a matter of faith

i'm glad i made the effort to byron's birthday party last night, because i had a chat with tanya (who was also celebrating her birthday). my little spiritual dilemmas, my loss of faith in the world, my cynicism - it's all a case of been-there, done-that for tanya. she's met people who radiate wisdom and contentment from their shoulders and fingers and in everything they do. and she didn't mean psychiatrists either - she chuckled at my suggestion and said "they're so cognitive about everything". i want to meet these people. i want to have faith. i want to be sure of my actions, to act with purpose and not self-doubt.

i guess lou was right once again. *worships worships* i need to get out more. it seems answers are found in life as they are written down in books.

no woman no cry

louise, my midwife for the soul, helped me come to this conclusion last night: finding myself a girlfriend is not really a priority for me right now. having never had someone i can truly call a girlfriend, someone whose irritating habits i not only tolerate, but treasure; and having never been in love, as far as i know, i suppose i have no idea whether or not it'd be something i want. i'd much rather sit around with my mates playing cards, talking shit and drinking beer, than making myself go out and meet new people. true, observing those of my friends who are in relationships or are looking to be in relationships, i can see the inevitable trend of groups splitting into couples towards our thirties; true, sometimes i wonder if it might be worth all the trouble, in order to hold loneliness at bay; and true, sometimes i have even been tempted by someone.

perhaps i am still too immature; maybe it is because i am afraid; perhaps i am simply looking for excuses; or maybe i can't be bothered because it is in my nature to be lazy. whatever it may be, there are other things on my mind right now that interest/bother me more.

pyschosocial = root of all evil

developmental psychology, personality disorders, post-traumatic stress disorder - it is amazing what clues you can dig up from the dim dark past that seems to shed light on someone's present condition, if only you know where to look and persist long enough. maternal depression leads to dysfunctional attachment, rolling into separation anxiety, becoming oppositional defiant disorder, developing into conduct disorder, culminating in antisocial personality disorder, an entire catalogue of forensic histories, domestic violence and abuse. the vicious cycle continues. faced with a patient across the desk, at the tender age of twenty-something, against the backdrop of all of the above, the overwhelming psychosocial burden would seem to snuff out any hope of change before it can flicker. our arsenal of management options suddenly feels like a box of useless toys. what can medication, psychotherapy or social agencies hope to achieve against such a formidable fortress of human tragedy and maladaptive coping? years of psychodynamics therapy will merely peel away layers after layers of misery, anger and guilt, only to uncover more failed developmental tasks. it seems futile.

a patient presenting with any medical condition can be approached in a similar way. a middle-aged man presenting with angina - a seemingly typical problem to be managed in a matter-of-fact manner, working through the modifiable risk factors, shopping for the latest pharmaceutical miracles. but in addition to the bad genes, ailing heart, and a whole vascular system choked with atheroma, there might be a person, stressed from the demands of work; coming to terms with his own developmental tasks; coping with the responsibilities and fading dreams of young adulthood. around this person, a partner, children, relatives, friends, and a whole society revolves. how much can a doctor know and do? it can never be enough.

we had dinner with dr greenberg and his wife yvonne tonight at soulmama. the food and the restaurant was very decent; the mood from the table reflective and hopeful, looking to the past and the future. i glimpsed the bay outside and couldn't help but wonder at the mass of humanity that the bay had witnessed passing by its shores: all the dreams, emotions and lives that were, are and will be. we are all children; wonderful, ridiculous, oblivious children. the bay does well to laugh at us, at our silliness. it will still be there when we are gone.

the trouble with human beings is we can grasp the idea of eternity and a sense of our mortality at the same time. it is our gift, and our curse.

at last - found my turkish delight! 

lost and happy

today i spent the day with the cat team at broadie, where i met maria the worldly czechoslovakian psych reg, noel and alan the wizened cynical road-weary psych nurse-warriors, and angela the young intelligent idealistic nursing student. i am of course sterotyping outrageously here. it was a fairly quiet day, and i spent the most time talking to maria. she raved on about psychotherapy and got me excited and even suggested i go and see a psychotherapist myself, just to satisfy my curiosity, to cultivate my inner awareness, to explore issues that are ingrained in my subconscious, so i can become a mature and better person and doctor. this lady obvious knew how to push my buttons because i spent the whole afternoon absolutely certain that i wanted to become a psychiatrist. we also chatted about psychiatry training, subspecialties, spending more time in the hospitals gaining exposure to medicine versus streamlining into specialty training, the ridiculousness of diagnosing using DSM-IV criteria, the mental state examination, the new medical curriculum, share housing accommodation, the pros and cons of driving, whether a patient visiting prostitutes is a symptom of mania or simply a lifestyle choice, and whether it is the role of a case manager or the public housing commissioner to clean up a psychiatric patient's flat. i even scored a ride back into town with her in her flashy silver chrysler - sure beats catching the train!

you know i'm not one to conform to social norms; in fact, i like rebelling agains them, sometimes because i see through them, other times just to get a response out of people. but often it's purely accidental (i swear!) - i'm just as lost and confused as the next person, only i like to think i have insight. anyway, today's experience confirmed my belief that being lost can be a good thing. i enjoy being lost. when you have no idea where you are and where you are heading - it's liberating. knowing exactly where you want to go can give you tunnel vision; you forget to look around and enjoy the scenery; you close your heart to the world.

so i say to myself: fuck trying to finish my training as soon as possible. i don't even know if i want to get there. i'm lost and i'm happy. i'm just gonna enjoy the ride, baby! get to know myself; try out all the things that interest me; and go book myself an appointment with a good-looking private psychotherapist!