“ALL THE SAME”
(Publshed in the East Bay Psychiatric Association Newsletter, August, 2006)
I recently left my one-half day a week part time job at the Contra Costa County Forensic Mental Health Clinic. My responsibilities there for 14 ½ years had been primarily to provide medication management for some 40 conditionally released offenders who were undergoing mandated treatment in the community after a period of years stabilizing in a state mental hospital. Typically, these patients had committed major felonies while psychotic, had been found “not guilty of reason of insanity”, and were diverted from the prison system to the state mental health system. Their crimes were the worst kind, such as homicide (including infanticide), unprovoked assaults, and arson.
I enjoyed this part time work as a contrast to my own private practice. These two patient populations were about as different as night and day. The forensic patients typically came from minority groups in the inner city, had disadvantaged or abusive backgrounds, and often had psychoses complicated by substance abuse. These were the “throwaways” of the population—the people no one wanted. In contrast, my private patients were drawn mostly from the white, suburban, professional class—the people of privilege.
What surprised me was the impact that my leaving this job had on some of the patients. I had not realized that my relatively brief visit with them monthly for prescriptions and support had had such an impact on many of them. Some simply said polite goodbyes at their last appointment. But others amazingly spoke eloquently about how they felt at a little retirement party. And one of the female patients, with whom I felt very little connection, said something very poignant. She suffered from a major psychosis as well as a personality disorder. At her last visit, she brought me a small bouquet of flowers, an appropriate retirement card, and said, “Dr. Winig, you’re a good doctor. You treat us all the same,” and she started to cry.
I realized then, without having fully appreciated it before, that I was taking care of certain people for whom being taken care of was a very foreign experience. Perhaps no one else in their lives cared very much about them, or certainly never treated them as if they were “the same.” It was natural for me to do this. I was just being their doctor. But for some of these patients, the nature of the human relationship that they had with me may have been qualitatively different from anything else they had ever known.
It is important to keep in mind the powerful impact we may have on our patients. Even brief contacts may bring an individual hope and the sense that they are worth something, in the face of a lifetime of experiences that may have communicated something quite different. Sometimes, what seems so simple may actually be quite profound.
Monday, June 25, 2007
Friday, June 15, 2007
THE PRICE OF SELF-DECEPTION
(Published as a review of Arthur Miller's play "The Price" in the East Bay Psychiatric Association Newsletter, October, 2005)
I recently saw Arthur Miller’s play "The Price" at the Aurora Theatre in Berkeley. This is another one of Miller’s incisive and insightful dramas, like his Death of a Salesman, that cuts to the quick regarding the failure of families to face their own reality. This play was written in 1968 as a metaphor for our own government’s lack of honesty in facing up to its failed policy in Vietnam. As Miller himself said then, “50,000 Americans and millions of Vietnamese paid with their lives to support a myth and bellicose denial.”
The struggle for many families to deal honestly with their lives probably lies in their attempt to maintain a fragile balance between practicing a certain amount of self-deception versus risking the total breakdown of the family unit. Many families have an “elephant” that sits at the dinner table every night that is never mentioned, so that the family can survive, albeit dysfunctionally.
Sometimes this fragile balance breaks down in unanticipated ways. Recently I saw the mother of a 21 year-old son who had bipolar illness and alcoholism. For years the family had not been strong enough to confront this child’s chaotic, dysfunctional behavior, which escalated at times to physical assaults and death threats on the part of the son within the home. The family remained largely codependent, choosing to avoid confronting the son and practicing self-deception, until one day they finally called the police. The son was then in turn jailed and hospitalized, but tragically took his own life while in confinement—not exactly the kind of resolution the family had wished to accomplish.
Miller’s "The Price" is an attempt to show “that through the mists of denial, the bow of the ancient ship of reality could emerge.” His metaphorical use of family self-deception to reveal the nation’s problem confronting the Vietnam War in 1968 holds true today as well. We as a nation are now facing a similar dilemma as our administration explains its rationale for the war in Iraq in varying ways depending on how events unfold. Most recently we were told that the reason to “stay the course” is not to dishonor those brave soldiers who have already died in the conflict, as if simply sacrificing more troops will do more good. (We were also told that in the Vietnam War era when only 100 soldiers had perished). A more honest approach, a la Arthur Miller, would be to come clean as to why we are in Iraq in the first place—why we are building the biggest American Embassy building that exists anywhere in the world, and why we are establishing Air Force bases around that country. But to do that would risk the already eroding public support for the war, and throw the “family’ into chaos. Better to practice deception, it seems our administration has concluded. But this also robs the nation of a chance to change course correctively.
People (and nations) will pay “the price” in the present for dysfunctional decisions they have made in the past, and then take no corrective action in the present. As an individual, for instance, one may be overly attached to a parent, or manipulated by that parent, to make a choice of a career or spouse that is not really one’s own. The price paid can be a lifetime of unhappiness if self-deception is practiced. Similarly, Miller tells us, we pay a price as a nation when we make choices and then do not deal with the reality of the consequences.
Whether one is running a government, a company, or just helping a family or individual to cope, denial and self-deception can get you only so far. At some point you will pay “the price.”
(Published as a review of Arthur Miller's play "The Price" in the East Bay Psychiatric Association Newsletter, October, 2005)
I recently saw Arthur Miller’s play "The Price" at the Aurora Theatre in Berkeley. This is another one of Miller’s incisive and insightful dramas, like his Death of a Salesman, that cuts to the quick regarding the failure of families to face their own reality. This play was written in 1968 as a metaphor for our own government’s lack of honesty in facing up to its failed policy in Vietnam. As Miller himself said then, “50,000 Americans and millions of Vietnamese paid with their lives to support a myth and bellicose denial.”
The struggle for many families to deal honestly with their lives probably lies in their attempt to maintain a fragile balance between practicing a certain amount of self-deception versus risking the total breakdown of the family unit. Many families have an “elephant” that sits at the dinner table every night that is never mentioned, so that the family can survive, albeit dysfunctionally.
Sometimes this fragile balance breaks down in unanticipated ways. Recently I saw the mother of a 21 year-old son who had bipolar illness and alcoholism. For years the family had not been strong enough to confront this child’s chaotic, dysfunctional behavior, which escalated at times to physical assaults and death threats on the part of the son within the home. The family remained largely codependent, choosing to avoid confronting the son and practicing self-deception, until one day they finally called the police. The son was then in turn jailed and hospitalized, but tragically took his own life while in confinement—not exactly the kind of resolution the family had wished to accomplish.
Miller’s "The Price" is an attempt to show “that through the mists of denial, the bow of the ancient ship of reality could emerge.” His metaphorical use of family self-deception to reveal the nation’s problem confronting the Vietnam War in 1968 holds true today as well. We as a nation are now facing a similar dilemma as our administration explains its rationale for the war in Iraq in varying ways depending on how events unfold. Most recently we were told that the reason to “stay the course” is not to dishonor those brave soldiers who have already died in the conflict, as if simply sacrificing more troops will do more good. (We were also told that in the Vietnam War era when only 100 soldiers had perished). A more honest approach, a la Arthur Miller, would be to come clean as to why we are in Iraq in the first place—why we are building the biggest American Embassy building that exists anywhere in the world, and why we are establishing Air Force bases around that country. But to do that would risk the already eroding public support for the war, and throw the “family’ into chaos. Better to practice deception, it seems our administration has concluded. But this also robs the nation of a chance to change course correctively.
People (and nations) will pay “the price” in the present for dysfunctional decisions they have made in the past, and then take no corrective action in the present. As an individual, for instance, one may be overly attached to a parent, or manipulated by that parent, to make a choice of a career or spouse that is not really one’s own. The price paid can be a lifetime of unhappiness if self-deception is practiced. Similarly, Miller tells us, we pay a price as a nation when we make choices and then do not deal with the reality of the consequences.
Whether one is running a government, a company, or just helping a family or individual to cope, denial and self-deception can get you only so far. At some point you will pay “the price.”
Monday, June 11, 2007
THE NONEXISTENCE OF RACE
(Published in the East Bay Psychiatric Association Newsletter, September 2000)
When I was a little boy, before the age of 4, I lived in a town in upstate New York. In my neighborhood, there lived a family with two girls close to me in age, the Chu sisters. I would play at their house and they at mine. When we moved away, the Chu family gave my brother and me a copy of Grimm’s Fairy Tales as a present, inscribed with best wishes from them. I did not know that they were Chinese, as I had no concept of race.
A few years later, my parents were told by our extended family who still lived there, that the Chu’s were forced to move--that some of the neighbors had maliciously banded together and pressured them to leave: “No Chinese Allowed!” As a youngster, I did not understand then what had happened, as I still had no real concept of race.
When I was growing up as a schoolboy, race began to be presented simplistically. One was either of the Black, White, or Yellow race, and everyone could see that such differences existed. Then as Native Americans were considered, a Red race was discussed. As time went on, I began to ask questions about people who were not Black, White, Yellow or Red. Few answers were forthcoming, so I turned to the encyclopedia. There the concept of race was enlarged to 9 groups, including such exotic peoples as Micronesians, Melanesians, and Australoids. I felt satisfied, based on encyclopedic information, that I now was beginning to really understand the concept of race. However, later, while in college, I read an article that expanded racial groupings to 21, and now I was beginning to get confused and to question how scientists were coming up with these groupings.
Now that the human genome project is marching forward, some remarkable information is being uncovered. The geneticists at Celera Genomics Corporation, which were the first to unravel the human genome sequence, have drawn some dramatic conclusions. The different physical characteristics that make up different “races” appear to be only “skin deep.” One-hundredth of one percent of our genetic material accounts for these physical differences, such as skin color, lip contour, hair texture, etc. The other 99.99% of our DNA is the same from one ethnic group to another. Genetic endowment of such complex characteristics as intelligence requires at least 1000’s of genes, and cannot be distinguished by looking at the DNA of one ethnic group or another.
In a recent article in the New York Times, the “Out of Africa” theory is outlined. According to this theory, modern Homo Sapiens originated between 200,000 and 100,000 years ago, at which point, a small number of them, perhaps 10,000 or so, began to migrate into the Middle East, Europe, Asia, and across the Bering land mass into the Americas. Since that time, a mere 7000 generations have passed. Because of such a limited founding population and such a short time since dispersal, humans are strikingly homogeneous, differing from one another only once in a thousand subunits of the genome.
Because Homo sapiens have only been around for these 7000 generations, only different ethnicities, with differing physical traits, have become distinguishable. Ethnicity is a broad concept that encompasses both genetics and culture, whereas race only takes genetics into consideration, and therein lies the crucial difference. We seem to be a single human race, as biologically we have the same complex set of human genetic characteristics, as do all our fellow men.
Those obvious physical ethnic differences that do exist are adaptations to the environment, stemming from specific mutations that gave that group living in a certain region an advantage (like pale skinned people in Northern Europe being more able to produce Vitamin D from pale sunlight). Formulating the concept of a single human race, which comes in a variety of “flavors,” should alter our current categorization of each other which falsely places us into several different racial groups.
Learning about race while growing up in American society has misled most of us into believing that somehow we are biologically different from people of other races. What may be true, is that we are significantly different culturally, and that may be the source of distrust or prejudice. Race is very politicized in this country, unlike elsewhere. Here, it may be good to be of a different race, as you represent diversity. (College admissions committees are intensely interested in racial diversity of their student bodies). Or it may be bad to be of a different race, as is the case when people band together to keep away people who are unlike themselves. (Realtors often work hard to keep neighborhoods racially distinct, believing that this keeps property values higher). Whatever the case, race in America is rarely viewed from a neutral perspective.
The elimination of biology from the formulation of race as a result of the human genome project may be a quantum leap forward toward helping us all coexist more compatibly. Unfortunately for the Chinese family in that neighborhood of my early youth, this data comes somewhat late, as it does for all other individuals who have suffered the indignities of racial prejudice. However, just as placing a man on the moon led to a variety of scientific discoveries unrelated to space travel, the human genome project may lead to certain sociological advances unanticipated by this biological research.
(Published in the East Bay Psychiatric Association Newsletter, September 2000)
When I was a little boy, before the age of 4, I lived in a town in upstate New York. In my neighborhood, there lived a family with two girls close to me in age, the Chu sisters. I would play at their house and they at mine. When we moved away, the Chu family gave my brother and me a copy of Grimm’s Fairy Tales as a present, inscribed with best wishes from them. I did not know that they were Chinese, as I had no concept of race.
A few years later, my parents were told by our extended family who still lived there, that the Chu’s were forced to move--that some of the neighbors had maliciously banded together and pressured them to leave: “No Chinese Allowed!” As a youngster, I did not understand then what had happened, as I still had no real concept of race.
When I was growing up as a schoolboy, race began to be presented simplistically. One was either of the Black, White, or Yellow race, and everyone could see that such differences existed. Then as Native Americans were considered, a Red race was discussed. As time went on, I began to ask questions about people who were not Black, White, Yellow or Red. Few answers were forthcoming, so I turned to the encyclopedia. There the concept of race was enlarged to 9 groups, including such exotic peoples as Micronesians, Melanesians, and Australoids. I felt satisfied, based on encyclopedic information, that I now was beginning to really understand the concept of race. However, later, while in college, I read an article that expanded racial groupings to 21, and now I was beginning to get confused and to question how scientists were coming up with these groupings.
Now that the human genome project is marching forward, some remarkable information is being uncovered. The geneticists at Celera Genomics Corporation, which were the first to unravel the human genome sequence, have drawn some dramatic conclusions. The different physical characteristics that make up different “races” appear to be only “skin deep.” One-hundredth of one percent of our genetic material accounts for these physical differences, such as skin color, lip contour, hair texture, etc. The other 99.99% of our DNA is the same from one ethnic group to another. Genetic endowment of such complex characteristics as intelligence requires at least 1000’s of genes, and cannot be distinguished by looking at the DNA of one ethnic group or another.
In a recent article in the New York Times, the “Out of Africa” theory is outlined. According to this theory, modern Homo Sapiens originated between 200,000 and 100,000 years ago, at which point, a small number of them, perhaps 10,000 or so, began to migrate into the Middle East, Europe, Asia, and across the Bering land mass into the Americas. Since that time, a mere 7000 generations have passed. Because of such a limited founding population and such a short time since dispersal, humans are strikingly homogeneous, differing from one another only once in a thousand subunits of the genome.
Because Homo sapiens have only been around for these 7000 generations, only different ethnicities, with differing physical traits, have become distinguishable. Ethnicity is a broad concept that encompasses both genetics and culture, whereas race only takes genetics into consideration, and therein lies the crucial difference. We seem to be a single human race, as biologically we have the same complex set of human genetic characteristics, as do all our fellow men.
Those obvious physical ethnic differences that do exist are adaptations to the environment, stemming from specific mutations that gave that group living in a certain region an advantage (like pale skinned people in Northern Europe being more able to produce Vitamin D from pale sunlight). Formulating the concept of a single human race, which comes in a variety of “flavors,” should alter our current categorization of each other which falsely places us into several different racial groups.
Learning about race while growing up in American society has misled most of us into believing that somehow we are biologically different from people of other races. What may be true, is that we are significantly different culturally, and that may be the source of distrust or prejudice. Race is very politicized in this country, unlike elsewhere. Here, it may be good to be of a different race, as you represent diversity. (College admissions committees are intensely interested in racial diversity of their student bodies). Or it may be bad to be of a different race, as is the case when people band together to keep away people who are unlike themselves. (Realtors often work hard to keep neighborhoods racially distinct, believing that this keeps property values higher). Whatever the case, race in America is rarely viewed from a neutral perspective.
The elimination of biology from the formulation of race as a result of the human genome project may be a quantum leap forward toward helping us all coexist more compatibly. Unfortunately for the Chinese family in that neighborhood of my early youth, this data comes somewhat late, as it does for all other individuals who have suffered the indignities of racial prejudice. However, just as placing a man on the moon led to a variety of scientific discoveries unrelated to space travel, the human genome project may lead to certain sociological advances unanticipated by this biological research.
Saturday, June 02, 2007
G.I.'s Battered by the Trauma of Iraq
( Published as a letter to the Editor in the New York Times, December 17, 2004)
To the Editor:
Re ''A Deluge of Troubled Soldiers Is in the Offing, Experts Predict'' (front page, Dec. 16):
As President Bush cavalierly hands out Medals of Freedom to three people who were central figures in the war in Iraq, it might behoove him to observe what his policies have wrought: tens of thousands of soldiers with psychiatric problems who, you report, ''are going to need help for the next 35 years.''
The president is trying to write the history of the Iraq war as a success despite its uncertain outcome.
Expert predictions of the emotional devastation befalling another generation of young Americans sent to war is one of many reasons Mr. Bush sounds more like a salesman than a statesman.
The psychiatric impact of this war on our troops was as predictable as night following day by those of us who work in the field.
Hugh R. Winig, M.D.
(The writer is a psychiatrist.)
( Published as a letter to the Editor in the New York Times, December 17, 2004)
To the Editor:
Re ''A Deluge of Troubled Soldiers Is in the Offing, Experts Predict'' (front page, Dec. 16):
As President Bush cavalierly hands out Medals of Freedom to three people who were central figures in the war in Iraq, it might behoove him to observe what his policies have wrought: tens of thousands of soldiers with psychiatric problems who, you report, ''are going to need help for the next 35 years.''
The president is trying to write the history of the Iraq war as a success despite its uncertain outcome.
Expert predictions of the emotional devastation befalling another generation of young Americans sent to war is one of many reasons Mr. Bush sounds more like a salesman than a statesman.
The psychiatric impact of this war on our troops was as predictable as night following day by those of us who work in the field.
Hugh R. Winig, M.D.
(The writer is a psychiatrist.)
Dangerous Precedent—The Unabomber Case
(Published as a letter to the editor, New York Times, December 5, 1997)
To the Editor:
Re “Brotherly Intervention” (Op-Ed, Nov. 29): We can all be indebted to David Kaczynski for helping the authorities apprehend his brother Theodore Kaczynski, the suspect in the Unabomber case. But there will be little assistance from family members again in such cases if we put their kin to death: this would create too great a moral dilemma for even the most law-abiding among us.
For prosecutors in the Kaczynski case to close their eyes to this human conflict is to create a dangerous precedent. No one else will ever be harmed by Theodore Kaczynski if he is imprisoned for the rest of his life, but someone likely will be if he is executed for his crimes. Here is yet another example of how the death penalty creates problems instead of solving them.
Hugh R. Winig
(Published as a letter to the editor, New York Times, December 5, 1997)
To the Editor:
Re “Brotherly Intervention” (Op-Ed, Nov. 29): We can all be indebted to David Kaczynski for helping the authorities apprehend his brother Theodore Kaczynski, the suspect in the Unabomber case. But there will be little assistance from family members again in such cases if we put their kin to death: this would create too great a moral dilemma for even the most law-abiding among us.
For prosecutors in the Kaczynski case to close their eyes to this human conflict is to create a dangerous precedent. No one else will ever be harmed by Theodore Kaczynski if he is imprisoned for the rest of his life, but someone likely will be if he is executed for his crimes. Here is yet another example of how the death penalty creates problems instead of solving them.
Hugh R. Winig
Friday, June 01, 2007
WOMEN’S EMPOWERMENT IN THE GLOBAL SOUTH
(Published in the Northern California Psychiatric Society Newsletter, May 2004)
This adventure occurred only one year ago, but it had its roots more than 20 years in the past, as you will see. It was in May of 2003 that my wife, my daughter and I traveled to Peru to visit two remote areas—one in the High Andes and the other in the Amazon Basin. These are not areas that tourists tend to visit. In fact, in the Amazon, we visited two communities never before contacted by a group from North America. We were 7000 miles away from the Bay Area as part of a delegation of 15 people from the American Jewish World Service (AJWS). We were in Peru to observe the work of two non-governmental organizations (NGO’s) as they furthered the cause of empowering women to better control their health and their finances.
In part, this is a family tale, as my daughter works in international public health and was one of the leaders of the trip. The beginnings of this trip really trace back some 20 years, when our children were fairly young (ages 14,12, and 8). My wife and I decided then to begin to invest some of our resources in foreign travel as a family. We recognized that raising children in the Bay Area suburbs was not a sufficiently broad experience. We felt that the kind of family trips we were taking like camping and going to Yosemite should be supplemented with international travel experiences. This venture to Peru was but one of a myriad of international experiences that members of my family have participated in during these following two decades; but this trip, in particular, seems to have been a direct consequence of encouraging such experiences as a family 20 years earlier.
But back to Peru, which is a country located in what is now called “The Global South,” to be politically correct, as opposed to the more outdated terms such as the “developing world” or the “third world.” Peru is a land of beautiful mountains and captivating sites and people, but also a country with grinding poverty that leaves some children with only rags for clothes, no bed to sleep in, and no shoes to wear. Their runny noses just run—there’s nothing like a handkerchief or a tissue in such circumstances. Giving them a single colored pencil doesn’t just make their day, it makes their whole week! How could the local NGO’s help raise the standard of living in these remote areas, and how could AJWS help?
There were several challenges on this trip, not the least of which were medical in nature. I was not the trip doctor, but since I was the only physician in the group, I had prepared myself with knowledge and medicines to help my fellow travelers if they got into trouble with altitude sickness in the High Andes, or other maladies in the searing heat of the remote Amazon Basin. Suffice it to say, the Diamox, dexamethasone, and Cipro that I brought with me were put to good use! Fortunately, despite the severe environments we encountered, no one took seriously ill and had to leave the trip.
In the city of Puno in the Andes, we observed social workers and group therapists from the NGO “Pro Mujer” (“For Women”) provide services that would make any county public health department in this country proud. These workers built women’s self-esteem with workshops expertly conceived and conducted; they provided “micro-credit” to help start or stabilize women’s small businesses to establish greater financial independence; and they provided medical clinics for all health matters, including reproductive health. Pro Mujer also ran a radio station, which transmitted daily educational “soap operas” which cleverly depict characters having family or health problems that were illustratively solved within the context of the radio show.
The women clients of Pro Mujer, hundreds and hundreds strong, were gradually learning to take control of their lives. They could better stand up to the abuse they often encountered at home, and they could begin to use their financial resources from their succeeding businesses to help their children and themselves. They were already politicking for day care centers for their children so that the children would have a safe place to be during the day while the women attended to their shops in the open marketplace on the streets. In short, the women were learning to break the cycle of poverty and dysfunction that had previously characterized their lives. This NGO seemed to be “heaven sent’ for these women, and our delegation knew that they deserved the technical, financial, and volunteer assistance that our organization (AJWS) was prepared to provide.
In the Amazon, we visited with the leaders from the NGO “Minga Peru” (“Collectives for Peru”). We began by staying overnight in the large city of Iquitos, some 400,000 strong and the largest city in the world not accessible by car (one has to travel there by plane or boat). The following day, we went by motorized canoe some 80-100 miles up the Maranon River, a feeder river into the Amazon, which begins in Iquitos. This river area is three times the size of California, but populated by just 900,000 people. There are 492 communities of indigenous peoples living in the river areas, comprising some 40 different ethnic tribes. Most of the people live in very small, impoverished communities, and some speak only their tribal dialect and no Spanish. They provide their own subsistence, their own health care, and travel about the river by canoes. Infant mortality is high as is death during childbirth. Public Health nurses travel 600 miles up river to visit each of these communities by motorized canoe bringing in health supplies and medical knowledge during their occasional month long trips.
Minga Peru provides amazing services to these remote and impoverished people. We observed childbirth classes utilizing the most modern methods of instruction for the community members who provide these services. Engineers are sent into these communities to help them construct fishponds to be able to grow and harvest fish to sell in the markets along the river. Agricultural experts are sent to teach how to plant the land to raise agricultural products. Minga also runs a radio station in Iquitos with educational soap operas broadcast to the river communities by radio tower transmission that plays on the radio station at 5:00 am over load speakers for all to hear as they start their day. (The communities have no electricity or running water or personal radios).
American Jewish World Service supports community based projects of grassroots NGO’s in an attempt to help groups lift themselves out of poverty a step at a time. AJWS is an independent, not-for-profit organization founded in 1985 to help alleviate poverty, hunger and disease among the people of the world regardless of race, religion or nationality. Their projects involve health, education, sustainable agriculture, economic development, emergency relief and reconstruction, women’s empowerment, and the building of civil societies. They are active in over 50 countries with over 100 projects. The premise of the particular project of women’s empowerment, which we observed, is based in part on studies that show that if women are given funds and supportive services, that they tend to utilize these resources for the benefit of the family. When similar resources are given to men, these monies tend not to be spent for the welfare of the family and are often misused.
Traveling, particularly to countries which are not yet industrialized, has a very broadening effect on one’s psyche. One appreciates more the economic advantage and freedom that we take for granted here in the United States. But even more importantly, one develops empathy and understanding for people around the world and not just from a nationalistic perspective. This is the concept that President Kennedy recognized when he conceived of the Peace Corps originally in 1960.
One never knows what experiences have an impact on children growing up. Twenty years ago, I never imagined that taking family trips abroad could eventuate in a trip to remote river communities in the Amazon Basin. This article has not been about child rearing practices; but it is of more than passing interest to me as a psychiatrist to observe retrospectively how what I thought was a simple way to expose my children to more than just the community they lived in, actually helped shape their careers, their personalities, and their political views of the world. Each of them has become someone more than just an American citizen; they are really global citizens and their psychological sense of themselves has stretched them well beyond the typical boundaries of who they are as individuals.
In these troubled times, it is heartening to know that there are still places to go and activities to pursue, that have nothing to do with national defense or fighting wars. There is a world of poverty, hunger, and despair all around the globe, but there is also a world of opportunity to do something about it.
Hugh R. Winig, M.D.
(Published in the Northern California Psychiatric Society Newsletter, May 2004)
This adventure occurred only one year ago, but it had its roots more than 20 years in the past, as you will see. It was in May of 2003 that my wife, my daughter and I traveled to Peru to visit two remote areas—one in the High Andes and the other in the Amazon Basin. These are not areas that tourists tend to visit. In fact, in the Amazon, we visited two communities never before contacted by a group from North America. We were 7000 miles away from the Bay Area as part of a delegation of 15 people from the American Jewish World Service (AJWS). We were in Peru to observe the work of two non-governmental organizations (NGO’s) as they furthered the cause of empowering women to better control their health and their finances.
In part, this is a family tale, as my daughter works in international public health and was one of the leaders of the trip. The beginnings of this trip really trace back some 20 years, when our children were fairly young (ages 14,12, and 8). My wife and I decided then to begin to invest some of our resources in foreign travel as a family. We recognized that raising children in the Bay Area suburbs was not a sufficiently broad experience. We felt that the kind of family trips we were taking like camping and going to Yosemite should be supplemented with international travel experiences. This venture to Peru was but one of a myriad of international experiences that members of my family have participated in during these following two decades; but this trip, in particular, seems to have been a direct consequence of encouraging such experiences as a family 20 years earlier.
But back to Peru, which is a country located in what is now called “The Global South,” to be politically correct, as opposed to the more outdated terms such as the “developing world” or the “third world.” Peru is a land of beautiful mountains and captivating sites and people, but also a country with grinding poverty that leaves some children with only rags for clothes, no bed to sleep in, and no shoes to wear. Their runny noses just run—there’s nothing like a handkerchief or a tissue in such circumstances. Giving them a single colored pencil doesn’t just make their day, it makes their whole week! How could the local NGO’s help raise the standard of living in these remote areas, and how could AJWS help?
There were several challenges on this trip, not the least of which were medical in nature. I was not the trip doctor, but since I was the only physician in the group, I had prepared myself with knowledge and medicines to help my fellow travelers if they got into trouble with altitude sickness in the High Andes, or other maladies in the searing heat of the remote Amazon Basin. Suffice it to say, the Diamox, dexamethasone, and Cipro that I brought with me were put to good use! Fortunately, despite the severe environments we encountered, no one took seriously ill and had to leave the trip.
In the city of Puno in the Andes, we observed social workers and group therapists from the NGO “Pro Mujer” (“For Women”) provide services that would make any county public health department in this country proud. These workers built women’s self-esteem with workshops expertly conceived and conducted; they provided “micro-credit” to help start or stabilize women’s small businesses to establish greater financial independence; and they provided medical clinics for all health matters, including reproductive health. Pro Mujer also ran a radio station, which transmitted daily educational “soap operas” which cleverly depict characters having family or health problems that were illustratively solved within the context of the radio show.
The women clients of Pro Mujer, hundreds and hundreds strong, were gradually learning to take control of their lives. They could better stand up to the abuse they often encountered at home, and they could begin to use their financial resources from their succeeding businesses to help their children and themselves. They were already politicking for day care centers for their children so that the children would have a safe place to be during the day while the women attended to their shops in the open marketplace on the streets. In short, the women were learning to break the cycle of poverty and dysfunction that had previously characterized their lives. This NGO seemed to be “heaven sent’ for these women, and our delegation knew that they deserved the technical, financial, and volunteer assistance that our organization (AJWS) was prepared to provide.
In the Amazon, we visited with the leaders from the NGO “Minga Peru” (“Collectives for Peru”). We began by staying overnight in the large city of Iquitos, some 400,000 strong and the largest city in the world not accessible by car (one has to travel there by plane or boat). The following day, we went by motorized canoe some 80-100 miles up the Maranon River, a feeder river into the Amazon, which begins in Iquitos. This river area is three times the size of California, but populated by just 900,000 people. There are 492 communities of indigenous peoples living in the river areas, comprising some 40 different ethnic tribes. Most of the people live in very small, impoverished communities, and some speak only their tribal dialect and no Spanish. They provide their own subsistence, their own health care, and travel about the river by canoes. Infant mortality is high as is death during childbirth. Public Health nurses travel 600 miles up river to visit each of these communities by motorized canoe bringing in health supplies and medical knowledge during their occasional month long trips.
Minga Peru provides amazing services to these remote and impoverished people. We observed childbirth classes utilizing the most modern methods of instruction for the community members who provide these services. Engineers are sent into these communities to help them construct fishponds to be able to grow and harvest fish to sell in the markets along the river. Agricultural experts are sent to teach how to plant the land to raise agricultural products. Minga also runs a radio station in Iquitos with educational soap operas broadcast to the river communities by radio tower transmission that plays on the radio station at 5:00 am over load speakers for all to hear as they start their day. (The communities have no electricity or running water or personal radios).
American Jewish World Service supports community based projects of grassroots NGO’s in an attempt to help groups lift themselves out of poverty a step at a time. AJWS is an independent, not-for-profit organization founded in 1985 to help alleviate poverty, hunger and disease among the people of the world regardless of race, religion or nationality. Their projects involve health, education, sustainable agriculture, economic development, emergency relief and reconstruction, women’s empowerment, and the building of civil societies. They are active in over 50 countries with over 100 projects. The premise of the particular project of women’s empowerment, which we observed, is based in part on studies that show that if women are given funds and supportive services, that they tend to utilize these resources for the benefit of the family. When similar resources are given to men, these monies tend not to be spent for the welfare of the family and are often misused.
Traveling, particularly to countries which are not yet industrialized, has a very broadening effect on one’s psyche. One appreciates more the economic advantage and freedom that we take for granted here in the United States. But even more importantly, one develops empathy and understanding for people around the world and not just from a nationalistic perspective. This is the concept that President Kennedy recognized when he conceived of the Peace Corps originally in 1960.
One never knows what experiences have an impact on children growing up. Twenty years ago, I never imagined that taking family trips abroad could eventuate in a trip to remote river communities in the Amazon Basin. This article has not been about child rearing practices; but it is of more than passing interest to me as a psychiatrist to observe retrospectively how what I thought was a simple way to expose my children to more than just the community they lived in, actually helped shape their careers, their personalities, and their political views of the world. Each of them has become someone more than just an American citizen; they are really global citizens and their psychological sense of themselves has stretched them well beyond the typical boundaries of who they are as individuals.
In these troubled times, it is heartening to know that there are still places to go and activities to pursue, that have nothing to do with national defense or fighting wars. There is a world of poverty, hunger, and despair all around the globe, but there is also a world of opportunity to do something about it.
Hugh R. Winig, M.D.
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