assistant, and my personal laptop that I use for writing that doesn’t have confidential information on it). We have four printers (my home printer, my office printer, Mary Pat’s old home printer, and a new printer that she bought that is compatible with New Zealand electricity of 220 volts (US is 110 v). (You can skip this next part if you already get the big picture). My personal laptop works on NZ current and communicates with my printer, but it doesn’t have any of my practice information. I have to get working on US and NZ taxes, so I needed to get my work desktop computer to run on NZ current. I looked into buying a converter that would work for it, but had a couple of recommendations that I just have the power supply switched out. I did that, there were various problems…eventually I had a new exterior case for the computer, it runs on 220 v, but not all of the USB ports work with it, also, it is not compatible with the printer because it is a newer printer and I can only find a Windows Vista installation disk and the computer is Windows XP. (Also, I can link to the internet with my laptop, but haven’t figured out how to do that with either of my desktops to download printer drivers). Incidentally, my printer (the one that does run on NZ current, the other – my office printer – does not) has decided it doesn’t want to print in black since it got off the boat in NZ. I can’t print my tax information or business information. My work laptop stopped backing up properly in July of 2009 and I was never able to get that sorted out through the support team. My newer desktop computer, which is Vista, doesn’t have all the practice information I need. Also, it has decided that it has an unauthorized version of windows. It seems to work fine, but I have to go through a whole series of pop-ups every time I turn it on. I think I have made the dilemma clear enough. Maybe you are thinking I shouldn’t have so many computers and printers. I agree. The fact is, I do, and to get the information, electricity, and printer to all be compatible doesn’t seem to be happening easily. Incidentally, another reason that I wanted to get my work desktop up and running is that it had all my old files from computer disks on it and was the only one that had a disk drive, and once it was up and running, I found the paper (discussed above) which is not fitting the word limit for submission.

Last night we had dinner with some friends of ours from England. Two of us had jobs in the fields we trained in, although we are pretty grumpy about many aspects of the job not fitting our more extensive training than what the job requires. One of us is trying to get jobs in two different professional careers – Mary Pat has her NZ teaching certification, but can’t get a job in that field, and is currently waiting on her psychology registration that she started as a back-up. Another one of the four of us is running into all sorts of trouble getting nursing registration, but has a part-time job as something like a mental health technician. More problems with not fitting in. Plus, three of us have had various health problems since arriving in New Zealand. My own have been a series of different hip and knee injuries/pain that seem to relate to some difficulties in being transplanted here and putting down roots.

In my job, I have been getting increasingly frustrated with a sub-cultural pressure to make things smaller and slower. I have tried to move ahead with several different programs, groups, or initiatives and yet I feel constantly restrained, contained, and thwarted in what I try to put into practice. I have seen this curious sign or poster a number of places since I have come to New Zealand that says “Keep Calm and Carry On,” which I think is a Winston Churchill quote. I recently saw in a magazine someone wearing a shirt that had the same logo of a crown and words, but this one said, “Get Excited and Make Things.” I feel like I can relate more to the second saying and it does seem more “American.” The tension between these two sayings seems to sum up my frustration.

Fitting In and Not Fitting In

Posted on October 23, 2010 by davidrkopacz

In a lot of my life, I have felt like I didn’t fit in, yet it is a natural human impulse to fit in and be part of the group. In the cross-cultural psychology/anthropology class I took in college, much of it involved looking at how individualistic a person or culture was compared to how collectivist a person or culture was. The dimension of individualism valued individual achievement, accomplishment, separation from the group, and individual goals over collective or group goals or norms. The dimension of collectivism valued group cohesion, social norms, and a person’s sense of identity was achieved through the group rather than in separation from the group in the individual. I find myself thinking of these categories as we have been in New Zealand these past 3 months.

Maori culture definitely seems very collectivist in orientation. I have read some of Mason Durie’s books (a Maori psychiatrist) and he writes about how Maori people get there sense of identity from their whanau (family), as well as from their larger tribe, and even from their connection to ancestral land. The context of identity is the collective group and even the context of relationship to the land. New Zealand Europeans (as those born in New Zealand, but of European ancestry are called) are more individualistic, but seem more collectivist than people from the United States. Kiwi culture is much more group oriented and even socialist in orientation. New Zealand prides itself on being the first country to grant women the right to vote, they are also the first or one of the first countries to establish a modern social welfare system of health care, financial and medical support for those injured in accidents (ACC), and sickness, disability, unemployment, and retirement benefits. There is much more of an emphasis on collaboration and personal relationships in organisations and in decision making.

A dark side of this collectivist orientation in Kiwi culture is what is called the “tall poppy syndrome,” in which anyone who dares to stand out or stand above others is mercilessly cut back down to size. It is a sort of regression to the mean, which, from the outside, can seem like Kiwi’s value something other than excellence, or being the best at something (quite the contrast to the “we’re number one” collective mantra of Americans).

The logical outcome of someone from a more individualist country coming to a more collectivist country is a culture clash or culture shock. The individualist speaks up frequently, trying to constantly figure out ways to make the system better, whereas the collectivists are more concerned with fitting in, not making waves, getting by without making a big fuss. On the one hand the collectivist culture seems more laid back, but can also seem anti-progressive. I realize that these are generalizations and that cultures and individuals have multiple motivations and values.

I was recently in a small group discussion of local psychiatrists. In our group of 7 people, only one was a born in New Zealand and trained in the NZ medical system. The other 6 of us were from across the globe, Asia, Europe, North America. One of the topics that came up in the discussion was how those of us from other countries try to balance fitting in and not making waves with our own cultural and professional values. Someone said something that really resonated with me, that in trying to fit into the Kiwi medical system, a person could be fitting into a dysfunctional system.

This gets into an area that a lot of people declare off limits due to “political correctness” and “cultural sensitivity,” that there is no better or worse, just different, but I am really not sure this is a valid way of looking at things and it seems to shut down any conversation between cultures by avoiding stirring up any conflict. When two (or more) cultures come together, there is inevitably conflict. The issue is how the conflict is handled that is important rather than pretending there is no conflict. Conflict is when two people or groups come into communication with each other and they realize that they have different assumptions, perceptions, motivations, expectations, and goals than the other. The conflict is the sign that communication and interaction are occurring, albeit in an inharmonious way. The transformative issue is in how this conflict is managed, whether it goes into war, aggression, genocide, discrimination – or whether it is channeled into dialogue, conversation, attempts at understanding, and, most importantly, whether or not the two can develop a shared language or culture which holds together the interactions in a socially acceptable way.

I remember reading about a word, that I cannot now recall, that was used in the former Yugoslavian areas of Bosnia. It was a word that was a kind of glue that seemed to hold disparate people and groups together, even though there were generations of past conflict and genocide. This term spoke to a kind of social cohesion and acceptance of difference between a humane society. The fact that this society fell apart into genocide and war, does not negate the importance of this concept.

The medical system in New Zealand is now staffed by 40% international physicians. New Zealand, and particularly Auckland, are taking in people from all over the world, immigrants looking for a better way of life, professionals interested in something different for a brief stint of work, and refugees from many of the worlds conflicts. Auckland is the largest Polynesian city in the world. It is also a very diverse city with 30% of its residents having been born outside of New Zealand. The question of fitting in will be a big one for not just the medical system within New Zealand, but for all of New Zealand.

On a more personal level, I find myself re-visiting this question of to fit in or not fit in. I have always been comfortable gravitating toward the fringe in different ways, whether it was punk/new wave music, mysticism, spirituality, the philosophical problem of nihilism, psychiatry, trauma studies, holistic medicine, or energy healing, many of my interests are often not valued or are actively disdained by the larger cultural group. Physicians tell psychiatrists they are not “real” doctors. Many main stream physicians say that holistic physicians are not true scientists or “real” doctors. To study trauma and to treat people who have been traumatized is often not popular. Even amongst holistic doctors, energy healing is often seen as a fringe field. You would think by now I would be comfortable with an outsider role, but here I am finding myself desperately wanting to fit in and to be accepted. Yet this is problematic because I am a restless, outspoken American who has high levels of professionalism and ethics, who believes that holistic medicine means looking at not just the holistic dimensions of a particular patient, but also the social context and the context of the health care delivery system. Additionally, it seems almost impossible for me to shut off the part of me that wants to make things better when I come across a problem. (I suppose the cultural critique of this last issue could be that I go around looking for problems instead of seeing the strengths in a given system.)

I guess this desire to fit in is always a part of me. In some ways, this experience of moving to New Zealand and practising psychiatry reminds me a little bit of that strange cultural soup of high school, where kids were continually forming, remaking, and revising identities and social structures. I can remember desperately wanting to fit in while at the same time rejecting and disdaining many of the shared cultural values of a small high school.

I guess I’ll close this blog with a few queries. How important is it to be accepted by a group? How important is it to be true to your inner self and your personal ideals and ethics? How does one balance the rules of the group with the drives of the individual? How does one find a place in the collective world, while at the same time following their own unique path? How does one come to terms with the fear that they may not fit in anywhere in the world? Is it possible to be one’s self without becoming isolated? Is it possible to fit in without blindly conforming? Is being an individual and being an accepted part of a group a tension that can be transformative as well as potentially destructive

The Benefits of Being Lost

Posted on October 9, 2010 by davidrkopacz

I just finished reading Rebecca Solnit’s book, A Field Guide To Getting Lost, and it deals with some themes I have been thinking about lately. Her book is a series of loose meditations on different aspects of becoming lost and of what a person can find out about themselves in the process. Whether it is about getting lost in the wilderness, being an immigrant, losing oneself in a time or place, losing oneself in sex, drugs, and rock and roll, suicide, or about various species of animal going extinct or coming back from the edge of extinction, the book explores the inevitability, costs, and consequences of becoming lost.

What I have been thinking about, and probably why I was drawn to the book, is about choosing to move to a new country for the experience of it and then finding the experience really challenging.

On the one hand I am daily excited and really enthused by the clinical work I am doing. New Zealand, Auckland, at least, is a place of immigrants and immigrants all have stories of leaving, losing, and finding.

This week, I met with a client from Central Africa, and another from North Africa. I had a Maori client who felt that one of his medications, the one that he said worked the best for his psychosis was also associated with a curse that caused him to “stargaze.” I met with a Pacific Island woman and her family and looked at the reasons why she had stopped most of her medication, what the medications were supposed to do, and how we might come up with some compromise of medications that would treat her psychosis, but would have acceptable side effects. I met with a New Zealand European client and her family and discussed her reasons for stopping her medication, that she felt the medications controlled her (and she was on a combination of sedating medications that I never would put someone on) and how she felt she couldn’t travel like her friends were doing, because of the restrictions of being on medication (sedation, need to be on it or become psychotic, the logistics of trying to get prescriptions abroad). With her, we looked at how sometimes when you accept your limitations, they actually limit you in your life less. That is quite a paradox. With the woman from Central Africa, she came from a lifetime of war and lawlessness and it will be quite a challenge to figure out if her paranoia, which has at times crossed over into psychosis, is really a reaction to her past trauma and her recent relocation to a country in which she doesn’t speak the language, or if she is really developing a psychotic mental illness. Another client spoke about how they would be alone here in New Zealand, or they would be alone if they moved to the country where their spouse was working, and they would be alone if they moved back to their country of origin.

On the other the hand, I realized that this is the worst job I have worked in as I look back at the seven jobs I have previously had since graduating residency. The orientation has been terrible. The mismatch between my expectations & the jobs expectations and how the structure of the job seems to do everything it can to frustrate meeting expectations. I feel like I am working hard all day long, but that I am pulled in so many different directions that at the end of the day I am exhausted and feel like I haven’t hardly done anything.

I understand, logically, that wanting to do something completely different means that I will not be doing the same old, comfortable thing. But sometimes, this all seems a bit ridiculous and I long for the good old days when I had some control over my professional life and I could feel good about getting some work done in a day.

I haven’t made the case yet for the necessity of becoming lost at times throughout one’s life, the need for that seems pretty obvious, at least to me. I understand the saying, that if nothing is lost, nothing is gained. However, many of the above clinical stories show some of the dangers of becoming lost and staying lost. I suppose psychosis, from a psychological perspective, is another way of becoming lost, losing touch with reality and getting stuck in a self-referential world in which one’s fears become self-fulfilling prophecies.

What Solnit’s book helped me to see is a deeper understanding of the double-edged sword of getting lost. I don’t think she really looks so much at the reasons why getting lost is necessary in life. It just seems like a given in the book. What the book does look at is the hard work and energy that goes into becoming lost in the first place and then in making sense of it in the second place. It is a serious book, but not a hopeless one. The book seems to honor the need and the process and the benefits of being lost without becoming too Pollyannaish or “therapeutic.”

Solnit mentions the early 1980s post-punk band from Manchester, England, Joy Division. There is a page or two devoted to the band, the environment their music grew out of, and the atmosphere that the music created. This last week, I went to see the bass player from Joy Division, Peter Hook, and a new band of young punks, recreate the album Unknown Pleasures, for its 30th anniversary. The other two original band members weren’t there. I wasn’t sure what to expect of the show. On one hand, I didn’t want to have an experience that lessened the original album and band, but on the other hand, I was really curious to hear what it would be like and to experience that music, that I had listened to over and over as a teenager, performed live. The technical sound of the music was incredible, it had the old effect I remember from the past of a dangerous and powerful current and how it has the effect of opening up strange, wonderful, and unsettling places within myself. (Although I think Cries and Whispers, honestly, at least in my memory, did better covers of Interzone and Day of the Lords). Listening to this music born in Manchester, that I had lost myself in while in my basement room in the Midwest of the United States, performed in Auckland, New Zealand, was amazing and unsettling.

Solnit writes in her book about book that she had conceptualized but had never written. It reminded me of the writing I had done on Joy Division, as well as other topics, for a book I had planned. The idea for the book was to look at the lives and work of people who had experienced some form of trauma in their lives and then addressed trauma in some way in their creative work. The chapter on Joy Division was to be called, “Trauma and Transformation in Punk Rock.” As I was recently thinking about this, I realized that I was working with some of the same themes about the dangers and benefits of becoming lost. I realize that the work I had done was not lost, because I am still working on the themes. I remember a Carl Jung quote that said something like, people don’t work on many themes in their lives, rather, they work on one theme from different perspectives.

The ways in which I currently feel lost are that I am having trouble seeing how I fit into the larger system of health care in New Zealand. The clinical work is challenging and rewarding, but how the community mental health centre I am working in will come through its own transition and what role I will play there is a big question. I have never had this much difficulty adjusting to a job. Many days I feel like the structure and system of the job is designed to prevent me from doing the clinical work that I know how to do.

I realize that the place I am working is in chaos and transition, but the overall New Zealand health system also seems lost in a way. Of the 50 spots for psychiatric trainees in the country, only 10 spots were filled last year. This year, the district health board I work for only has one new psychiatric trainee starting for the year, out of 10 positions. 40% of all physicians in New Zealand are from overseas. New Zealand is experiencing a steady brain drain of physicians going to Australia where they easily make 30% more for the same work which is probably not in a setting of continual strain and loss of staff. Even if my specific job sorted out, I would be unsettled by these larger trends. I knew of some of these issues before I arrived here, but I had no idea how dire the situation was. It seemed like this would also be an opportunity for creative ways of working and providing care, but the system seems incredibly apathetic and has incredible inertia that seems difficult to shift.

This reminds me, in a way of the US financial crisis, in which the people who seem least able to solve the crisis are the people in charge, because they are the ones who are the architects of the crisis. As Einstein said, you can’t solve a problem using the same tools you used to create the problem. You have to lose the old tools and step into the unknown of developing new tools. To an outsider, the situation the New Zealand health care system is in looks critical. While people get upset about little things with the system, no one seems to be revamping the whole system.

One thing that I am frustrated to have lost is the canvas on which to work – in my private practice, I could change things and develop new things as the need or mood would arise. Now, I have to ask permission from a system that is often apathetic and unresponsive. I have had a few experiences of putting a lot of energy into something that either goes nowhere, or the plug is pulled on. I am used to being a creative, hard-working, and conscientious person and sometimes these things seem to be either not culturally appropriate, or at least not supported within the local system. These are things that I know I can’t change or ignore within myself. The current system where I am working seems to require a tremendous amount of energy to function and in its functioning it seems to put energy into trying to make the system not function. I often feel like I am spinning my wheels and putting in a lot of energy with very little to show for it at the end of the day. I am also spending a tremendous amount of energy trying to figure out what is the local culture of the mental health centre (which almost everyone in and out of it admits is not functioning well) and what is the culture of the larger New Zealand health care system.

My observation about a dimensional difference between the United States and New Zealand is that in the United States, work is often very systematized and there are policies, procedures, and protocols. This is something that I have seen the dark side of in that the humanness of the individual physician and patient is often lost to the needs of the functioning of the system. Scientific, “evidence-based” medicine, also plays into this dehumanization and overly technical systematization of the doctor-patient relationship. The good thing in the United States is that things get done effectively and efficiently. The question is whether the things that are getting done are doing any good.

In New Zealand, there seems to be more of an Old World who you know instead of what you know. The “system” seems to function on the basis of individual relationships more than on policy and protocol. I have tried to banish the 4 P’s from my vocabulary: policy, procedure, protocol, and process. Things seem to be done the way they are done or the way they have been done and if there is a deviation from this, there is often a sense of floundering in the abyss, rather than an organized approach to system development and change. There is a manual that I see on a shelf at work entitled, CAOS. I fantasize that it is the English spelling of the word, “chaos,” but I haven’t worked up the nerve to look at the manual to see if it is for creating chaos or managing chaos.

New Zealanders really seem to despise anything negative being said about their country. There is the phenomenon of the “tall poppy” and “cultural cringe,” here. The “tall poppy” refers to New Zealanders trying to tear down anyone who dares to do something out of the ordinary or to stand above the crowd. Presumably this comes from a culture that is very collectivist and group oriented. The effect is a culture that creates mediocrity rather than fosters individual self-expression and creativity. I was reading an interview with Jemaine from Flight of the Conchords, and he was talking about “cultural cringe,” which is similar phenomenon, in which anyone who becomes popular or does better than others at something evokes a cringe and negative reaction from the culture. For instance, he says his popularity in the United States is dismissed as “Americans are idiots, so he can’t be that good.” I wonder if I am running into some of this attitude here as well. I know that there is a stereotype of Americans being clueless, self-centered know-it-alls, and I try to be sensitive to this, but I also know that it won’t work for me to try to be apathetic and mediocre.

In some ways, New Zealand seems like a culture that has lost its external referents, but hasn’t found itself. There is an official policy of Bi-culturalism here, based on the Treaty of Waitangi, which recognizes the countries responsibility to maintain Maori culture, the people who were the first human beings to colonize New Zealand. However, I have come across some comments that the New Zealand Europeans either don’t have a culture, or that their cultural identity is still with the UK more than with themselves. There have been debates in the newspaper whether or not New Zealand should become a republic after the current Queen of England is gone. Many of the arguments for keeping the monarchy over New Zealand seem to arise from a desire to be defined from someone and someplace else.

A friend of mine was talking about when her ancestors came to New Zealand in the mid-1800s and how her identity and much of New Zealand’s identity is still from the UK. I found it interesting that her relatives had come to New Zealand decades before many of my relatives, and yet I had a more of an identity as an American than she did as a New Zealander.

There are many ways that cultures work through being thrown in contact with each other. History shows that cultural interaction tends to enrich a culture more than any drive toward cultural purity or superiority does. The enriching interactions of different peoples and different ideas seem to be far more leavening than a lot of a single ingredient. (In fact genocide or discrimination seems to be how many of the single ingredient recipes work out). People seem to have different attitudes towards difference. Some don’t want one food to touch another on their plate, whereas others find mixing everything up to be more enjoyable.

The mixing of peoples and cultures is one form of change and this change is an inevitability. New Zealand is importing 40% of its physicians and that will change the culture of the medical system here. New Zealand, maybe more than any other place colonized by Europeans, is founded on a contract and treaty, that is still living, between two very different cultures, the Maori and the European colonists. Now New Zealand is opening up to refugees from all over the world and also many immigrants from Asia and the Pacific Islands. There are now more Pacific Islanders in Auckland than on some of the original islands. The United States went through the typical colonial exploitation of native peoples and is now struggling to make sense of the influx of Latino immigrants and Latino culture.

How this mixing, in New Zealand and the United States, and intermingling is handled will determine what is lost and what is gained. You cannot go to another country without losing something and gaining something. Similarly, a country cannot have an influx of new immigrants without changing in some way, and all change entails loss and gain. Maybe it is each individual’s and culture’s attitudes toward loss that determines the outcome of cultural interactions and the change that inevitably comes from it. On an individual level, maybe one’s attitudes toward loss and being lost determine what will eventually be found.

The Up Side of Burn Out

Posted on September 23, 2010 by davidrkopacz

5 of the 9

While most people think of burnout as a bad thing, maybe it is not always that bad. While burnout can lead to apathetic withdrawal and an acceptance of the status quo, it can also be a turning point where one decides that they are no longer going to put their energy into a system that is not functioning and resists change.

synthesis

I suppose you could map out the stages of burnout and I am sure that someone has. I suppose it could start with enthusiasm, idealism, active coping and problem-solving, then frustration, confusion, and then finally a kind of withdrawal from the situation while at the same time plodding along. Complete burnout might not be that great of a thing, but maybe some of the earlier stages can be useful in overall adaptation to a situation and also as a means to achieve a radical reorientation to a situation.

What do I mean by this?

I’ll give an example from clinical psychotherapy. Often times a clinical stalemate or equilibrium can happen, in which not much change happens because both the client and the therapist hit a comfortable way of dealing with or avoiding discomfort. In trying to be “nice, supportive, and understanding,” for example, a therapist could be contributing to and maintaining a pattern of interaction which actually resists change and insight. It is only on that bad, stressful day, when the therapist, often for other personal or professional reasons, can no longer maintain the facade of “niceness” and loses their temper, or in some other way breaks the equilibrium of the therapy, that at this point, something new and interesting and more real, open and honest can emerge. It is in the aftermath of this “failure of empathy” that real gains in understanding may really become possible.

Maybe this can be similar for dealing with a dysfunctional system. Maybe it is only at the point of burnout, where one can no longer handle trying to be polite and helpful and conscientious, that at this point, one can no longer put energy into a situation that is really not working on many levels. Maybe burnout is not all bad, as long as it doesn’t lead to complete withdrawal and nihilism.

journey

journey

An interesting thing happened today. I was feeling really upset and angry and I flicked off the light switch at work, feeling like I just had to get out of there, and “POP” the overhead fluorscent light bulb blew. I thought, man, I must be pretty charged up about this. I flicked the light switch again to see if the light would go back on and “POP” the other bulb blew. Man, it was time to get out of there.

Tomorrow, I will request new light bulbs, and I imagine that when I get them in a few days, that if nothing else, new light will be shed on my situation.

generator

Better, Different, Worse

Posted on August 29, 2010 by davidrkopacz

The Orientation Reflex

In moving to a different culture, one encounters many things, some familiar, some similar, some different, and some exotic. To orient oneself, there is a natural tendency to like what is familiar and to dislike what is unfamiliar. Even in a state of adaptation to a culture, under stress, one reverts to learned behaviours. For instance, if you grew up driving on the right side of the road and are learning to drive on the left side of the road, and you hit some panic or disorientation, there is a tremendous drive to go back to what is familiar and over-learned, the right side of the road. This orienting reflex is similar to what Laurence Gonzales writes about in his book, Deep Survival, when he describes the human tendency to respond to the known, even when one realizes that one is in an unknown situation. In a life and death situation, responding as if the unknown situation is known can be a fatal mistake. What Gonzales describes could be seen as an example of the orientation reflex, an attempt to apply a mismatched response to a situation that is causing disorientation. The stronger the sense of disorientation, the stronger the orientation reflex.

The orientation reflex could be seen as a form of psychological defense, although I am not sure that really does it justice. A defense is a fixed psychological state in response to a challenge or stress from the environment. There are differences in opinion as to whether a defense is always a distorted reaction or whether it was perhaps a valid reaction at one point, but is now no longer valid because it is out of date, from an earlier time in life, and therefore immature when compared to one’s present abilities. Either way, the orientation reflex is a mismatch between the current environment and the over-learned behaviour. The question is how to resolve the mismatch or whether to live with it.

In life and death situations, like Gonzales describes in his book, the orientation reflex can lead to death. Similarly, in trying to drive on the left side of the road, the orientation reflex could get you into a lot of trouble and maybe even get you killed. The challenging question arises in situations that are not life and death, but rather socio-cultural interactions between individuals with different over-learned behaviours or different orientation reflexes. At a certain point, if you are living in a different culture, you end up hitting a place where your sense of self and your orientation reflexes come into conflict with the host culture you are living in. At this point, the question is do you change yourself, do you adapt to the new host culture. The vast majority of people will choose to adapt somewhat, but it is a spectrum and people may find that they are comfortable with different places along the spectrum.

At the two extremes of the adaptation spectrum are the choice to not adapt at all, but rather to concretize one’s own culture and orientation reflexes, and at the other extreme, to fully adapt and blend with the new culture and to leave one’s previous sense of self and orientation reflexes behind (“going native”). The really challenging thing is that a person’s sense of self is also made up of these automatic orientation reflexes, and that to change these reflexes requires at the very least to re-wire your brain, so to speak, or to make major changes in your sense of self.

One simple way that a person can respond to a new culture is to break down everything that is not familiar into the categories of Better, Different, or Worse. In a very real sense, everything that is not familiar in a new culture is Different. (Of course, even some of the things that seem similar could turn out to be different and this could be some of the most disorienting cultural interactions). Some of the things that are Different, may then be judged to be either Better or Worse. If someone voluntarily moves to another culture, there must have been at least some aspects of that culture that were thought to be Better than the culture being left. Even if one claims to just be seeking Different, I would guess that there is still a drive to find Different Better.

It may seem to not be politically correct to say that another culture is Better or Worse than another. I for one, do not believe that statement to be true. Part of being Different means that some things may just be plain Different (driving on the left vs. driving on the right), whereas other things may be Better or Worse. Even to go back to the old dimension of cultures being somewhere on the spectrum between Individualist and Collectivist will mean that certain cultures have more individualist strengths (such as a strong sense of self separate from the collective) and others will have more collectivist strengths (such as strong in-group and family bonds). A culture in which bribery is common could be said to be Worse – in that dimension – than a culture that does not have bribery.

In looking at cultures as having different strengths and weaknesses, different values and preferences, it follows that certain cultures will have different things that they do Better or Worse than others. Admittedly, to say that something is Better or Worse is to make a judgment from an outside perspective. Someone who grew up in a culture in which bribery is the way to get things done may very well think that is the best way to get things done, from a moral relativist position, it can be difficult to make any judgment of anyone or anything at all. However, there are certain elements of mutually agreed upon realities. Most of the people of the world would probably agree that torture, deceit, unfairness, cruelty, and discrimination are Worse than the opposite, or at least the attempts to have the opposites of those qualities.

On one level, there is this universal level where most people would consider something Better or Worse. Are these stereotypes or do stereotypes have an element of truth to them. Are the French Better cooks and the Germans Better engineers? Is it true that French culture places a higher value on good food and good living and German culture places a higher value on structure and order? Is it true or false that American culture is Better at some things and Worse at others?

Lately, I have found myself using this heuristic of breaking down challenging cultural situations into the Better, Different, Worse framework. I try to always remind myself that the reason something is disorienting is that it is Different. I hold off judgment as to whether something is Better or Worse until I have been able to have a series of situations in order to see some kind of larger pattern. Even once I decide that something is Better or Worse, I realize that this is still relative to me and my values and I try to see how what seems worse could be the weakness of a strength in another dimension. For instance, it would be difficult to have both very individualistic and collectivistic strengths in the same culture.

I am still working out patterns in New Zealand culture and how these are Different than patterns in US culture. While I have the luxury of taking an anthropological approach in certain areas, in my job, I have to function as a professional in a system that may very well have different concepts of what is professional and ethical behaviour. I face the dilemma of having to rapidly decide in what ways to adapt to the culture and in what ways to hold to my professional orienting reflexes. This is quite a challenge.

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