14 June 2020
[Above photo: At our University of Medicine 1 library classroom. The woman on the TV screen is out of the picture to the left. She is doing Zoom psychotherapy with a 15yo girl in Dawei.]
This was the first week in our new clinic space. The students and I bought a couple of child-size tables and interlocking rubber foam pads for seeing children from a huge discount warehouse. On our second day a 15yo girl was brought in by her employer. The girl is a housemaid from a very poor village family and has been having nightmares. She imagines that a man is naked in bed with her and squeezing her very hard. She’s also been hearing voices telling her that she is a bad girl, but she is far from psychotic. She is bright and quick and very engaging. I wonder if she is trying to tell us that a naked man, the husband of her employer, for example, is getting into bed with her and squeezing her very hard. I fear for her if the man of the house is abusing her; she’ll have to leave and her employer, the woman, seems very attached to her and helpful. There is no child protection service, no SCAN team (Suspected Child Abuse and Neglect) to summon. We’ll see how it plays out at the next visit.
I’ve done some more cooking. I baked another loaf of onion bread but this time I ran out of wheat flour. I had a sack of glutinous rice flour to make an incredible cardamom cake Ariane told me about so I used that. It wasn’t so great as it browns quickly, doesn’t rise very well, and the bread is pretty underdone inside. Still, it’s good for grilled cheese sandwiches and for toast with lovely New Zealand butter on it. I bought asparagus and made a lazy man’s aioli—juice of 2 limes, 5 cloves of garlic minced, salt, some yoghurt, and an equal amount of mayonnaise. It is good on anything; I used it on French fries, as well. It likely can be used to soften skin and as an alternative to Brylcreem.
“Brylcreem, a little dab ‘ll do ya, Brylcreem, you look so debonair. Brylcreem, the gals ‘ll all pursue ya. They love to run their fingers through your hair.”, hearkening back to the 40’s and 50’s. Little did I know that Brylcreem was de rigeur for British pilots during WW2 in order to keep their long hair in place during air battles. Since they wore leather helmets, I wonder is that simply myth? Maybe it was for the romantic films of British WW2 aces in air battles and they didn’t wear helmets so the swooning females in the audience could see their long hair in place..
Another culinary treat is to finish rolling your pizza dough in oats. My Scottish take on an old Italian favorite. It makes for a really crisp, yet chewy, crust. I mentioned both the aioli and the pizza crust to my friend Clementina, who is Italian; she just looked down at the floor and said nothing.
The monsoon is with us. It rains most days, some nights, and sometimes 4x/day. Since I don’t like to sleep with aircon, I leave several windows open as the wind direction changes during the night. I’ve gotten up and had to mop the floor at 3 AM a couple of times. I haven’t personally gotten drenched yet. The rain has brought the temperatures down to a reasonable 90/80F with 70-90% humidity. I love the storms. A downpour is always preceded by a strong, gusty wind, so you hustle to your destination. The air is clear and the Yangon River is muddy. I hate to think of the poor boatmen, plying the river and caught in weather. I can often see them, chugging across the river as the rain pours down. They run all night; if I am up at 2AM, I can hear a boat or two crossing.
I took a head shot for a webinar I did last night. The sponsors wanted to identify me on the announcement. Good lord! I look old. I mean, wrinkles and creases and thinning hair. A white soul-patch. It woke me up. I am woke now—at least to my own age bracket! It really was a shock, although I’m sure I look like the same old guy to everyone else. I mean, the barber 4 days ago guessed I was 55! He’s a young kid from Yunnan, China; anyone over 50yo must seem ancient to him. I’ve been in a state of denial, definitely. Better to face it, unpleasant as I find it. Time appears to have marched on.
The webinar went, I think, well. After I spoke, two of my students presented a case each. Professor Tin Oo distributed audience questions, of which there were 45 before we started talking. There were >500 participants from all over the country: GP’s, Pediatricians, and General Psychiatrists. The presentation was sponsored and arranged by an Indian pharmaceutical company. I said there was not much call for psychopharmacology in Child Psychiatry, excepting in a few disorders, and certainly not much for Behavior Disorders, about which I spoke. I was clear that medications were never the first thing to think about in managing these issues. I’m not sure but I probably won’t get asked back by the drug company. The local head suggested before the program started that we have lunch together this week but hasn’t followed up and I suspect won’t. Why would he, or I, want to? Not for a free lunch. I was, however, impressed by the number of interested physicians and will talk with Professor Tin Oo about using University of Medicine 1 resources to spread the word. People are very hungry here to learn other than medication approaches. We may get a flood of patients from the webinar.
I have been thinking about tribalism. And epigenesis. As they relate to racism. We are wired, I am convinced, to be tribal. Be wary of strangers, those different from you. Gather your friends and press the others down so they aren’t a threat to you. When we were roaming bands of hunter-gatherers, there must have been some survival utility, some evolutionary advantage, in tribalism. Although the value of it has long since vanished, it is tough to throw off several thousand years of bad habits. We started this country on the premise, not usually mentioned during 4th of July celebrations, that whites of European origin were the lords and rightful owners of all they saw. Thus, slavery (Africans), genocide (Native Americans), and land theft (from Native Americans) were our initial accomplishments as we began this, also, quite amazing experiment in democracy. We haven’t relieved ourselves of the legacy and since tribalism is likely in our genes (or epigenes), its removal is like purging ourselves of ourselves.
If you pair a neutral odor with a painful stimulus, classical conditioning, after awhile the odor alone causes fear and trembling in experimental rats. But most amazing is that the odor alone will cause fear and trembling in subsequent litters of rat pups. Epigenesis, or acquired heritable traits. Is our tribalism like that, encoded in our RNA? Is that partly why racism, prejudice and fear with consequential actions towards those not like us, is so hard to eradicate. Not to mention the worry that if I let you on this ladder, you may displace me to a lower rung. It is totally worth the struggle and effort to shed, of course, but it is interesting to consider this as one reason it is so stubborn to remove and how it leaves many among us so vulnerable to the divisive predations of a coward like Donald Duck—I mean Trump.
“You’re just lucky we want equality, not revenge.” True and powerful words by a black female protester. For years I have been amazed that, given all the oppression and suffering of blacks, they haven’t arisen in armed struggle. The Black Panthers were a self-defense and community social movement, feeding children and operating medical clinics before J. Edgar Hoover harassed, infiltrated, and assassinated them. The rest is a very sad tale of black leaders being jailed, exiled, and executed as the Party, with thousands of members and offices in 68 cities in the US, shrank and died.
A Psychiatrist in Myanmar 