Sunday, December 16, 2012

Advent

I recently saw an icon of the Visitation (the meeting between a pregnant Mary and her cousin, Elizabeth) which I absolutely loved; it inspired this poem, told from the point of view of Elizabeth.



Visitation

I was months into the heaviness
Of child-carrying,
swaybacked and swollen, and my husband
Mute as an old stone—
So that I heard it all the louder when Miriam’s shout
Reached me from the dust-choked road outside.
I raced out to see her standing there,
Glowing with sweat, her body just beginning
To take on a mother’s curves beneath her robes.
And then the child that nestled sweet
Beneath my heart
Leapt—not a simple turning, not a kick,
But jumped as if some new and secret joy
Had set him dancing: and it was then I knew—
Knew who it was she bore within herself.
Later some would call it solemn, grand; but truthfully,
We laughed as we embraced: breast to breast,
Cheek to smiling cheek,
And I know that both our sons
were laughing too,
in that way of old friends meeting
after years,
when all time seems as nothing,
and the space
between lives collapses
into grace. 
-AG

Saturday, September 01, 2012

I know no one ever reads these poetry posts, but...


Leeward

Thus far we've been protected
from the storm,
huddled inside,
the only sounds
your even breathing and
the steady rush of rain
against the windowpane; I wish
that we could linger
in this valley, ever leeward, never facing
lashing water, or time's flow
which also
wears down and divides.
But there it is: ordained,
like a cloud on the horizon,
coming from a new direction
as the wind picks up and stalls;
I count the freckles on your back
and catalogue your dreaming
and wait, silent, for the whirlwind
to come ripping through these walls.

Friday, August 24, 2012

Myths about Suicide

So, I'm going to be taking part in the annual Out of the Darkness walk to support the American Society for Suicide Prevention in about a month's time. Suicide is an issue close to my heart, both personally and professionally. There's a good body of research on the subject, yet many myths persist--not only among the general public, but among health professionals (and even mental health professionals) who should know better. Following are those I've heard most often.

1. A person who talks about feeling suicidal isn't likely to actually commit suicide--ie, "If they talk about it, they won't really do it." I'm really not certain where this one got started, though I guess it might have something to do with the idea that talking about suicide is just 'blowing off steam,' or a manipulative gesture to get attention. Regardless, imagine applying this line of reasoning to something more mundane: for instance, imagine saying, "Someone who talks about wanting an ice cream cone isn't likely to actually go to Ben and Jerry's." That's pretty obviously BS, right? The same goes for discussions of suicidality. Any communication of suicidal feelings, thoughts or intent deserves to be taken seriously.

2. Don't bring up the topic of suicide with someone who's depressed--you don't want to give them the idea. Speaking as someone who's been there, if a person is severely depressed, there's a damn good chance the idea has occurred to them already. I've yet to meet a depressed person who, when asked about suicidality, replied: "Holy shit, you mean you can kill yourself? Like, that's a thing?" If you're worried that someone is thinking of hurting themselves, ask. Better to ask and get an answer--even if the answer is yes, and even if it's painful to hear--than to miss a chance to help someone who needs it.

3. Once someone decides to kill themselves, there's nothing anyone can do to stop it. Suicide is preventable. The majority of people who commit suicide are suffering from a psychiatric illness. Hospitalization to stabilize the acute crisis and ongoing psychiatric care to adequately treat the underlying illness can almost always resolve the suicidal feelings. In other words, once suicidal does not mean always suicidal.

4. Only older white men (or the poor, or teenagers, or whomever) commit suicide. While there are some groups at higher risk for suicide than others, every race, gender, socioeconomic class, ethnicity and sexual orientation is touched by suicide. Saying things like "young women don't kill themselves" is not only stupid, it's dangerous.

5. Most suicides occur without any warning. There's no way to anticipate or prevent them. No to the first assertion and no to the second as well. The majority of suicidal people DO offer clues to their intentions, though they may be subtle. For instance, a patient in a deep depression may suddenly appear to feel better despite not having had adequate treatment--the sense of peace may have come as a result of the decision to commit suicide. A depressed friend may start giving you her prized possessions, saying she doesn't need them anymore. A family member may say, "You won't have to be bothered with me much longer." Again--going back to myth #2--if someone makes statements like this and you're concerned they may be harboring suicidal thoughts, ASK and EXPRESS YOUR CONCERN.

Monday, August 06, 2012

Five Favorite Works of Fiction

It occurred to me the other day to sit down and think of my ten favorite books. Of course, I soon dismissed that as too difficult and decided to divide this task into several smaller ones. I've now selected my ten favorite works of fiction, ten favorite books of poetry/essays, and ten favorite non-fiction books. These are the books that have made me who I am; the books I would choose if I were stranded on a desert island. What are yours? I'll start with my ten favorite novels--in no particular order:
1. Catcher in the Rye, J.D. Salinger. Yes, I actually read it in high school, and yes, I actually liked it--despite being sufficiently young and innocent that I was appalled when I realized Holden had hired a prostitute. In fact, I went through a bit of a Salinger phase during my junior year of high school (similar to the Ayn Rand phase that a lot of people seem to go through in high school/college, except that it made me a more astute observer of human nature rather than a self-absorbed twit).

2. Things Fall Apart, Chinua Achebe. One of the great African novels, and a fantastic read. Barbara Kingsolver's 'The Poisonwood Bible' (which only narrowly missed this list, and which more people have probably read) is the white-girl yang to Achebe's yin. I'm not going to lie--I also just loved saying a lot of the Igbo names to myself over and over...Ikemefuna, Ezinma, Umuofia.They sounded like music.

3. Notes from Underground, Fyodor Dostoevsky. I probably identified with the protagonist (who's only barely a 'pro'tagonist...) more than I ought to've, considering he's defined by his ennui, sense of inertia, and an existential awareness that leads him to consider spite the best defense against necessitarianism. Then again, I read this in high school, a time when I also discovered Camus and Sartre and it first occurred to me that, holy shit, I could CHOOSE to skip Calculus one day, or not sign up for the absolute maximum number of hours at work (I still went to all my classes and never missed work, but I think the idea that I didn't *have* to kept my tightly-wound self from going completely round the bend). A lot of people also label it the first existentialist novel. So there's that.

4. The Handmaid's Tale, Margaret Atwood. Most people's introduction to the idea of dystopia comes from George Orwell, and I've read 1984 too, but as the possessor of a uterus I found Ms. Atwood's tale more relevant to my interests. What really terrifies me is that there are those (cough--Sarah Palin and Rick Santorum--cough cough) who would like to see this dream/nightmare brought to fruition.

5. The Bell Jar, Sylvia Plath. Plath--or 'Victoria Lucas,' the pseudonym under which the book was originally published--is the mother of crazy-chick lit (OK, maybe that was Charlotte Perkins Gilman...but certainly the mother of all mental-hospital chick lit). Kaysen's 'Girl, Interrupted' and Elizabeth Wurtzel's 'Prozac Nation,' the bevy of eating-disorder memoirs in the spirit of Lori Gottlieb's 'Stick Figure': there would be none of these if The Bell Jar hadn't been there first. As a middle-schooler with severe depression, what I wanted more than anything was my own Dr. Nolan--but absent that, this book, paradoxically, offered me hope both that I might someday conquer my own demons and that I might one day publish the story of that conquest and make some money into the bargain. 

The other five, after the jump!

Thursday, July 26, 2012

White men and guns: male privilege hurts us all

Dylan Klebold and Eric Harris in Littleton, CO. Kip Kinkel in Springfield, OR. Luke Woodham in Pearl, MS. Mitchell Johnson and Andrew Golden in Jonesboro, AR. James Holmes in Aurora, CO. Jared Loughner in Tucson, AZ.

What do all these people have in common? Yes, they perpetrated mass shootings that left many dead and wounded (and scores more, though physically untouched, emotionally scarred). Yes, all share dubious emotional stability. But there's something else that they have in common--something that's hidden, as the saying goes, in plain sight. All of these killers are also young, white and male, and to my mind, that is something important. To (loosely) quote Alison Bechdel, if one of these shooters were black or female, all this discussion about what's wrong with the generic youth of today would get awful specific, awful quick.

But why young, white men? It's not just a numbers game; nearly 100% of US mass murderers in the past twenty years have been white guys, and they certainly don't make up a commensurate proportion of the population. Part of it, of course, has to do with men's greater affinity for guns (the same reason men are more likely to complete suicide than women--they have access to and use firearms more often than the ladies, who are more likely to try pills or cutting and thus survive). Yet something else plays a part: what the sociologist Michael Kimmel calls aggrieved entitlement.

From birth, white guys in America are promised the world. No, there's never an explicit promise made, but look at who's in power in business, in the legislature and on the Supreme Court. Turn on your television and see who's being marketed to, whose tastes are considered the norm, who's courted and flattered. Being white and male in America is supposed to get you power (that dream job), money (that dream job again, a car, a house), love, and perhaps most of all respect. They deserve to succeed.

As a result of this conditioning (see, women aren't the only ones hurt by cultural conditioning), it's not surprising that many white young men develop some degree of entitlement--after all, they've been told for years that the position at the top of the totem pole is their birthright. So what happens when someone stands in the way, cutting them off from "what's theirs"? When a stagnant job market and failure in school forces a man like James Holmes to go looking for an entry-level job (doubtless experienced as degrading)? When he's turned down romantically? When the world just plain doesn't deliver the life of success and respect that he feels entitled to? Most likely, he gets pissed (who doesn't get angry when someone reneges on a promise?), and when he gets pissed, someone has to pay.

When women get angry, they tend (cultural conditioning again) to turn that anger inward. A young woman in Holmes' position, and even with his same constellation of psychiatric symptoms, would be much more likely to self-injure, or fall victim to an eating disorder, or become depressed/attempt suicide. Men, on the other hand, tend to externalize anger--and when that tendency is combined with American society's acceptance of violent masculinity, a sense of thwarted entitlement (and a whole slew of other things, from the breakdown of the mental health system to lax gun laws), you have the toxic stew from which tragedies like Aurora emerge.

This is not meant to be a man-hating post. Nor am I trying to deny the role that mental illness or other extenuating circumstances play in such violence. I'm hoping, rather, to explore and explain the ways in which the current American model of masculinity (and entitlement) ultimately hurts us all.

Sunday, July 22, 2012

Batman, Arkham and the Evil/Mental Illness Divide


I had a phone conversation with my dad the day after the movie-theater massacre in Aurora, Colorado (for those somehow unaware: a young man opened fire in a packed movie theater during the midnight showing of the latest Batman flick. He was wearing what amounted to full riot gear, and had four guns and two canisters of teargas with him; it appears to have been carefully orchestrated, and scores of people were wounded. A dozen were killed. His apartment was booby-trapped with multiple incendiary devices, apparently designed to kill anyone attempting to access his apartment). “It’s pure evil,” my father said. 

“I don’t know,” I replied. “Maybe. But I also read that he was in the process of dropping out of grad school because he’d been failing, and that he’d gotten pretty reclusive. For a guy in his early twenties, that sounds like it might be a schizophrenia case study to me—and schizophrenics aren’t evil, they’re sick.” He semi-conceded the point (my dad never just concedes anything) and said, “Well, you’re going to be the psychiatrist. It’s your job to figure out the difference, not mine.” This got me thinking: in the 21st century, with our knowledge of mental illness constantly expanding and our willingness to assign absolute values like good and evil diminishing, what does it mean to call someone evil—or, in a deterministic worldview, can we call anyone evil at all? Can an act be evil even if the doer is not? Can a mentally ill person be called evil, or is that the sole provenance of the sane? Do we judge different degrees of illness differently—ie, hold a depressed person morally accountable while excusing someone who’s psychotic? 

Sadly, we’ve seen this before—too many times before. In 2007, the National Review—I know, I know--published a symposium discussion with the title ‘Comprehending the Incomprehensible’ after the Virginia Tech shootings. The subtitle was “Evil is what this is, whatever else can be said about it.” One of the writers, Fr. Thomas Berg, commented:

We’ve had eight years to come to understand how our society produces angry young men like the Columbine shooters Eric Harris and Dylan Klebold. We’ve diagnosed them as the tragic by-products of practical nihilism — that mix of materialism, sensuality, and meaninglessness that drives young people to the brink. We know that tragically — if our diagnosis has been correct — this will not be the last time that a twenty-something nihilist tries to blow a hole in the world, a scream of existential defiance in the face of nothingness.

Of course, we know he was right—about the fact that there would be more sad, infuriating cases just like that one. On the other hand, I don’t know that we've yet come to ‘understand how society produces [these] angry young men.’ If we have, we sure as hell still don't know what to do about it.

I guess the best answer I can put forward is that we still need the word, the category, of evil to make sense of the world. There are some acts, some impulses and thoughts, that can’t be satisfactorily explained any other way. Perhaps mental illness, or an extreme lack of human empathy, or an overwhelming, angry sense of having been victimized (whether this victimhood is real or only in the perpetrator’s mind), or all of these in concert lead to actions like those we saw in Aurora. After all, in the Batman universe, the Joker is returned to Arkham Insane Asylum each time he’s apprehended, but that makes his crimes no less heinous and his status as villain no less sure.

Wednesday, July 18, 2012

The OTHER n-word: on women and neediness


So, about a week ago I came across this great article (written by a man—which I found pleasantly surprising)here about how women are made to feel like expressing a need is a major imposition. In fact, “needy” might as well join the ranks of ‘the c-word’ and ‘the b-word’ in terms of gendered power. True, it doesn’t carry the same shock value, but its power to insult and demean women comes from a similar dark place in sexual politics. It was a great moment for me, a prime example of something that we psych folks call ‘generalization.’ So what does that mean—for me and for womenfolk at large? I’ll start by speaking for myself. 

All my life, I’ve held the secret but ironclad conviction that I and I alone am a needy, depraved morass of desperation and longing. Granted, I virtually never display this to anyone; I overcompensate and tend to carry myself like a Teutonic Ice Queen. In the past, and today, I’ve needed to be loved, or held, or comforted, or heard, or celebrated. I ‘ve needed space, time, healing, understanding. However, the idea of looking someone in the eye and saying, “I need you to hold me,” or perhaps less intimately, “I need you to listen,” has always seemed as brazen and insane as leaping at someone shrieking, “Oh God, PLEASE LOVE ME!” I was—still am—terrified that asking someone to fulfill, or even just respect, a need is gauche; overly demanding; in poor taste. That’s the ‘fear of being labeled crazy’ end of the spectrum that’s most associated with the word ‘needy.’ However, there’s also the fear of being labeled bitchy that comes with demanding that boundaries be respected, or with calling others out on bad behavior. 

During my second year of medical school, during the psychiatry course, one of the lecturers had a PowerPoint slide that featured a comic about bulimia. It wasn’t ultra-aware, meta, culture-jamming humor. It wasn’t laughing WITH eating disorder patients, it was laughing AT them. And having spent quite a bit of time in treatment, and knowing women who have died of eating disorders, I didn’t find it funny at all. I felt furious. I felt belittled. I couldn’t believe a psychiatrist, of all people, would mock sufferers of the most deadly psychiatric disease there is. So why didn’t I stand up in the middle of the lecture and say something? Or, failing that, why didn’t I go up to the lecturer after class and state my objection, or even just write an email saying I felt it was in poor taste? Why didn’t it feel OK to say, “I NEED the lecture hall to be a place where no one is demeaned, particularly on account of an illness they can’t control”? You got it—fear of being labeled a bitch (or derided for being ‘too sensitive’ or ‘not getting the joke’—a form of victim-blaming jujitsu which is a topic for a whole different post). 

So what? Well, it’s not just me. Women are conditioned from childhood to place the wants and the needs of others before their own.  Asking for time, attention or affection (“I need to see you more often”) is painted as something selfish and, well, needy, while defending boundaries (“I need for you not to resort to insults when we argue”) is seen as bitchy, entitled behavior. Meanwhile, men by and large ask for their needs and wants without fear of being saddled with negative labels. 

In the end, recognizing this as a societal problem (and not a personality flaw or psychiatric disorder) means not having to carry around the paralyzing fear of monstrous, hidden neediness that I’ve schlepped for the past quarter century. The women who pioneered ‘consciousness-raising’ circles during the 60s and 70s were on to something. The personal is political, and vice versa; sharing our individual struggles will sometimes reveal them to be problems with societal mores and not “ours” at all.

Friday, July 06, 2012

FLASH FICTION--The Sludge

FLASH FICTION
The aliens had arrived. Not, as we had long anticipated, in hovering spaceships or glowing green pods (which my new acquaintance G'ttt'ghax said were "Relics of the past, fuel-inefficient and wasteful--the kind of thing we used before we cared about our carbon blorkprints." It took a while for me to realize that Xorblaxian blorks are analogous to our feet), but on individual contraptions resembling vintage Schwinns with solar-powered thrusters. There were only a few Earthlings left.
"Did you have any warning?" G'ttt'ghax asked. "Do you know what caused it? As I understand it, en masse, their blood simply turned to a liquid too viscous for their hearts to pump. The Sludge, it was called, yes?"
I led the group of alien scouts to what had been the epicenter for The Sludge in our district, and pointed at the sign still hanging on the wall of the now-abandoned building.
"I don't have any proof," I said, "but I have my suspicions."

Remembering old dalliances...


Yes, it IS, as they say, "based on a true story." 

July

It was July and my skin
was alive with wanting you,
alive the way cicadas buried
underground
age and blossom forth,
humming their hungers.
I was so in love I walked
the four miles to your house
in the boiling that is Kansas
in the summer,
each bead of sweat
an affirmation of desire.
And when at last
you opened your screen door,
dress falling down your shoulders,
two brown hills–
what body could resist your body's pull?
It was July and we spent
the whole long afternoon
wreathed by our heat,
Lazy in one another's arms
atop a quilt your mother pieced herself–
and when your father
came in the door at six,
I crawled out your bedroom window
like a thief,
carrying your need as well as mine
walking alone through early evening's haze
as the cicadas all around
went wild.
-AG

Tuesday, June 19, 2012

Useless Statements from Personal Ads

OK, so we've established that writing a personal ad is hard. How can someone be expected to encapsulate their personality, their desires and their dreams in a one-paragraph blurb? I'd suggest that people make room for more substantive stuff by cutting out the following statements that, while occasionally sounding meaningful, actually offer no information at all.

1. "I'm spiritual, not religious." I wouldn't have such a problem with this if just once someone who's made this statement to me had been able to expound on it in any meaningful way. Do you mean that you're basically a Christian, but you have problems with the ways doctrine has been misused as a sledgehammer over the centuries? Then say that. Not sure you believe in God, per se, but think there's Something More? Say that. Do you believe in the healing powers of angels and crystals and now that you think about it, maybe you COULD do the whole Religion thing if you could just find a nice coven to join? Say it. Don't just wave your hands at me and say 'spiritual...Spiiiiiiritual!"

2. "I'm a laid-back girl who loves to have fun!" When people start putting 'I'm uptight and anal-retentive' in their profiles, you can put 'laid-back' to differentiate yourself. Perusing match.com has led me to believe that 98% of all lesbians between the ages of 25 and 50 are laid-back girls who love to have fun. I'm in the 2% that HATES fun.

3. "NO drama!" Methinks the lady doth protest too much. And anyway, who DOES like 'drama' (aside from people with bona fide personality disorders)? I've yet to see an ad that says "Laid-back girl looking for love...hope you will be just like my last bitch of an ex-girlfriend who sent me threatening texts after I tried to break up with her and tried to get me fired from my job at Chik-fil-a by spraypainting 'Amber is a ho' on the drive-thru menu."

More to come.

Friday, June 08, 2012

On Suicide


It’s June 8th and I’m thinking about suicide…not about committing it, not about personally undertaking it, but about the subject in general. My uncle killed himself on this date two years ago. It still seems achingly, almost unbearably fresh. My cousins and the rest of my extended family in St. Louis were having a get-together the weekend before it happened. I had just taken Step 1 of the US Medical Licensing Exam that Saturday (for those of you unfamiliar with it, imagine an 8-hour long exam with the potential to determine whether the career you’ve been planning for the past decade will actually come to fruition). When I got home that evening I was too tired to make the drive out to the ‘burbs, so I called and begged off. It was the last time any of us saw him alive (or dead, for that matter—after a shotgun to the head, the coroner said it wasn’t worth having anyone come in to identify him). I still kick myself for not going. I still dream sometimes that I am standing at one end of a long dead-end street; I can see my uncle’s car parked there at the end, and can vaguely see someone moving about in the driver’s seat. Panicked, I sprint towards his car as fast as my legs can carry me, heart pounding, my lungs about to burst. Faster. Faster. Faster. And always—just as I’m a few yards away—the shotgun blast tears through the air, and I drop to my knees and scream. 

For the next several months after his suicide—during my first rotations of medical school—I was either in a daze or despondent. During my pediatrics rotation in the newborn nursery, I was so addled I couldn’t keep track of the babies’ weights from day to day; try as I might, I couldn’t hold the numbers in my head long enough to punch them into the calculator. I would give a patient’s weight loss or gain during rounds only to be corrected by a resident and earn an eye-roll from the attending. I was on overnight call every fourth day, which interrupted my usual routine of “finish work, go home, curl into fetal position in bed and cry until asleep,” and which made me feel even more trapped and desperate. Several times I looked up from the nurses’ station and saw my uncle standing in the hall, only to disappear as I got up to go to him (I’ve since learned that this is actually a fairly common phenomenon in the newly grieving, and not a sign of incipient psychosis as I believed at the time). I should have made my excuses and taken the rest of the rotation off, but stubborn as I am I stuck with it and ended up passing the rotation by the skin of my teeth (and by the grace of the clerkship director). I’m sure my uncle didn’t intend this. I’m not certain he was even in a state of mind to fully comprehend the effects his death would have on those of us left behind. 

Over the years I’ve known several people who have killed themselves/committed suicide/died by suicide/whatever your preferred phrasing is. Too many, of course; more than seems statistically likely, and certainly more than is fair, for them, me or their friends and family. The US suicide rate is around 12 per 100,000 per year. One of my friends from high school killed himself the summer after I graduated—a sensitive, loner-ish guy with a penchant for fantasy novels and a love of nature. I still have a copy of Mark Twain’s ‘Letters from the Earth’ he loaned me that I never had the chance to return. My first year of medical school I got a call from a college friend; one of our housemates from Cornell had killed himself. He was a profoundly intelligent man, supremely passionate about…well, just about everything. I knew he’d struggled with depression, but never knew how bad it was. And then during my third year, as mentioned above, my uncle killed himself. My uncle was something of a family black sheep because his religion consisted of philosophy, science and the Sierra Club rather than Christianity; I think that was part of what made him my favorite relative. Interestingly, all the completed suicides I’ve known have been men, while all the other attempters I’ve known have been women (this is in keeping with the psychiatric maxim, “Women attempt, men complete”). 

There’s more that I want to say about this, but this is getting long and I’m getting depressed. I’ll come back to it later, I think. I just wanted to honor my uncle today, and offer a picture of what suicide really does to those who are left behind. Perhaps that’s why suicide prevention and awareness is a passion of mine—I’ve seen too many people make that grave error, and want to prevent it from happening to anyone else. To quote a man who jumped off the Golden Gate Bridge (and survived!): “I instantly realized that everything in my life I thought was unfixable was totally fixable—except for having just jumped.”