[Above photo: Crossing the Gokteik viaduct, the second highest bridge in the world when constructed by the Brits in 1901. The train crosses it at a slow walking speed, swaying and creaking.]
20 September 2019
For those of you who were concerned that something was wrong when I didn’t post last weekend, I appreciate the sentiment. I was underwater, preparing the final exams and a lecture and exercise on Couples Therapy, for which I had to finish reading a text. This weekend is similar, with breaks for two suppers with friends and catching a film at the Myanmar Film Festival. Plus, I’ll go with one of my students, likely each day, to see a 13yo boy in hospital who attempted to kill himself by drinking organophosphate pesticide. So this entry is it for both weeks.
The lad is from a small farming village and is a tiny boy for his age, preferring to play with girls than in the rough and tumble with his male peers. His uncles and other village adults tease him, calling him “Gay”. He has been getting more and more depressed over the past 2 months, culminating in an early morning attempt. Fortunately, his father found him soon after he ingested it. He is very smart and excels at school, but deviations from cultural norms are no more easily tolerated here than anywhere. I’m thinking of Matthew Shepherd and the powerful play about his death some years ago.
He will hardly talk with us, so we must lure him out of his cave. We don’t know if his suicide attempt was triggered simply by the teasing, by being so petite, if he is gay, if he is transsexual, or whatever else but he cannot leave the protection, such as it is, of the hospital until we have a better understanding and a sense that he is safer than he is at present. Projection can partially relieve us of painful, unwanted feelings but it also can turn those around us into our seeming critics and enemies. Part of our job will be to help him accept his conflicted feelings, whatever they are, so that he can then see us as sympathetic to them and identify with that acceptance.
This is all complicated by the fact that he lives 6 hours away and the family is as poor as church mice so travel to our clinic would be prohibitive. There are, of course, no mental health services anywhere near him. I may have to fund their transportation for awhile. My students regularly pay for their private patients’ medication if the latter cannot afford the cost.
I obviously have decided that I can describe cases from our clinic here, if disguised, without violating principles of confidentiality.
Speaking of which, my last weekend was spent in some agony. Well, something considerably more painful than a quandary. One of my students who struggles with boundaries—timeliness, sharing information—-said she had prepared lunch for us both. The students generally share, with me and each other, whatever is on the table in front of them. It was duck and it was very tasty, especially the gravy which she liberally ladled onto my rice. Walking out of the restaurant where we were eating—As long as you buy some side dishes, they aren’t upset if you bring in food, happy for any business and hopeful for more in the future.—, she said, “Professor, I owe you an apology.” Wonderful, coming to some sense about those inappropriate Facebook posts or drifting into class, regularly, an hour late. Not to be. “I put some cannabis in the lunch.” I was stunned, and hopefully not on my way to stoned, as I had to lead a 1 ½ hour discussion of the Felitti et al ACE (Adverse Childhood Events) study, a landmark in the trauma literature.
I felt no effects from the drug but massive effects from the revelation. I resolved to discuss it with her before talking with Professor Tin Oo. I thought her judgment is so poor that she should be prevented from working with patients. Maybe she can re-train as a pathologist or radiologist. I like her a lot; she is kind and bright but a bit unhinged by critical, persecutory parents. Still, she has a lovely 10yo daughter and is totally in love with her and her younger sister, breaking the generational chains binding her mother and grandmother to their hated parents. I lost sleep and felt awful at what I had to do—-to protect patients in the future and to protect her from self-destructing with them.
Monday I took her aside and asked why she had invited me to lunch and, unbeknownst to me, put cannabis in it. What did she expect would happen? She looked very puzzled. Then she laughed and said, “It was just a little pinch. The Shan and Karen use it to flavor poultry dishes.” I later checked with others and it is true. I could have hugged her but, mindful of my boundaries, I didn’t. My relief was audible, as I sighed and she laughed. Her judgment isn’t that impaired.
I was asked to meet with the head of Child Protection for UNICEF and after some talk, they want to hire me to do some training of Medical Social Workers in the various conflict zones. I’ll not be in the line of fire, for those who might worry. They have had no mental health training and need to learn how to be helpful to children traumatized by the fighting, by displacement from their homes, by the loss of a family member, and by what they may have witnessed. Once you put your toe in this water I think there is plenty of opportunity for work, paid work.
We saw a 9 year old girl from rural Rakhine State who has developed panic attacks over the past two weeks. Her village, which sits in a valley, has been underneath a battle being fought between the Arakan Army and Myanmar government forces dug in on opposing hillsides; there has been no damage to the village and no soldiers passing through it but the thunder of constant shelling overhead has terrified her. We adults are so depraved at times.
Speaking of which….No, I’ll restrain myself. I do get a little addicted to rotating through the talking heads on YouTube—Trevor Noah, Seth Meyers, and Stephen Colbert. All of their narcissism is a bit overwhelming but not, to me, as consuming as Rachel Madow’s. Her pace is so slow that I find it off-putting, although her analyses are sometimes excellent. Surprising to me, I like the Daily Show the best. And I read the daily NY Times. It all leaves me feeling a little ill, staring into space, like after eating too much popcorn.
Torrential rains and lightning last night awakened me. It was, hopefully, the last throes of the rainy season before we move into drier and a bit cooler weather. I’m liking The Burma Beat.
A Psychiatrist in Myanmar 