26 May 2019
[Above photo: A snapshot from my deck of the evening sky during the rainy season. ]
Yesterday on our trip to the University of Medicine 1 cafeteria I suggested that we eat somewhere else for variety. Kyi Min Tun, who was driving, read my mind before I had the thought and had already planned an outing to a place he knew from student days. We were heading down Lamnidaw Lan just before the train overpass near the University when he turned right into a dusty yard. A little restaurant sat in the back serving authentic Shan food. It has been there for 18 years. Clean, modest, quiet, inexpensive. I’d never seen, or eaten, any of the dishes and were they amazingly good! Steamed fish in banana leaf. Fermented pork with rice steamed in a banana leaf. Shan noodles with a wild, goopy, soft-tofu sauce. Steamed chicken feet with a spicy, lime dipping sauce. And more.
The conversation turned to the film we’d seen the day before, Daddy and Papa, about gay men adopting children. A friend of mine who is a gay dad and a documentary film maker used the occasion of their first adoption to explore the issue, complete with footage of Anita Bryant on one of her rants. It stimulated a lively discussion in our class and I was able to correct some misperceptions. No, they are not simply recruiting children for sex. Yes, the studies so far show no difference in outcomes of child adjustment between gay and straight parents. Gay marriage is too new to be able to speak intelligently about its comparative longevity. And, no, there is absolutely no increase in homosexuality in the children of gay men as compared to the children of heterosexual couples. And pedophiles share common qualities with adult rapists, not homosexual men.
Hnin Aye slyly inserted that pigeons are the birds with the highest percentage of gay males, a suspect fact. More fascinating to me than avian homosexuality is the reaction to it: “Homosexuality in animals is seen as controversial by social conservatives because it asserts the naturalness of homosexuality in humans,” How burdened and constricted, if true. She also encouraged me to try the chicken feet. I ate one, found it pretty strange nibbling on little fat flavorless fingers, and don’t feel a need to repeat the challenge. I was then told of “Home Chicken”, skinny, flavorsome free-rangers vs. “CP Chicken”. The latter are the huge, bloated, fatty things we buy in the supermarket, named after the CP Corporation, a huge, bloated Thai multinational enterprise with branches throughout Myanmar. I was assured that CP Chicken lacks flavor and is filled with fat, hormones, and antibiotics, which I doubt not. Home Chicken is called Local Chicken in Malawi, and makes for a dry, stringy lunch. I seem to be cooking suppers for myself, mostly, and haven’t bought chicken, eating lean pork, shrimp, and fish. It was fun, the 5 of us in this tiny place feasting for about $3 each. It’s certainly not in the guide books and I would never have found it.
Last night was the wildest sunset ever. The sky was deep orange, with thunderheads and lightening all around. I could see it was pouring rain in the northeast of Yangon. The night before it had poured in the northwest of the city, according to one student who stays there. No real rain in Chinatown, however. I keep waiting to try out my new, larger and sturdier, umbrella. No rain dances.
We saw a just-ten year old girl who lives 3 hours away, referred to us from the neurologists. She is an inpatient at Yangon Children’s Hospital while she is being worked-up. A normal, bright, happy child with good friends who did well in school, 7 months ago she began to withdraw from her friends and family, having auditory and visual hallucinations, fearing others might hurt her, not talking, and withdrawing from school. The neurologists, who have considerable experience, want to rule out Anti-NMDA Receptor Encephalitis but think that she has Childhood-onset Schizophrenia. Never having heard of Anti-NMDA Receptor Encephalitis I read about it, and reviewed Childhood-onset Schizophrenia (of which I recall having treated 2 cases, total) last night and think that she has the former. She was a normal, social kid with no gradual cognitive or social decline or other manifestations suggesting Schizophrenia until, suddenly, it was upon her. The crucial difference is that most NMDA is highly treatable with immunosuppressives whereas Childhood-Onset Schizophrenia is a life-long disease with progressive deterioration. They’ll do a lumbar puncture, get antibodies, and make a decision. I’ll push them for a trial, at least, of immunosuppressives. The stuff I am learning!
On a cheerier note, two students started play therapy with the girl who’d been molested in her pre-school. They had little confidence or idea of what they were doing, despite my teaching. To learn to do therapy all must read about theory and technique but can only learn it by supervised doing. Anyway, I quietly observed, as did other members of the class. It seemed awkward to me since I am accustomed to being alone in a quiet room with a child, but the girl was focused on her play and seemed oblivious to us. She developed play themes of attack and defense, of drowning and being rescued, of being rewarded and admired, and of running away and being found, always engaged with the therapist. Afterwards, the class gathered around and we tried to make sense of it. Of course, since we were just beginning to see her, we could mostly observe and note, try to help the two students conducting the therapy to not interfere or moralize—-“You shouldn’t punch him. He just rescued you from drowning.”—and remind them of their role(s) as containers of her feelings. We’ll see where it goes but I am excited to get them started at last. I’ll videotape the sessions so we can review them as a group.
I met an Australian, Harry Minas, a Psychiatrist in Public Health at the University of Melbourne, who is consulting with Dr. Tin Oo and others as they develop a National Mental Health Policy for Myanmar. It is thrilling and I have been assured that Child and Adolescent Mental Health is included. I can’t really advocate to be on the committee, although it would make sense to have a Child and Adolescent Psychiatrist on it. I was told that they’ll be writing a Curriculum for a year-long Child and Adolescent Psychiatry Diploma course, equivalent to a US Child and Adolescent Fellowship, which they want me to edit. I’m tempted to teach part of it but I also want to create my life in Maine so perhaps I can do a couple of months here. In any case, Harry is a terrific and interesting guy who will help them and who I wish lived here. He’d be a fun friend.
How ironic that I should be preparing my lectures on ADHD for the class and I demonstrate, to myself, a perfect example of it! I went shopping this morning for enough meat/fish and vegetables to feed me for several days. I bought from various street vendors on Maha Bandoula and 18th streets. The entire operation, from leaving my apartment to returning took less than 30 minutes and I now have enough pork, prawns, and fish to last a week, as well as a variety of fresh vegetables. As I was soaking the veges in a bit of bleach for 5 minutes, I prepared the protein to store, trimming the pork, splitting it into smaller portions, and freezing it.
Then I realized the fish wasn’t cleaned. Nor was it scaled. So I set to work, feverishly, scales the size of dimes flying all over the kitchen, in my hair, on the floor, amongst the condiment jars. At some point I realized this wasn’t the smartest way to do it but forged ahead. The long and short is it took about an hour to gut and scale the fish and then clean up the mess. I could have done it in the sink with minimal scatter in 10 minutes. That’s why there is a fish cleaning station on the beach at the Skeleton Coast in Namibia, a concrete trough with fresh water, far from floors and counters and dishtowels. Talk about impulsivity and a failure of executive function.
I am disciplined enough that I can force myself to focus and work creatively. A patient I saw for several years came in with a new haircut one day. When I didn’t comment, being hyperfocussed on what she was saying, she accurately stated, “You wouldn’t notice if I came in wearing a burka.” Alternately scattered and hyperfocussed, often very inefficient and having to re-do things, I work much harder than I need to. In the past when I’ve wondered idly if I had ADHD, it seemed like an excuse I was giving myself and I dismissed it. I think it is part of why I enjoyed my psychotherapy practice so much; the work welcomed my hyperfocus and I enjoyed not going in seven directions at once. As if my handwriting wasn’t enough of a tipoff. I was the only kid in 2nd grade whose handwriting was so bad that I had to copy a page from a Shakespeare synopsis every night as we learned cursive. It still is nearly illegible. Just imagine, with a little Ritalin I might have been a contender. Ha, ha. Is that from Requiem for a Heavyweight?
Good god! Today provides the second of two incredible downpours in two days. Most impressive is the lightening and thunder; the latter is almost simultaneous with the former, indicating proximity. So close, the thunder sounds like a howitzer shot, crisp, cracking, and fearsomely loud. Makes a penthouse dweller wonder why he hadn’t snugged up on a lower floor in the middle of the building. I am a bit reassured by taller buildings some blocks away, often with metal structures on top, so I will just unplug all my electronics and hope for the best. Kit Cowperthwaite, who lived in Denver and was a few years my senior, was hiking with his girlfriend on a summer day in the Rockies when an afternoon electrical storm hit, blasting him out of this world. I also recall a tale of a hiker sheltering in the stone hut on top of Mount Whitney during a storm when a lightning bolt hit the hut, throwing him across the room. Like being on a sailboat in mid-ocean, I am respectful—sometimes terrified—of Nature’s dispassionate, unselective fury.
It does recall my terror at my mother’s loud dark moods when I was a young child; I suspect it felt just as dangerous as the lightening. Surely a good Shan couq swe—their equivalent of matzoh ball or chicken noodle— soup would calm the troubled spirits.
A Psychiatrist in Myanmar 