[Photo: Flower in the foothills of Giant’s Castle, Drakensburg Massif, South Africa]
26 March 2017
Mefloquine, our once-a-week anti-malarial medication, often gives people vivid and strange dreams. I’ve been taking it since July 2016 and haven’t noticed livelier REM sleep. However, I had a dream three nights ago in which I saw a canvas bag in the street containing 4 or 5 LARGE rats. I mean, 15 pound rats. I thought I’d better contain them because if they began breeding in the general rat population it would be a disaster. One jumped out and I grabbed him by the scruff of the neck and was going to toss him off a bridge into a stream—not very bright, as they swim well, but, hey…—but he grabbed onto my arm with his claws and wouldn’t let go. The harder I tugged at him the firmer he dug into my arm. I finally awoke with the pain of grabbing and tugging at my left bicep with ferocity. We do make most of our own problems, outside the catastrophic ones beyond our control, which are much more common in an impoverished, powerless population than in the world I inhabit. I’ll leave further interpretation of the dream alone for now; it was almost comical, though, how hard I was grabbing and tugging at myself.
A student here flunked one of his rotations, his third not-pass which means pretty automatic expulsion from the school. He’s from a very poor, single parent family, as many here are, thanks to AIDS, alcoholism, displacement to another country for work, and the general chaos and hopelessness that impoverishment and lack of education foster. And for him, without friends in high places and a well-off family to support him, there will not be a second chance at an education. Which means he can farm, be a guard, do “piecework”, or sell small things in a market somewhere. Other issues complicate the picture but it is, even so, heartbreaking to sit with him as he shouts, “I’m a dead man.” Perhaps the worst part was that he couldn’t accept his own part in it, feeling he was just “a poor nigger from the village” that the “tricky” COM powers wanted to “finish off”.
I suppose the learning point/teaching moment for me is how crucial it is for all of us, and physicians in particular, to accept we’ve erred, attempt to learn from it, and move on. In my child psychiatry training I had an argument with a therapist about a child with whom we both were involved. She argued, “I’ve been doing this for 13 years!” as a response to my disagreeing with her. I thought to myself, “Yup, and you are likely doing the same thing now you were doing 13 years ago.” I don’t know if I was right or she was right. I do know that if we don’t change and grow, especially in this field, like a plant that has stopped growing, we’ll wither and essentially die. Of course, there are all the things we do and ways in which we act of which we aren’t even aware. You get the point.
Animals seem to have fared better, likely through natural selection. The neurotic ones who kept shooting themselves in the foot limped around with a competitive disadvantage. Easily eaten, not seen as good mating material, etc. It helps to have more of your life instinctually-driven, I suppose. But then we wouldn’t have Bach or the Beatles or Shakespeare or the rest of that lot. And our diet would be pretty dull, though people can be passionate about the same bland food if there is enough of it.
Beyond the pleasure of companionship, including sex, I wonder about the moral opprobrium attached to not being strongly affiliated with a partner. Linda has been gone for 4 days at a memorial for a young PC volunteer killed in a road accident. The days have seemed enjoyably long and I’ve managed to watch a movie, read in two books, cook, putter around and generally be self-indulgent. I realize how different I am on my own, how much I always worry about the effect of my needs on whatever person I’m with. I tend to be more relaxed by myself, as many of us are. Yet there are echoes in the hall and a certain emptiness in the air. I doubt I am alone in this. It’s complicated for me to negotiate a relationship for that reason. I tend to efface myself.
To my amazement and satisfaction, all this relationship-free time has allowed me to: 1) learn how to put photos on this blog, and, 2) learn how to operate our stove. It is a fancy electric—dare I say electronic—one with a Ceran TM top and many buttons and dials. The brand name is Defy and aptly so; it defies reasonable attempts to operate. But I think I have got it now and can even program it to start and stop automatically. To operate the oven, for example, there are 3 dials, including one with 6 options of cooking with or without fans, and 6 buttons. On the other hand, I am loving WordPress, simply because I am able to force it to my bidding. Sometimes I force too hard and the entire site crashed for an hour or so today. I think I impatiently tried to perform a second operation before the first was complete. But I’m learning from my errors!
I sat on the wicker couch on the condi three days ago and watched a White-browed Robin Chat bathing at dusk. He is a handsome devil, with an orange chest, abdomen, and tail, a gray back, and white and black stripes over his head. He just plunged into the birdbath, after looking around for a potential ambush when his guard was down, and vigorously flapped his wings, causing water to spray over the lawn. He repeated this probably 10 times before feeling adequately cleansed and refreshed, at which juncture he flew off. To see a lady, no doubt. Must have had a supper date.
I must now finish re-reading Selma Fraiberg’s “Ghosts in the Nursery”, a wonderful and seminal paper she wrote about two infant/mother pairs she saw when starting the Infant-Parent Program at the University of Michigan. We’ll discuss it in the child study group tomorrow evening. It simply and elegantly illustrates many central tenets of psychodynamic therapy. It is so wonderful to read about her feeling her way along as she initiated an approach to interrupting multigenerational psychopathology. Infant-parent programs have sprouted up in many places and her early efforts are widely emulated these days.
Certainly a repeated reliving of the bad parts of one’s childhood relationships in the present leads to misery for many. And Dr. Fraiberg’s pioneering efforts have inspired more than a few to step off that well-worn path.
A psychiatrist in Malawi 