New Article in “The Badger”

“The End of E pluribus unum?

The De-evolution of “Out of Many, One” to ME First!”

My new article in The Badger examines the national and international movements away from seeing all people as interconnected (as One) to the separation of nationalism, racism, and xenophobia (fear of the “other”). The motto of the United States on the Great Seal is e pluribus unum, which means “out of many, one.” However, more and more, we are seeing an attitude of “ME first” which promotes bullying and selfishness above our motto of seeing unity within diversity.

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A Few Words About Language

I just had the most amazing meal. A Reuben sandwich (rye bread, corned beef, Swiss cheese, dressing, and sauerkraut) with potato salad (red potatoes, skin on, the dressing was pinkish, as if slightly colored by beets) and iced tea with refills. This may seem mundane, but it is a combination that I haven’t had in New Zealand, for all I know, I may not have had a Reuben in two or more years. Even if I did have a Reuben in New Zealand, it wasn’t this way, names can be the same, yet the content and experience incredibly different.  I had this marvelous lunch at the Moonkiss Café in Waquoit, Massachusetts. Walking out of the café, I saw a small sign tucked into the flower garden that said, “PEACE.”

I haven’t been back in the US for about a year. It doesn’t seem like a country at war, but we have been at war for 11 years, now. We are fighting terrorists, mujahedeen, who were previously freedom fighters against the Soviets. The Soviets were hostile occupiers, but the US is spreading freedom and democracy and killing “others” with machines that are growing in intelligence and deadliness (drones – definition). There is no sign of war here and no sign of deaths that are happening elsewhere. Peace:  a wish, a protest, a religious statement, or political commentary. The flowers bloom, regardless.

I have just set foot on US soil after almost one year away. I have been up in Nova Scotia, Canada for the past two weeks. On the way there from New Zealand, I was briefly in Sydney, Australia on a layover. I had four country’s currencies in my pocket, which I thought was very cool, until I tried to pay for something and three of the currencies had the English queen’s likeness on them. Does that make me a global citizen or a bumbling, economic colonialist?

I was at the ALIA (Authentic Leadership In Action) conference, which I will discuss in more depth in another entry. Here, suffice it to say, I spoke with people from all over, mostly Canada, Quebec, the US, Barbados, Australia, and even New Zealand. The first thing that was strange is when I got on the Air Canada flight in Auckland. First I noticed one person speaking North American English, then another and another, suddenly, I was surrounded by people who spoke similarly to me, the Aussies sitting next to me were more the minority with their pronunciation. I didn’t realize how used to being different, in the New Zealand context, I have become. I had a weird experience in a Tim Horton’s yesterday, after already being in Canada for a couple of weeks, of having that feeling of needing to speak quietly so that everyone doesn’t know that I am American and then I realized that I didn’t need to change my way of talking, as there isn’t as much difference between Canadian English and US English, as there is between the US and NZ. Still, I would rather not stand out as obviously American in another culture. Sometimes in New Zealand, people think I am Canadian, I generally take this as a complement, based on the perception of the US in the world. So, I have learned to speak quietly, pronounce many words differently, and to make this kind of “um” noise and to say “eh” (or someone said I should spell it “aye,” but it sounds a lot like a Canadian, “eh,” eh?).

But then, there are those Canadiens from Quebec, with not just a different accent, but a different language. As New Zealand is bicultural (New Zealand European (pakeha) and Māori), so Canada is bilingual (French and English). In New Zealand, I worked hard to learn some Māori words and phrases. I learned some Albanian from my Kosovar friend. I have worked to understand and even say some words in different English accents. At the conference, I think one of the most beautiful words I heard was the Zimbabwean pronunciation of the word “here,” which sounds more like haeare, and it reminds me of my friend in New Zealand who grew up in South Africa and England, as he says haeare in a similar way.

One is at a distinct disadvantage being in a bicultural or bilingual country and not speaking the other language or understanding the other culture. There are complex dynamics around this. Sometimes it seems that those who speak “the other” language expect you to learn their language, but there is variability in whether or not someone teaches you their language. I don’t understand the Anglophone/Franocophone dynamics in Canada enough to comment. Māori culture in New Zealand is somewhat closed, it is more collectivist and tribal in orientation, which tends to have stronger ingroup/outgroup distinctions. There is also both a dual expectation that you are sensitive to and informed about their culture, but there are barriers to learning it as it is something of their own that is not easily shared. As an outsider bumbling in, there can be a feeling of discomfort, ignorance, being disliked (perhaps for one’s group affiliation – rather than one’s individual self), with the accompanying projection that the other is proud, arrogant, disdainful, angry, or perhaps playful, or maybe just seeing what a newcomer knows. What is behind this interaction, what motivates someone to speak a language to you that they know you do not know? In a bilingual country, a visitor could reasonably be expected to learn a few words in the host language. I admit it bothered me when Americans would use American currency in Canada (which I also admit, I did a couple of times near the end when I ran out of Canadian currency), why not exchange money?  So why not learn some French, I ask myself. Well, I did embarrassingly learn “come see come saw” which means something like “I am so so,” (Ok, I know it isn’t spelled that way, but I am not sure how it is spelled, just how it sounds).  I should learn some French, at least a few words out of courtesy.

I am listening to Stereolab right now, mostly English, but some French songs, although I have listened to this band for years, I don’t know what the words are to the French language songs. I like Jovanotti and I have looked up the English translation of some of those songs sung in Italian. Sigur Rós, I have looked up the translated lyrics on a couple of songs from Icelandic to English.

It was easier for me to learn to speak a few phrases of Albanian in New Zealand than Māori in New Zealand, why is that? I developed a relationship over some time with someone from Kosovo at the bus stop every morning, and it just seemed natural to want to learn a few phrases. Most of my learning of Māori has been from reading books and learning certain terms.

Language is a touchy subject, a difficult subject, it allows for connection, it can create clarity or confusion, it also can be used for disconnection. I know that it took me about a year, maybe a year and a half of having to activate a little more of my brain to translate accents in New Zealand – the place I noticed this the most was in jokes, I would often be about 10 seconds behind the joke before I would get it. Being in a different culture is an adventure and it also entails a degree of isolation and difference. I have written earlier on this theme shortly after arriving in New Zealand, particularly the dilemma of having a tendency to feel like an outsider and gravitate to the periphery in one’s own culture and then moving to another culture and being perpetually an outsider. I have met Americans who have been in New Zealand for years, and even though they pronounce some words like a Kiwi, they don’t speak with a Kiwi accent, only those who come at a young age seem to be able to do that. There is something akin to aural butter in hearing one’s own language and dialect spoken, of speaking to someone who has a familiar rhythm and tempo in their speech, it is kind of like the meal I had for lunch today – it was really good, partly because it was expected and predictable, the variations maintained the essence of the food, whereas in another culture the name is retained, but something about the essence just doesn’t feel like the food you are used to. And yet, for many people, there is a desire for newness, difference, a change of pace, a new perspective – but all things are in a balance, it would be good if I could explain that, but I cannot, other than to say that I have felt at times a craving for sameness, security, the expected in reaction to a temporary state of being overwhelmed by otherness.

So, what do I say, “I am culturally insensitive because I am an American, and that is in fact our culture and other cultures should be sensitive to that?”  I don’t think that will fly. I will need to learn at least some conversational French before returning to Canada. But for now, merde (second favourite French word), I must work on my idée fixee (favourite French phrase), and I bid you adieuMon Dieu, I almost forgot my third favourite phrase! I also like the French pronunciation of idiot, which is probably fortunate.

The Great American Dissatisfaction/Dream

On returning from a trip back to the US, I have several observations about the country and myself. I was struck by the sheer material abundance of the place and the feeling of dissatisfaction and lack in the people and myself. The solutions for this problem of dissatisfaction are generally material. Yet these material solutions do not fulfill the need or satisfy the dissatisfaction.

What is the American dream? Maybe that gives a clue to the dissatisfaction. It seems that that dream is of acquisition and/or improvement. The desire to “make things better” seems to be very American, and yet I am beginning to wonder if the impulse to make things better comes from an inability or difficulty in accepting what is. One often hears of “American ingenuity” as a source of innovation. At what point does change become a trap rather than an ongoing adaptation to the environment? I used to be perfectly happy with a razor that had two blades, but then it became harder to get refills for it, so I moved up to the new triple blade, and then it became more difficult to get refills for that, so I tried the quadruple blade, it seemed absurd, but I could no longer find refills for the triple blade. Now I just bought a quintuple blade razor and I feel manipulated by the razor blade companies.

It is instructive to look at the dissatisfaction as the flip side of the dream. This is one principle I feel that I have gained from living abroad for a year, that every culture creates itself according to its values and that the drawbacks or blind-spots of a culture are the shadow of its strengths. In this way it is not so unusual to examine strengths and weaknesses in relation to each other. The United States values efficiency, innovation, and the pursuit of happiness. These facets have made the US a very productive, powerful, and creative force in the world, but is there a point where these strengths are over-developed and we have an impersonal society in which people are processed in a quick and efficient manner (I am writing this after having just got through the check-in and security at O’Hare airport where I had to take off anything metal, take everything out of my pockets and go through a “backscatter x-ray” machine for my “safety”). We have bewildering choices for everything from razors, to toothpaste, to blue jeans, and yet are we, as a people, happy or fulfilled?

The dream is for more; the dissatisfaction is that what we have is never enough and that things could always be “better.” On my last day in the US, Borders bookstore was closing. It was very sad to step inside and see the giant signs, “EVERYTHING 40% OFF,” the long lines, and the sense of good deals to be had. We left almost immediately. To me, this felt like the end of an era. While it is true that Borders was a business and it was about acquisition, it was also a place that created a social place that people could meet, that you could check out new books and ideas. Borders wasn’t my favorite place to go for coffee, community, and new ideas, but when I lived in Champaign, I did go there fairly regularly, maybe every few weeks. It was a place to go before or after a movie to talk and browse, or a place to go and read a book, but to also be in a public space that contained the possibility for socialization if I ran into a friend.

The space shuttle also landed for the last time on my last day in the US. This also seems like an end of an era of creativity, dreams, exploration, and innovation. This collective work led to many new scientific discoveries and a common purpose and focus for the country and the world. As the movie, “In The Shadow of the Moon,” showed, it also led to a change in the way that we, as human beings, see and experience the Earth. It was a chance to have an awareness that we are all part of something larger than ourselves and that what happens to one person has the potential to affect everyone.

In the development of ideas, there is often a point where the fullness of the idea is reached and nothing much new is discovered or created (although there can be endless variations on this, like the many new psychiatric medications that are not significantly different than the medications already in use). The idea becomes sterile, the work technical and tedious, and the benefits and results more meager and less gratifying. It seems possible that the United States is at that point. Are we using our creativity, our ingenuity, and our ability to design efficient systems in such a way that the pursuit of our dreams only leads to dissatisfaction? If that is the case, the more energy we put into the pursuit of our dreams, the more unfulfilled and dissatisfied we become. We buy food that does not nourish or gratify, but it is efficiently made, conveniently packaged, and it looks good. We buy bigger and bigger TVs and home theater systems, to give us a more convenient and efficient way to watch movies in isolation from other people. We can download anything we can imagine, and yet our imaginations are unfulfilled.

I have had a couple of recent conversations with people about the Buddhist concept of “the hungry ghost.” What I can remember about these creatures is that they have tiny throats and insatiable appetites; they eat and eat, but are never satisfied or fulfilled. The restless consumption of US society does seem reminiscent of these creatures who only dream of consumption, yet they are never nourished.

Much of the efficiency of American culture seems to neglect nurturance, which is an aspect of fulfillment. For all their conspicuous consumption and discharge of the acquisitive drive, there is an emptiness, dissatisfaction, and persistent hunger in American society. Coming from abroad, the US seems filled with busy people, impatient, in a hurry, irritable, restless, self-absorbed and a little bit like locusts consuming mass quantities of goods and food in a way that is not only not fulfilling, but is also not sustainable.

New Zealand: One year on

It is hard to believe that it has been one year since we moved to New Zealand! So many ups and downs and sideways…  

We arrived back in the US for our first visit back to the Midwest, so we were actually in the US on our one year anniversary of our arrival in New Zealand. It seems fitting that I reflect on the last year at this point.
New Zealand: One year on

The predominant feeling I have about the move is one of gratitude and happiness for having made the leap. It has been an incredibly exciting year, as well as being very challenging, and a year of intense growth and reflection. My life feels so amazingly and irrevocably different from the experience of moving to another country and working there. Even my first job, which in the end, wasn’t the best fit for me, was an incredible learning experience that taught me a lot about the culture and about the public health care system in New Zealand, plus I met a lot of great people. My current job at a psychiatric rehabilitation centre is one of the best jobs I have had in my career and is a place that I can see continuing opportunities for growth.

I feel like I should be able to provide some general statements about my year in New Zealand. I would say that I have a greater appreciation of any culture (US, NZ, and in general) has both strengths and weaknesses. Every culture has different inherent values and once those are understood, the culture makes more sense. US culture values efficiency and consumption, thus banking, shopping, commuting, and work systems run very well, yet the downside is that they can be cold, callous, and impersonal. NZ culture seems to value connection and quality of life, thus relationships, even casual ones, can be more open, nurturing, and personal, however, organizational systems can be disorganized, “unnecessarily” complicated, and inefficient. These are broad generalizations. I can’t say that I have an in-depth understanding of NZ culture(s), but I can say that this appreciation of cultural differences in reference to an organizing value or principle seems true.

I do feel that what I wanted to get out of a move abroad, I have gotten and more so. The process has been uncomfortable and painful at times, but it has also been exciting and rewarding. I feel that I have broadened my view and experience of myself, my practice, and the world, and this is incredibly gratifying. A good decision is one that seems to make more sense as time goes on, and as you live it, and this is how it has been for this move. I do feel that the particular cultural adaptations that New Zealand requires are good challenges for me personally. As my wife and I talk about the future, we really aren’t sure that we know what we will do in 2 years’ time (which is our point of decision for whether we stay in NZ longer, go back to the US, or look at other options), but we both feel that we are where we need to be right now.

Full Circle

FULL CIRCLE

I had a really great day today. I am currently at the American Psychiatric Association meeting in Hawaii. I feel like a lot of my professional life has been a critique of the mainstream of psychiatry, whether it has been studying psychotherapy (which according to a lecture today has “always been subversive,” because it challenges people’s understanding of themselves, their relationships, and it challenges the status quo), learning about trauma and bearing witness, or moving outside the confines of psychiatry into holistic medicine. The thing about living a critique is that it can start to get lonely, because I seem to continually question the fitness of the different treatment/personal growth philosophical systems that I put myself in. It is kind of like the dilemma of trying to find a group of people who don’t fit in and who form a community of “misfits.” Looking around at the conference today, I felt that old desire to be part of the group while also finding fault in the limitations of the dominant, evidence-based paradigm. I was slightly envious of the people who seemed to have built something in their lives over time as I compared myself to them. The thing with continually being open to new ideas and practices is that there is a risk of ending up intellectually homeless and unrecognized, another way of saying that I felt outside of the circle. With my recent move to New Zealand, I have faced this dilemma of wanting to fit in, but also wanting to follow my own passion and my own ethics and idealism.

FULL CIRCLE

Yesterday, I had this realization. I won’t bother putting it into words, it would sound incredibly simplistic, anyway, but it was just this felt sense of connection and meaning, even if I wasn’t feeling a clear sense of purpose. That is when I thought about blogging on the topic of coming full circle, which can mean so many things at so many different levels. On this trip, I brought along Maugham’s, The Razor’s Edge, a book I read a lot when I was in college and medical school. In some ways, the book is important and in some ways it is not, what is more important is re-connecting to things that I was interested in the past, and more important than intellectual things I was interested in, it was about connecting to the feeling of who I was when I was younger and what was important to me, including questioning, searching, and idealism. I had this sense of meeting an old friend, only the old friend was my younger self.

Part of what I was going to write about was a critique (or maybe just another chapter) of my article for PrivatePractice.MD, “Say Yes to Private Practice,” that I wrote as I was leaving private practice. I referenced the movie, “Yes Man,” which I just re-watched again when it was on TV. In the movie, Jim Carey’s character turns his life around by saying “yes” to every opportunity that came along. His life opened up and changed and became more rewarding when he said “yes,” and it closed down, became painful, or problematic when he refused to say “yes” to a new opportunity. In the movie, he hits a peak, though, in how useful this way of living is, everything starts to fall apart as he realizes that he can’t build a relationship if he is constantly saying yes to other things. He comes to learn a more sophisticated way of using this attitude, he learns to say yes only to things that he really, in his heart, wants to do. It isn’t about saying yes to everything, although that was a useful stage that helped him get unstuck in his life, but he learns discernment in choosing to say yes to what he is really passionate about. So that is where I have been feeling like I am lately, that I am at that point where I need to be more discriminating in what I say “yes” to, particularly after my first job in New Zealand where I feel like I burned out after about 2 months in the job and I took on a lot of challenges that were bigger than my own interests.

So, that is what I was going to write about, how I had so much growth in my life through saying “yes,” but that it was time to start reining all that in a bit and to start being more discerning in what I put my energy into and making sure that I am not just doing what needs doing, or jumping into an opportunity, but really practicing discernment and making sure my heart was in whatever I take on in the future. That said, today I had two really cool synchronicities that happened only because I said a few chance words. It was like the old accidental networking (which is what I used to call it) kicked in again. Things started to make sense, I felt more connection, more trust in myself and the universe. I think I won’t write about the actual events, the process is more important anyway. I will talk some about coming full circle, though.

FULL CIRCLE

I imagine that as a person goes through life, they have various circles that they go through. For one thing there is the grand circle of birth and death, that is really the foundation of life, I suppose, it is the most basic and incontrovertible fact. There are other circles, too, though.  For me, I just went through a training so that I can supervise psychiatry trainees in New Zealand (registrars, or what we would call residents in the US). In looking over the supervision pathways, I mentioned that I had done a lot of psychotherapy training, enough so as to be considered to have done a sub-specialty in it in New Zealand. So I mentioned it, and now I am also a psychotherapy supervisor and I already have been assigned my first registrar. Being at this conference also helped me to get excited about the role of psychotherapy in psychiatry. It is tending to get less and less attention and some training programs are even questioning whether it should be taught, but to me, it provides the humanitarian and ethical counter-point to guideline-driven medication management. I have also started doing some psychotherapy at my new job, whereas at the community mental health centre, it really wasn’t part of the work (at least not in a formal and in-depth way) and there were always so many patients that needed to be seen.

Here is what I have to say about this whole full circle thing, it can sometimes feel like you are going backwards when you are really just circling back to some important point in your life, from which you will venture off into another circle. I think of my colleague, Patte Randal’s, diagrams she uses in her work, making the distinction between “vicious cycles” and “victorious cycles.” I guess it is hard to know which kind of circle you are in sometimes. Looking at myself and my life, lately, I am amazed at how intensely I have felt that I am in the depth of either a vicious or a victorious cycle. That struggle and self-analysis, and self-critique, and continual striving to try to get from one kind of circle to the other has really been wearing me out lately. I guess that one way I can describe my realization, from yesterday, is that I am in both circles at the same time. Maybe anytime that I am feeling like I am just in one isolated circle, I will always feel lost and desperate and like the energy I am putting into my life is not going anywhere, building anything, or connecting to anything larger than myself. All circles are parts of other circles. I remember a painting I did called, “There is No Perfect Circle.” It had a bunch of lopsided circles on it that I kept trying to redraw to make “perfect,” finally, in exasperation, I wrote, “there is no perfect circle” on it and that seemed to complete something at the time.  ut, I suppose it might be true to say that every circle is perfect, that every circle is an interpretation of what it means to be a circle and all circles are manifestations of some kind of circle energy or circle template, and in this way, there is an inherent connection between all circles. And, then, I suppose, maybe life is all about continually drawing and re-drawing these circles and seeing how they interconnect and repeat and create things that seem entirely new, even as they might also seem totally commonplace. 

Getting back to Hawaii, the little bit I have seen so far is beautiful. I have met some really friendly birds and I’ll post a few pictures of them. I am trying to go swimming in the ocean every day, so I better circle back to hotel and the beach and go for a swim.

FULL CIRCLE

Considering Identity and Culture

“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.

Facing Fear

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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.

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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.

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Fitting In and Not Fitting In (revisited)

FITTING IN AND NOT FITTING IN (REVISITED)
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.
FITTING IN AND NOT FITTING IN (REVISITED)

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.

FITTING IN AND NOT FITTING IN (REVISITED)

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.

FITTING IN AND NOT FITTING IN (REVISITED)

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 (REVISITED)

Making Things Better or Accepting Things as They Are?

Some artwork from the first 5 months in New Zealand

I suppose it is not fair to put this as a forced choice. I imagine there is some sort of yin and yang balance of a time for improvement and a time for acceptance. As an American, I know I can really get caught up in having the restless optimism to make things better. Americans don’t always have such a great track record in regards to the outcome of their attempts to make things better. Many of the wars we have fought in the past 60 years are the examples that come to mind. Also, I just read that the US government is starting several different law suits against BP and related companies for the oil spill damage in the gulf. I am sure that on some level presidents, congress, military professionals, and the general American public thought that war was a good way to make things better. I also imagine that in some way, all those oil executives imagined that there was some good that would come out of their decisions surrounding any decisions that led to increased risk regarding deep water oil well drilling – whether it was simply more profits, helping their investors, supplying cheaper oil, or helping to keep the world flush with oil.

Since moving to New Zealand, I have routinely found myself struggling with this question of should things be better or should I accept things the way they are. There are many things I have come across in business, safety, health care, and many organizational issues that would just not be tolerated in the United States, but here people don’t seem to get too fired up about them. There seem to be different cultural standards about how much can be changed, how much should be changed, and how much things can be accepted and how much things should be accepted. A 27 year old nurse died recently when she was riding her bicycle just a short ways from where we live. There are bicycle lanes on the road, but they are shared transit lanes for bicycle, motorcycle, bus, cars with 2 or more passengers, and even car parking. Some places along the road, there are separate bicycle lanes, but other places they seem to merge into this shared transit lane. Is it acceptable that 27 year old nurses die riding their bicycles on a supposed cycle lane? Is it an unavoidable accident, or is it a failure of planning that has created a dangerous situation. Should this be accepted or should there be an attempt to make the cycle path better?

I rode my bicycle for the first time in New Zealand this week. It was a short ride, less than 30 minutes. I rode past the place where the 27 year old nurse died, but I didn’t ride on the street. There is also a side walk bike lane. The side walk is painted down the middle and half of it is for pedestrians and half of it is for bicycles. It requires a lot of concentration and stopping and starting to ride on this off-road path, even at 6 AM. Groups of runners go 4 abreast and block the bike lane, people with their i-pods walk in the bike lane, you have to be aware of people walking their dogs so they dogs don’t get in the bike lane. Still, I’d rather have to slow down and ask people to move out of the way than be dead. I don’t really think that the on road bicycle lane is that safe and unless something major is changed with it (it is made better) I don’t think I’d ride in it.

Obviously, it is a good thing to make some things better. Obviously some things should be accepted as they are. I suppose that with a lot of things, you don’t really know until the dust settles whether or not it was a good thing to tear down that wall. There are other things that most people could say will not turn out well. Most examples of introducing some new species to make a problem better end up not working well, because the environment has so many complexes interlocking levels. Also, there are some things that you see and you just have to give it a go at changing them.

Maybe it is just because I am an American that I am constantly looking at the world, the businesses I interact with, and my job, and saying “how can this be made better?” Maybe it is really a culture clash in which I am putting my beliefs on other people who are perfectly happy to have things run they way they are. Maybe I shouldn’t get so worked up about a patient’s electronic notes being completely intermingled with another person’s notes who has the same name, or about a couple of pills of psychiatric medicine on the floor of a staff car, or about a client having a misdiagnosis, or about what seems like a tremendous waste of human potential with people sitting in meetings that have nothing to do with them or in a lack of efficient systems so that people spend big chunks of time doing things that could be stream-lined. Maybe all this is because I am an American Colonialist who wants to impose my “better” ideas on another culture. Maybe it is because I was born with something like 5 planets in Virgo and Virgos are driven to be service-oriented people concerned with self-improvement and improving things for others.

Sometimes I think about Paul Theroux’s book, The Mosquito Coast. In that book, Allie Fox seems like a restless American visionary. He is critical of the government, of people’s complacency, laziness, and blind acceptance of what they are given in a consumer-driven culture. To me, he starts off as a totally sympathetic character, a restless philosopher and mechanic, a practical dreamer. He takes his family to the Mosquito Coast in Central America. He works to make things better for the “natives.” He makes better houses, he tries to improve farming and food preparation, and he introduces civilization in the form of ice and refrigeration. Somewhere along the way, things start to go awry. What at first looks like selfless exercise in improving his family’s and other’s lives starts to slowly slip into a dangerous ego-trip that endangers the lives of many people and destroys the natural environment. As Allie Fox lies wounded in the bottom of a boat, asking his family, “are we still heading up stream,” his family lies to him and says, yes, as they head downstream and back to civilization. A cautionary tale about the restless desire to make the world a better place.

I remember a random psychotic man I met at a library in Edwardsville Illinois. He came up to me and asked, “Would you change the world if you knew how?” It was an interesting start to a conversation that had many interesting elements about John Stuart Mill’s philosophy, before it started to devolve into a paranoid rant in which this guy seemed to think he knew how to change the world, but that he would be the “child genius” and he needed a bunch of workers to do the heavy lifting of changing the world.

Many spiritual disciplines focus on acceptance. Sometimes Buddhism and Hinduism are critiqued as being passive and fatalistic. Classical Taoists, like Chuang Tzu and Lao Tzu teach that you are better off enjoying your life (running around like a weasel or a wildcat until you drop dead or are caught in a trap) than trying to improve your life or improve others or even to participate in the courtly society of China at that time. Better to be happy and alive, like a gnarled old oak, than useful and dead, like a sturdy, straight tree that would be great for lumber.

How do you really know when to accept something and when to try to change it? What if the “thing” you are contemplating is your self? I have definitely gotten too caught up in self-improvement schemes at times. Isn’t it ok to just be yourself sometimes, or do you have to constantly be striving to become better in some way?

I came to New Zealand to have an adventure, to learn something different, to see a beautiful part of the world, and to have some intensive cross-cultural experience. I am definitely accomplishing all those goals. What I struggle with on a daily basis is this constant questioning and doubting of myself, my desire to make things better, my desire to try something different and accept things as they are, my desire to just be who I am, and my desire to fit in and be accepted. If you have been reading along wondering how I will resolve this tension, I have to apologize; you will just have to live with it….

The Up Side of Burn Out

Fitting In and Not Fitting In

FITTING IN AND NOT FITTING IN

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).

FITTING IN AND NOT FITTING IN

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.

FITTING IN AND NOT FITTING IN

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

FITTING IN AND NOT FITTING IN