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.

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.

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.

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.

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


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

The Benefits of Being Lost
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.


The Benefits of Being Lost


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.


The Benefits of Being Lost


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.

The Benefits of Being Lost


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 Benefits of Being Lost

Better, Different, Worse

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.

Better, Different, Worse?

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.