“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.
Thursday, May 31, 2007
THE DEPROFESSIONALIZATION OF PHYSICIANS
(Published nationally in Psychiatric News, February, 2000)
Back in the last millennium when I was a young doctor, becoming a physician meant that one had a “calling”, something quite different than “going into business.” In those days, being referred to as “doctor” meant you commanded respect and were esteemed. Back then, the purpose of insurers like Blue Cross and Blue Shield were to see that their clients’ claims were paid. And in those days, the purpose of the hospital was to provide care for the ailing patient until s/he was well and could return home healthy.
Times have changed! CEO’s and other “bean counters” and business people of all sorts have hijacked American medicine and run it as if it were a manufacturing plant. Their “calling” is to make a profit, and the purpose of the insurer is to deny claims. The hospital’s goal, once the procedure or treatment is completed, is to get the patient out of there as soon as possible.
The latest tactic in the health care industry is to supplant the physician with all sorts of “physician extenders”, much like “beef extenders”, I guess. The physician’s care is becoming limited to doing the procedure or supervising the treatment. There is no need for the doctor to have a relationship with the patient--the “extender” will do that!
The art of medicine is dead. Even we psychiatrists, specialists in forming therapeutic relationships, talk more these days about neurotransmitters than about the angst of mental illness. Calling a physician’s office is now less of a personal experience than calling an airline to get a plane reservation. At least the person making my reservation talks to me politely and takes time to explain things. My doctor’s answering machine, in contrast, tells me to hang up and call 911 if I am having a life threatening emergency; otherwise I am instructed, after pushing many numbered options, to leave a message which may be responded to within 24 hours.
Physicians have been deprofessionalized. We are now all just “providers” in a massive health care industry which is increasingly impersonal, detached, and profit driven. Forget about even calling yourself a physician--your patients won’t know the difference between you and your “extender” anyway.
Fortunately for me, my career is in its late stages, and I am still able to practice the old fashioned way. I have a small one-man “cottage industry.” I try to provide personal attention for my patients, answer incoming calls when possible, return peoples’ messages promptly, and (of all things) even do my own psychotherapy. But I fear, as do my peers, that there will be no doctors left in the future to take care of us with the personal attention, patience, and understanding that once was common practice.
Don’t get me wrong, I appreciate much of this new high-tech age in which we live. I love the ease with which the internet connects me to information, and I value the convenience of my cellular phone. But I’ll take the physicians of yesteryear any day over today’s “providers.” Those doctors did have a calling and did know how to practice medicine as an art form. They knew how to comfort and how to ease suffering, and they understood the importance of a therapeutic relationship.
The tragedy of American medicine falling from its Golden Age, to what it has now become, is clearly a product of capitalism at its worst. When medicine is governed by health care planners whose only concern is profit, then the number of people who die because of premature discharge from the hospital amounts to a simple calculation of potential malpractice losses versus salaries saved. But if the person who died unnecessarily happens to be your loved one, the result is actually incalculable! Perhaps if every business person or insurer working in the health care industry today was required to work on an oncology unit, a hospice, or a psychiatric facility for a period of time, they would appreciate the nature of medicine rather than seeing it as just a business.
Medicine was never designed to be a business, and it never has been a good business, as measured by business parameters. Yet, one of the greatest accomplishments of twentieth century America, has been the nearly doubling of the human life span. This occurred, not in the context of worrying about every dollar spent, but by persevering in the development of medical science and improving the practice of medicine.
We are no longer struggling with recessionary pressures in our economy as we were 8 years ago, when the dismantling of American medicine began for the sake of controlling inflation. With the explosion of wealth over the past several years, maybe we can get back to quality in medicine, and let physicians run the show again. Business people can return to running businesses, and we’ll all be better off!
Hugh R. Winig, M.D.
(Published nationally in Psychiatric News, February, 2000)
Back in the last millennium when I was a young doctor, becoming a physician meant that one had a “calling”, something quite different than “going into business.” In those days, being referred to as “doctor” meant you commanded respect and were esteemed. Back then, the purpose of insurers like Blue Cross and Blue Shield were to see that their clients’ claims were paid. And in those days, the purpose of the hospital was to provide care for the ailing patient until s/he was well and could return home healthy.
Times have changed! CEO’s and other “bean counters” and business people of all sorts have hijacked American medicine and run it as if it were a manufacturing plant. Their “calling” is to make a profit, and the purpose of the insurer is to deny claims. The hospital’s goal, once the procedure or treatment is completed, is to get the patient out of there as soon as possible.
The latest tactic in the health care industry is to supplant the physician with all sorts of “physician extenders”, much like “beef extenders”, I guess. The physician’s care is becoming limited to doing the procedure or supervising the treatment. There is no need for the doctor to have a relationship with the patient--the “extender” will do that!
The art of medicine is dead. Even we psychiatrists, specialists in forming therapeutic relationships, talk more these days about neurotransmitters than about the angst of mental illness. Calling a physician’s office is now less of a personal experience than calling an airline to get a plane reservation. At least the person making my reservation talks to me politely and takes time to explain things. My doctor’s answering machine, in contrast, tells me to hang up and call 911 if I am having a life threatening emergency; otherwise I am instructed, after pushing many numbered options, to leave a message which may be responded to within 24 hours.
Physicians have been deprofessionalized. We are now all just “providers” in a massive health care industry which is increasingly impersonal, detached, and profit driven. Forget about even calling yourself a physician--your patients won’t know the difference between you and your “extender” anyway.
Fortunately for me, my career is in its late stages, and I am still able to practice the old fashioned way. I have a small one-man “cottage industry.” I try to provide personal attention for my patients, answer incoming calls when possible, return peoples’ messages promptly, and (of all things) even do my own psychotherapy. But I fear, as do my peers, that there will be no doctors left in the future to take care of us with the personal attention, patience, and understanding that once was common practice.
Don’t get me wrong, I appreciate much of this new high-tech age in which we live. I love the ease with which the internet connects me to information, and I value the convenience of my cellular phone. But I’ll take the physicians of yesteryear any day over today’s “providers.” Those doctors did have a calling and did know how to practice medicine as an art form. They knew how to comfort and how to ease suffering, and they understood the importance of a therapeutic relationship.
The tragedy of American medicine falling from its Golden Age, to what it has now become, is clearly a product of capitalism at its worst. When medicine is governed by health care planners whose only concern is profit, then the number of people who die because of premature discharge from the hospital amounts to a simple calculation of potential malpractice losses versus salaries saved. But if the person who died unnecessarily happens to be your loved one, the result is actually incalculable! Perhaps if every business person or insurer working in the health care industry today was required to work on an oncology unit, a hospice, or a psychiatric facility for a period of time, they would appreciate the nature of medicine rather than seeing it as just a business.
Medicine was never designed to be a business, and it never has been a good business, as measured by business parameters. Yet, one of the greatest accomplishments of twentieth century America, has been the nearly doubling of the human life span. This occurred, not in the context of worrying about every dollar spent, but by persevering in the development of medical science and improving the practice of medicine.
We are no longer struggling with recessionary pressures in our economy as we were 8 years ago, when the dismantling of American medicine began for the sake of controlling inflation. With the explosion of wealth over the past several years, maybe we can get back to quality in medicine, and let physicians run the show again. Business people can return to running businesses, and we’ll all be better off!
Hugh R. Winig, M.D.
Wednesday, May 30, 2007
SONS OFF TO EUROPE
(Published in the Contra Costa Times on Memorial Day, 1995)
This Spring I will be attending three graduations--my daughter's from graduate school, my older son's from college, and my younger son's from high school. Our family will also be celebrating my wife's 50th birthday--she was born exactly on V-E Day itself! As my children look forward with hope and optimism to their new lives, and in the midst of all of these wonderful family celebrations, my own thoughts turn to remembrances and gratefulness.
Coincidental with this 50th anniversary of V-E Day, both of my sons independently settled on the idea of marking their graduations by backpacking abroad this summer with a few of their best buddies to see the sights of Western Europe. My wife has felt a bit of maternal trepidation about their plans, especially the younger one's, even though he has traveled or lived abroad the past two summers. But, as their father, I can tell you I have a very different take on this bit of freedom my sons are exercising.
This summer is 50 years since the end of World War II! Fifty years since the liberation of Auschwitz and the loss of 6 million Jews! Fifty years since the Russian war dead numbered 20 million! And fifty years since the execution of Mussolini and the death of Hitler! Fifty years later, and my sons are the beneficiaries of all those who fell at Normandy, on Omaha and Utah Beach. My 22 and 18 year-old young men will be off to Europe with backpacks bought at our local mountaineering store, not government-issue duffel bags. They will leave with water bottles for hiking in the serene hills of Italy and France, not with canteens and mess kits issued by the military to help them survive battle-torn Europe. And they will buy eurail passes to crisscross Europe freely, not find themselves herded into cattle cars headed for a certain death in a concentration camp.
How does a father like me thank all those men lying under crosses and stars in Europe's battlefields and war cemeteries? How do I convey to my sons the good fortune they have to live in this generation, not the one that came of age fifty years ago? Who was looking over them and me when our turn came to travel this way?
I'm not a "love it or leave it" patriotic type, but I do like to fly the American flag on the Federal Holidays. I don't like it that school kids today have little sense of why they don't go to school on Memorial Day. There seems to be little appreciation for how the freedoms we take for granted were earned--most young people simply feel entitled to it.
If we can remember what this last fifty years has wrought, then there should be little but gratefulness that would fill our hearts. Had World War II ended differently, one can only try to imagine the nightmare that would have followed. Surely, none of us would have a life as we know it, or even have a life at all! From my perspective, I can honestly say, it's good to have 2 sons off to Europe this summer.
(Published in the Contra Costa Times on Memorial Day, 1995)
This Spring I will be attending three graduations--my daughter's from graduate school, my older son's from college, and my younger son's from high school. Our family will also be celebrating my wife's 50th birthday--she was born exactly on V-E Day itself! As my children look forward with hope and optimism to their new lives, and in the midst of all of these wonderful family celebrations, my own thoughts turn to remembrances and gratefulness.
Coincidental with this 50th anniversary of V-E Day, both of my sons independently settled on the idea of marking their graduations by backpacking abroad this summer with a few of their best buddies to see the sights of Western Europe. My wife has felt a bit of maternal trepidation about their plans, especially the younger one's, even though he has traveled or lived abroad the past two summers. But, as their father, I can tell you I have a very different take on this bit of freedom my sons are exercising.
This summer is 50 years since the end of World War II! Fifty years since the liberation of Auschwitz and the loss of 6 million Jews! Fifty years since the Russian war dead numbered 20 million! And fifty years since the execution of Mussolini and the death of Hitler! Fifty years later, and my sons are the beneficiaries of all those who fell at Normandy, on Omaha and Utah Beach. My 22 and 18 year-old young men will be off to Europe with backpacks bought at our local mountaineering store, not government-issue duffel bags. They will leave with water bottles for hiking in the serene hills of Italy and France, not with canteens and mess kits issued by the military to help them survive battle-torn Europe. And they will buy eurail passes to crisscross Europe freely, not find themselves herded into cattle cars headed for a certain death in a concentration camp.
How does a father like me thank all those men lying under crosses and stars in Europe's battlefields and war cemeteries? How do I convey to my sons the good fortune they have to live in this generation, not the one that came of age fifty years ago? Who was looking over them and me when our turn came to travel this way?
I'm not a "love it or leave it" patriotic type, but I do like to fly the American flag on the Federal Holidays. I don't like it that school kids today have little sense of why they don't go to school on Memorial Day. There seems to be little appreciation for how the freedoms we take for granted were earned--most young people simply feel entitled to it.
If we can remember what this last fifty years has wrought, then there should be little but gratefulness that would fill our hearts. Had World War II ended differently, one can only try to imagine the nightmare that would have followed. Surely, none of us would have a life as we know it, or even have a life at all! From my perspective, I can honestly say, it's good to have 2 sons off to Europe this summer.
THE NEW SOUTH AFRICA
(Published in the Esst Bay Psychiatric Association Newsletter, April 2007)
This past February, my wife and I spent 10 days touring 3 major cities in South Africa: Johannesburg, Cape Town, and Port Elizabeth. We went on a Study Tour with The American Jewish World Service (AJWS). This charitable organization provides funds as well as volunteer and technical assistance to grassroots organizations in the developing world. It helps support over 300 projects in some 36 countries in Asia, Africa, and South America. We visited about a dozen such non-governmental organizations (NGO’s) in an effort to understand their efforts in combating the HIV/AIDS pandemic now ravaging South Africa. One thousand people a day are dying there from this disease, and twice that many are becoming newly infected daily.
I knew little about South Africa prior to this trip, outside of its history of apartheid. I learned that from 1948 until 1994 blacks not only had no vote, but that they also were deprived of any meaningful education. In 1994 after South Africa became a democracy and freed itself of their racist white government, blacks were left uneducated, unskilled, and living in townships where they had been forcibly moved, in conditions of abject poverty. Shacks housing millions of people with little or no amenities or employment opportunities stood on the outskirts of the cities we visited. These slums were worse than anything I could imagine, although I have since learned that 1 billion people worldwide, or more than 1 in 7, live in such conditions. I was unprepared for what I saw, and my emotions welled up inside me more than once.
Nearly 19% of South Africa’s adult population is now HIV positive. The Mbeki government made things worse for a time as they denied the link between HIV and AIDS and promoted folk remedies and stood in the way of people getting the Anti-Retroviral Drugs (ARV’s) critical to controlling the virus. Conditions in hospitals were unlike anything we westerners are familiar with. In one hospital, I saw hundreds of people filling every nook and cranny waiting to be seen. The AIDS clinic opened at 8 am and closed at 4 pm that day. People started queuing up in the early morning hours in hopes of being seen. The elderly would have someone younger in their family hold a place in line for them until the clinic opened. If you were fortunate, a health worker would examine you and report to the single physician manning the clinic that day so that you could receive medication and/or other treatment. If you were not so lucky, 4 pm would roll around and you would go home to start the same process again the next day.
In South Africa HIV/AIDS is primarily a disease of heterosexuals, transmitted in the black community by the men who do not acknowledge their HIV status, to the women they have sex with, either consensually or forcibly. The ABC’s that are being taught to the populace are “Abstinence, Being Faithful, and Condomizing.” Because of the overwhelming number of AIDS deaths every week, and because funerals are held only on Saturdays and Sundays by custom, weekends are consumed with funerals, and the graveyards are fast filling up.
Because we were traveling with a group that helps support the agencies we were visiting, nearly everywhere we went the workers greeted us with songs in their tribal dialect with beautiful South African rhythms and harmonies. One Sunday we went to services in a Church in the townships and heard perhaps 1000 such voices singing Gospel songs. Even for a non-believer like myself, it’s difficult to imagine that the beauty of these voices was not being heard on high. It was a powerful spiritual experience.
Every time we witnessed situations that seemed overwhelming and made me feel hopeless, we would meet ordinary people doing amazing work to overcome the double scourge of the residues of apartheid and the current blight of AIDS, and I’d feel hopeful again. We met exceptional human beings throughout our trip, but of special note were three people from three different generations: Helen Suzman, age 89, was the leading voice in the Parliament for 35 years speaking out against apartheid; Helen Lieberman, age 63, a social worker in Cape Town, founded her own NGO, Ikama Labantu, and has devoted her entire adult life to providing social services for blacks despite enormous personal danger to herself for doing so; and Jacob Lief, a precocious 29 year old American, has set up his own extensive non-profit social services organization in Port Elizabeth and demonstrates the acumen of a corporate CEO in dealing with his complex organization.
We drove down the only street in the world where two Nobel Peace Laureates reside—Bishop Desmond Tutu and Nelson Mandela. The prestigious international recognition of these two contributors to overcoming apartheid signifies the importance that others have attached to building a new South Africa.
South Africa looks very much like the United States, unlike what I felt when I was in East Africa some 10 years ago where everything there looked different to me—the sky, the landscape, and the cities. But in South Africa, I felt at home. Johannesburg was like New York City, Cape Town felt very much like San Francisco (including having its own wine lands an hour away), and Port Elizabeth was a lot like many moderate sized beach towns along our coasts. The country is a mix of first world western conditions contrasted with, and lying adjacent to, developing world conditions. It’s a country worth visiting for many reasons, not the least of which is that it is on the brink and needs our help. I encourage you to go there and to educate yourself about this vast land on the opposite side of the globe half surrounded by the Atlantic and Indian Oceans. You won’t regret having made the effort. It’s quite a place to behold and a place worth saving.
--Hugh R. Winig, M.D.
(Published in the Esst Bay Psychiatric Association Newsletter, April 2007)
This past February, my wife and I spent 10 days touring 3 major cities in South Africa: Johannesburg, Cape Town, and Port Elizabeth. We went on a Study Tour with The American Jewish World Service (AJWS). This charitable organization provides funds as well as volunteer and technical assistance to grassroots organizations in the developing world. It helps support over 300 projects in some 36 countries in Asia, Africa, and South America. We visited about a dozen such non-governmental organizations (NGO’s) in an effort to understand their efforts in combating the HIV/AIDS pandemic now ravaging South Africa. One thousand people a day are dying there from this disease, and twice that many are becoming newly infected daily.
I knew little about South Africa prior to this trip, outside of its history of apartheid. I learned that from 1948 until 1994 blacks not only had no vote, but that they also were deprived of any meaningful education. In 1994 after South Africa became a democracy and freed itself of their racist white government, blacks were left uneducated, unskilled, and living in townships where they had been forcibly moved, in conditions of abject poverty. Shacks housing millions of people with little or no amenities or employment opportunities stood on the outskirts of the cities we visited. These slums were worse than anything I could imagine, although I have since learned that 1 billion people worldwide, or more than 1 in 7, live in such conditions. I was unprepared for what I saw, and my emotions welled up inside me more than once.
Nearly 19% of South Africa’s adult population is now HIV positive. The Mbeki government made things worse for a time as they denied the link between HIV and AIDS and promoted folk remedies and stood in the way of people getting the Anti-Retroviral Drugs (ARV’s) critical to controlling the virus. Conditions in hospitals were unlike anything we westerners are familiar with. In one hospital, I saw hundreds of people filling every nook and cranny waiting to be seen. The AIDS clinic opened at 8 am and closed at 4 pm that day. People started queuing up in the early morning hours in hopes of being seen. The elderly would have someone younger in their family hold a place in line for them until the clinic opened. If you were fortunate, a health worker would examine you and report to the single physician manning the clinic that day so that you could receive medication and/or other treatment. If you were not so lucky, 4 pm would roll around and you would go home to start the same process again the next day.
In South Africa HIV/AIDS is primarily a disease of heterosexuals, transmitted in the black community by the men who do not acknowledge their HIV status, to the women they have sex with, either consensually or forcibly. The ABC’s that are being taught to the populace are “Abstinence, Being Faithful, and Condomizing.” Because of the overwhelming number of AIDS deaths every week, and because funerals are held only on Saturdays and Sundays by custom, weekends are consumed with funerals, and the graveyards are fast filling up.
Because we were traveling with a group that helps support the agencies we were visiting, nearly everywhere we went the workers greeted us with songs in their tribal dialect with beautiful South African rhythms and harmonies. One Sunday we went to services in a Church in the townships and heard perhaps 1000 such voices singing Gospel songs. Even for a non-believer like myself, it’s difficult to imagine that the beauty of these voices was not being heard on high. It was a powerful spiritual experience.
Every time we witnessed situations that seemed overwhelming and made me feel hopeless, we would meet ordinary people doing amazing work to overcome the double scourge of the residues of apartheid and the current blight of AIDS, and I’d feel hopeful again. We met exceptional human beings throughout our trip, but of special note were three people from three different generations: Helen Suzman, age 89, was the leading voice in the Parliament for 35 years speaking out against apartheid; Helen Lieberman, age 63, a social worker in Cape Town, founded her own NGO, Ikama Labantu, and has devoted her entire adult life to providing social services for blacks despite enormous personal danger to herself for doing so; and Jacob Lief, a precocious 29 year old American, has set up his own extensive non-profit social services organization in Port Elizabeth and demonstrates the acumen of a corporate CEO in dealing with his complex organization.
We drove down the only street in the world where two Nobel Peace Laureates reside—Bishop Desmond Tutu and Nelson Mandela. The prestigious international recognition of these two contributors to overcoming apartheid signifies the importance that others have attached to building a new South Africa.
South Africa looks very much like the United States, unlike what I felt when I was in East Africa some 10 years ago where everything there looked different to me—the sky, the landscape, and the cities. But in South Africa, I felt at home. Johannesburg was like New York City, Cape Town felt very much like San Francisco (including having its own wine lands an hour away), and Port Elizabeth was a lot like many moderate sized beach towns along our coasts. The country is a mix of first world western conditions contrasted with, and lying adjacent to, developing world conditions. It’s a country worth visiting for many reasons, not the least of which is that it is on the brink and needs our help. I encourage you to go there and to educate yourself about this vast land on the opposite side of the globe half surrounded by the Atlantic and Indian Oceans. You won’t regret having made the effort. It’s quite a place to behold and a place worth saving.
--Hugh R. Winig, M.D.
TIME MOVES IN ONLY ONE DIRECTION
(Published in the East Bay Psychiatric Association Newletter, May 2007)
When my Dad turned 80 some years ago, a friend of mine gave him a book entitled “Getting Old Is Not For Sissies.” I didn’t fully realize then the implications of the title, as I was still in my late 40’s at the time. Now, as Medicare and Social Security loom around the bend for me, I am beginning to appreciate better the hard work of getting old that lies ahead. The march of time takes its toll on everyone, and everyone needs to train him or herself to be old in order to avoid certain pitfalls. Getting older requires major attention to one’s emotional, attitudinal, and physical wellbeing.
The emotional side of things is probably the subtlest. People have to learn to be comfortable when they no longer have a schedule, when they no longer are earning an income, and when they are spending more time alone. For most people this is a radical change, as one’s earlier adult years were usually spent maximizing income within the context of a job with a schedule and social interactions. Leisure time, although previously yearned for, may now feel unnatural; and time alone, rather than being enjoyable, may be experienced as isolative.
A shift away from one’s earlier sense of purpose begins to occur between ages 50 and 70. It is during this period that one needs to behave more like we did as children--to be able to play, to enjoy whiling away the time, and to pursue activities just for the sheer pleasure of them. One has to strategize about these new realities or one will be bored, no matter how much money and freedom one has carefully planned for. I’ve known retirees who can’t find enough hours in the day to pursue all the interests they have, but I’ve also known those who complain that “retirement is not all that it was cracked up to be,” and they dread the boring days that stretch out before them.
For those living in the transitional stage going from “working hard” to “hardly working,” it is important to take the time to understand your new needs, to assess your physical, emotional, and financial health, and to develop a plan to address your new realities. Retirement can be a time of creativity, newfound freedom and interests, and revitalization, but alternatively it could become a time of stagnation, isolation, and decline. There are academic courses to be taken, arts and crafts to explore or master, cultural interests to pursue more extensively, more time to spend with friends, and time to travel more extensively.
Attitude can be critical. A year ago my wife and I took an adventure trip to Costa Rica and Panama. It was a small boat cruise with elective physical activities every day, including kayaking, snorkeling, hiking—you name it. One of our travel companions on this trip was a 90 year-old man named Sidney who had taken the trip with a much younger female friend (his wife had died many years earlier), knowing he could no longer partake in the challenging physical offerings on the cruise, but wanting to continue to travel nonetheless. Every evening after the rest of us were pleasantly fatigued from our day’s activities, Sidney and I would sit on deck with a cocktail and he would wax eloquent about his past years of growing his own business and about all the other places he had traveled to. He reported that he had turned over the ownership of his company to his son years ago, but still went to his office regularly to keep busy because “my son was kind enough to give me an office to go to.” Sidney’s companionship greatly enhanced my trip, and I know that he had a wonderful time that week as well. But it was Sidney’s attitude of continuing to engage life so fully that impressed me the most.
The other major challenge of old age is attending to one’s physical wellbeing. The major tactic for helping oneself is this area is developing the habit of exercise. If there is one single thing to do for oneself that can enable you to look better, feel better, and live longer, it is to exercise regularly. This doesn’t mean running marathons. It’s a simple matter of a three-mile walk or its equivalent four or more days a week. Forget all those other claims of revitalization that are advertised. Exercise is as close to the fountain of youth as you can get.
Despite maintaining a regular schedule of exercise, the ravages of physical decline with age may become overwhelming nonetheless. There can be losses that can change everything for the worse, and these losses may mount up and become overwhelming. Your own good health is one crucial requirement for happiness, but for those who are in a long-term committed relationship, the life and health of one’s partner is as critically important as one’s own. If you or your partner’s health seriously declines, or your partner dies, retirement becomes a far different experience than you may have anticipated or predicted.
I would recommend a recent article in the New Yorker magazine (April 30 edition) by Atul Gawande, the Harvard surgeon who is also a gifted writer. The article, “The Way We Age Now,” describes the physical aspects of the body’s inevitable deterioration and what can be done to manage these changes. Gawande is particularly concerned about that lack of trained geriatricians who know how to treat the physical and emotional needs of the elderly, as opposed to the average internist who is best at primarily treating disease entities. Geriatric patients are mainly at risk for depression, social isolation, malnutrition, and the danger of falling. Having a personal doctor who looks after you with regard to these risk factors is important if and when you get to be in your 80’s and 90’s.
To the degree that one does have some control in life’s later stages, it would seem best to exercise that control to maximize one’s happiness. Some things are, after all, out of our control, and since time moves in only one direction, the one thing we know for certain is that eventually we will all run out of time itself!
Hugh R. Winig, M.D.
(Published in the East Bay Psychiatric Association Newletter, May 2007)
When my Dad turned 80 some years ago, a friend of mine gave him a book entitled “Getting Old Is Not For Sissies.” I didn’t fully realize then the implications of the title, as I was still in my late 40’s at the time. Now, as Medicare and Social Security loom around the bend for me, I am beginning to appreciate better the hard work of getting old that lies ahead. The march of time takes its toll on everyone, and everyone needs to train him or herself to be old in order to avoid certain pitfalls. Getting older requires major attention to one’s emotional, attitudinal, and physical wellbeing.
The emotional side of things is probably the subtlest. People have to learn to be comfortable when they no longer have a schedule, when they no longer are earning an income, and when they are spending more time alone. For most people this is a radical change, as one’s earlier adult years were usually spent maximizing income within the context of a job with a schedule and social interactions. Leisure time, although previously yearned for, may now feel unnatural; and time alone, rather than being enjoyable, may be experienced as isolative.
A shift away from one’s earlier sense of purpose begins to occur between ages 50 and 70. It is during this period that one needs to behave more like we did as children--to be able to play, to enjoy whiling away the time, and to pursue activities just for the sheer pleasure of them. One has to strategize about these new realities or one will be bored, no matter how much money and freedom one has carefully planned for. I’ve known retirees who can’t find enough hours in the day to pursue all the interests they have, but I’ve also known those who complain that “retirement is not all that it was cracked up to be,” and they dread the boring days that stretch out before them.
For those living in the transitional stage going from “working hard” to “hardly working,” it is important to take the time to understand your new needs, to assess your physical, emotional, and financial health, and to develop a plan to address your new realities. Retirement can be a time of creativity, newfound freedom and interests, and revitalization, but alternatively it could become a time of stagnation, isolation, and decline. There are academic courses to be taken, arts and crafts to explore or master, cultural interests to pursue more extensively, more time to spend with friends, and time to travel more extensively.
Attitude can be critical. A year ago my wife and I took an adventure trip to Costa Rica and Panama. It was a small boat cruise with elective physical activities every day, including kayaking, snorkeling, hiking—you name it. One of our travel companions on this trip was a 90 year-old man named Sidney who had taken the trip with a much younger female friend (his wife had died many years earlier), knowing he could no longer partake in the challenging physical offerings on the cruise, but wanting to continue to travel nonetheless. Every evening after the rest of us were pleasantly fatigued from our day’s activities, Sidney and I would sit on deck with a cocktail and he would wax eloquent about his past years of growing his own business and about all the other places he had traveled to. He reported that he had turned over the ownership of his company to his son years ago, but still went to his office regularly to keep busy because “my son was kind enough to give me an office to go to.” Sidney’s companionship greatly enhanced my trip, and I know that he had a wonderful time that week as well. But it was Sidney’s attitude of continuing to engage life so fully that impressed me the most.
The other major challenge of old age is attending to one’s physical wellbeing. The major tactic for helping oneself is this area is developing the habit of exercise. If there is one single thing to do for oneself that can enable you to look better, feel better, and live longer, it is to exercise regularly. This doesn’t mean running marathons. It’s a simple matter of a three-mile walk or its equivalent four or more days a week. Forget all those other claims of revitalization that are advertised. Exercise is as close to the fountain of youth as you can get.
Despite maintaining a regular schedule of exercise, the ravages of physical decline with age may become overwhelming nonetheless. There can be losses that can change everything for the worse, and these losses may mount up and become overwhelming. Your own good health is one crucial requirement for happiness, but for those who are in a long-term committed relationship, the life and health of one’s partner is as critically important as one’s own. If you or your partner’s health seriously declines, or your partner dies, retirement becomes a far different experience than you may have anticipated or predicted.
I would recommend a recent article in the New Yorker magazine (April 30 edition) by Atul Gawande, the Harvard surgeon who is also a gifted writer. The article, “The Way We Age Now,” describes the physical aspects of the body’s inevitable deterioration and what can be done to manage these changes. Gawande is particularly concerned about that lack of trained geriatricians who know how to treat the physical and emotional needs of the elderly, as opposed to the average internist who is best at primarily treating disease entities. Geriatric patients are mainly at risk for depression, social isolation, malnutrition, and the danger of falling. Having a personal doctor who looks after you with regard to these risk factors is important if and when you get to be in your 80’s and 90’s.
To the degree that one does have some control in life’s later stages, it would seem best to exercise that control to maximize one’s happiness. Some things are, after all, out of our control, and since time moves in only one direction, the one thing we know for certain is that eventually we will all run out of time itself!
Hugh R. Winig, M.D.
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