Sharing

31 March 2019

[Above photo: In traditional Myanmar formal dress.]

Burmese people share. Constantly and without expectation of return, I think. Little gifts of tamarind candy, or spicy, crunchy rice cakes.  Tea. At lunch on Mon-Thursday I sit with my students. Some bring food from home in those stainless steel containers that nest so nicely. Some buy lunch in the cafeteria. All of them put a bite onto my plate and onto other’s plates. Or if they want a bite, they ask for it. It is so sweet.

The students are all curious but non-competitive. They ask great questions, dispelling my worry that ain deh (Don’t ask. You may cause someone to lose face.) would reign. After I tried to explain projective identification for the third time, I said, “Let me see if I can find something to clarify this complex concept”. I’ve been on the receiving end of it many times, feeling corrupt, exploitive, useless, enraged, etc. with a couple of Borderline Personalities I saw for a number of years. I’m not sure how well I always managed those; I want to prepare the students for what they may experience. I think how far they all might have gone in their training and in their careers if they’d only been born elsewhere.

When I have looked for shampoo I keep seeing “White” and “Ultra White” on labels of lotion in the adjacent shelves. Tell me it isn’t so. But it is. And broadly so.  Asian women think that light skin is much more beautiful that brown skin. I expressed my surprise and dismay. The stuff has some sort of bleach in it. I mean, all lotions. It made me think of the Chris Rock film “Good Hair”. When I think of how poorly adapted my white Anglo-Saxon skin is to tropical Asia and Africa, I blanche. Brown is so healthy looking to me. And if people will keep intermarrying we’ll all eventually be a lovely café au lait.

Shifting topics, I have noted rusty red splotches on the sidewalks and streets. At first I thought, cavitary tuberculosis must be rampant, with people hawking up blood and expectorating it. Fortunately, it is “just” betel nut juice. Looking into someone’s mouth the first time when they are chewing is breathtaking, like discovering a vampire or a cannibal. Their teeth and gums are stained dark red. Now I see the betel nut sellers with their leaves, lime and flavor solutions, and bits of nut. They have an organized operation, like many drug dealers do. I’m not sure if I’ll try it.  Too many unwashed hands involved without any cooking, I think. The major booze competition here seems to be between High Class and Glan Master whiskies. That’s not a typo. For medical types, the glans is the head of the penis. Or perhaps it is from “Glen”, the Scottish term for a valley.  Or, likely, “Grand”. There may be a little subliminal advertising there. Remember Vance Packard and The Hidden Persuaders?  I have a bottle of High Class—-it must be so or they wouldn’t name it such, right? I’ll bring it and some Glan Master back when I return next year.

Another interesting bit is Chinese Stainless Steel, which appears to be an oxymoron. My sink and dish drainer were brand new, supposedly Stainless Steel. Both are rusting out rapidly. As I was doing some exercises the other night a large cockroach crept from my bedroom into the living room. I think it was headed for the kitchen, the source of all things tasty for roaches. When I say large, I mean 1 ½ inches long, not the massive central American or Hawaiian variety. You can step on those and they’ll simple keep walking, carrying your foot away. I don’t think it lives here. Probably came in from the deck through an open window. I gave it a solid thwacking with a fly swatter I bought. And deposited it in the garbage, which is where it was headed. Dead, though.

I went to the International School of Yangon annual gala fundraiser on Friday. My secret was to wear a black belt around my waist. With my taikpon buttoned, it wasn’t visible, and I never worried once about my pa so falling off. Only one other person was dressed in Burmese traditional. He introduced himself to me and we hit it off. I’ll meet him for lunch next week. He moved from Yangon to the US at 14yo, was a consulting engineer, and recently retired, moving back to Myanmar with his stunning wife. He was a scout leader in the US and both his sons are Eagle Scouts. He volunteers a lot here in schools. A really good guy with an interesting tale.

The gala was fun, with raffles and auctions and performances, and, eventually, dancing. Of the 250 people attending, only about 40 stayed for the dancing. My feet hurt in my awful pha net (I think they are 2 sizes too small.) so I kicked them off and danced in my bare feet. I won two nights at the Sule Shangri La with a raffle ticket. (Not for my dancing!).   The Sule is the very fancy hotel where the gala was being held. I gave them to Ruth, the teacher who asked me to the gala, since she has a studio apartment and has friends who visit. I’ll never use them, having an extra bedroom in my penthouse. [Addendum: It turns out it was brunch for two at the Sule Shangri La. My auditory discrimination issue.]

This morning I went out early to get a papaya for breakfast and some vegetables for supper and discovered two busy dim sum operations at the end of the block. So I bought a number of them and brought them back for breakfast. Gale, a Fulbright math professor who has been teaching in Mandalay, has been staying here for 3 nights and now is off to Columbo, Sri Lanka for a vacation with her partner who flies in from the US this evening. She is really fun and full of energy for ideas and travel and standing up for her students, especially the females who are discriminated against by dress code (must wear longyi) and curfew (girls in by 6, boys may be out until 10). She’s spunky, like Linda, and I admire it. Trying to nudge this society ahead, inch by inch.

I went to the clinic on Thursday and there was a “drug fair”.  It was approved by the Neurology Department so included booths touting a variety of anticonvulsants (sodium valproate, lamotrigine, etc) but also some old-fashioned snake oil, complete with extravagant claims on gaudy posters. For example, Kalysmon, a multivitamin “essential for prevention of infections by increasing Body Resistance” and “gives your child a good appetite and keeps them smart”.  Then Daneuron (Vit B1, B6, and B12) which is used to “Get rid of chronic pain” including “Inflammation of the optic nerve”, “Intense facial pain”, “Pins and needles”, “Sciatica”, and “Numbness”. And, Preven C Soft Caps (Vit E and refined fish oil) whose claims include “Strengthening Brain Function”, “Improving and Strengthening Visual Acuity”, “Prevention of atherosclerosis and cardiovascular disease in patients with high risk”, and “To improve brain function and growing up of the infant in the last period of pregnancy”.  From Indonesia in the purple trunks.

And weighing in for this heavyweight bout from the US in the red, white, and blue, a variety of SSRI’s with similarly doubtful results. Fluoxetine (Prozac) decreased the score on a depression scale by 30% in 53% of children and adolescents diagnosed as having Major Depressive Disorder. Placebo decreased it in 28% of the control group of depressed kids. The conclusion, which seems like boiler-plate for these studies, was “Prozac is, thus, safe, effective, and well-tolerated” for major depression in children and adolescents. Not strikingly effective, it seems. This is a many, many billion dollar industry built, I think, on sand.

I have thought that, yes, antidepressants aren’t so effective (in adults) for mild or moderate depression but they really do work well for severe depression where there is a large difference between active drug effect and placebo effect. On a close reading, it turns out the latter is due to a decreased placebo effect in severely depressed adults, not from increased efficacy of the drugs.

It is important to talk about these issues of drug money driving (corrupting) the marketing of drugs with my students but I must do it carefully since they are taught medication management of psychiatric illness only—with a bit of motivational interviewing tossed in—and no psychotherapy. I’ll arm them with psychotherapy skills.

I started this with sharing. I guess I end it with sharing my disappointment in the drug industry, in the health insurance/HMO industry that promotes the drugs as a cheap alternative to therapy, and in those of my US colleagues who, incuriously, peddle pills for a living, fooling themselves as to what is helping, or might help, their patients.