Heartbreaking News In New Zealand

NZ

When I first found out that there was an ACT OF TERRORISM being committed at two mosques in Christchurch New Zealand on Friday resulting in 49 Muslims killed and many others injured, I was devastated.

I had  to stop my studying for awhile and just devoured the news that were spreading like bushfire in my Facebook newsfeed. I wanted to cry. But I couldn’t. My eyes just refused to cooperate to tear up. So, I was left with deep heaviness in my chest instead. I know that the heaviness will go away if I just cry. (This is my problem. It is always difficult for me to cry. I think if I could just cry, I can relieve this ache in my chest.)

I have been to Christchurch when I was a medical student. I went there  with my housemates for a holiday during the first semester break of my 4th year of medical school. We enjoyed our New Zealand trip very much because New Zealand is just such a beautiful country. I never thought that this tragedy could happen in New Zealand because my impression was New Zealanders were much more tolerant towards ‘other’ people compared to their Australian counterparts. They are more progressive in terms of giving their indigenous people (the Maoris) their rights and privileges. The rights of the Maoris in New Zealand are better preserved and protected than the rights of the Aboriginals in Australia.

So when something heartbreaking like this happened in Christchurch, I just could not process it!

And then I found out that the evil perpetrator behind this massacre was an Australian who has a Neo-Nazi political leaning.

Well…. I love Australian people. Most of them are lovely and kind. But some of them can be such racist rednecks! Five years in Australia taught me all I need to know about white supremacy and racism. My experience in Australia shaped me into the kind of person I have become now. I am a person who is super-sensitive to any form of racism or supremacy or ‘budget bagus’ group. You can judge anyone as an individual if you are so inclined. But don’t overgeneralize the whole group because of any mistake done by some individuals in that group. I COULD NOT tolerate that EVER. Muslims living in the West post 9/11 would understand the kind of suffering we had to endure when we were all painted with the same brush. To them, either we were evil terrorists or oppressed Muslim women! Either way, we were treated with suspicions and being looked at as inferior just because we wore the hijab outside the house.

I remember how I felt like I had to prove myself as a Muslim medical student in Australia. I had to do MORE to get the same kind of respect or esteem that the Australians effortlessly enjoyed. As an introvert, it took some adjustment for me to push myself to be extra-friendly, to be outspoken in tutorials, to join group discussions, to mingle with people (now doing these things is much easier for me these days… especially the outspoken part. Haha)  I had to do all these extra efforts in an attempt to contradict the degrading narrative of what being a Muslim woman was perceived to be (when actually, I really preferred to keep quiet and just went home and read my books). Whenever I couldn’t answer any question in the tutorial group, I felt so embarrassed (more embarrassed than I would have been if I were in Malaysia) because I felt like I was feeding the stereotype that Muslim women are stupid by my inability to come up with a sensible answer. I felt like I had to say something (anything!) in the tutorial even when I had nothing to say. I felt like I had to fill up my speech quota of the day in order to appear fully switched on and involved in the tutorial discussion. I felt that way after finding out that some tutors had complained to the admin that “the Malaysian students are too quiet and not participating in the tutorial discussion”. So during each tutorial session, I doubled my effort to appear extrovert because apparently, the more you talk, the more intelligent people think you are. *rolled eyes* (And yes, Australians are very extrovert! And so, people who are too quiet would be thought of as less intelligent or less capable) So, I strove harder in order to contradict the stereotyped image of what being a Muslim woman was. My sweetest moment was when my assignment on Health Equity Selective was being put up on my uni website (in our students blackboard page) as an example to the juniors in the batch below mine on how to write a Health Equity Selective project in the category of Psychiatry.  Me, an International student whose English is only a second language, got the opportunity to display my assignment as a guidance for the juniors to emulate when doing their psychiatry Health Equity Selective… I was over the moon! (Yup, I had chosen Psychiatry for my Health Equity Selective project. I have been interested in Psychiatry since I was a medical student and had chosen that field for my elective.) I was over the moon because I felt like I had proven a point. It was like, I was saying “See… a Muslim student is not that stupid. If we don’t talk as much in our tutorial session, it is because some of the things are obvious already… that it is not even worth mentioning. And English is our second language… it takes more energy for us to come up with any sort of conversation compared to you guys. If we are a bit slow in articulating our thoughts, that is only to be expected, isn’t it? Besides, we just don’t feel the need to stand out all the time.”

My Malaysian juniors were like “Kami bangga sangat tengok Health Equity Selective Kak Afiza masuk dalam blackboard. Malaysia boleh gitu!”

I laughed.

I am proud of my juniors too. I was proud whenever I see my Malaysian juniors were more well-adjusted and had assimilated better with other Australian students compared to us, the seniors. The juniors learned from our own mistakes and put more effort in making Australian friends. They experienced less criticism that “the Malaysian students do not mingle with people. They like  to keep  to themselves and don’t put in any effort to assimilate with the whole batch”.  As the years progressed and we started getting more Malaysian students among our junior batches, I thought, we were doing such a good job of portraying that Muslims were not as bad as what were shown in the media. Slowly but surely, I felt like the stereotype against Malaysian students were eroding. My heart burst out with pride when I saw how Malaysians were very heavily involved in our university Islamic Society (I myself was the treasurer of University of Newcastle Islamic Society at one time) and we were always the front-liners when it came to interacting with non-Muslims at the Islamic booth during Islamic Awareness Week. Compared to the Saudi or other Middle Eastern Muslims, Malaysian leadership shone bright in the Islamic Society. (Perhaps because our command in English was better than them). We could answer controversial questions about Islam quite well while guarding the booth. All in all, we were making pretty good progress.

But it could get pretty tiring. Always having to prove yourself over and over again is tiring. Whenever there were new incidents of terrorism and bombings in the Western world, I felt like all our hard work to prove that Muslims are good people were completely undone. And we had to do it all over again. Prove ourselves all over again. It was exhausting. Mentally and physically draining.

But I never regret any of it! Because the struggle that I had gone through made me who I am today. There is beauty in the struggle that we have to face in order to live up to our Muslim identity and Muslim ideals when we are living in a non-Muslim country. Looking back, I was my best self in spirituality when I was a medical student in Australia. Because of the struggle I had to face in Australia, I was more conscious of God and more connected to my religion than I ever was in Malaysia. I invested more time to learn about Islam properly (partly because I had to prepare answers for the questions that non-Muslims liked to ask). I was my most patient self when I was in Australia… because I was carrying the image of a Muslim and I did not want my bad behaviour to tarnish the name of my religion. In Australia, I had a purpose GREATER than my own self because I had to be a small ambassador to my religion! So despite all the struggles and the difficulties, I was very motivated. Our social support were the usrah-attending seniors who kept reminding us to be good, to do good, to strive for the hereafter and not just the dunya. (This is the part of myself that I miss the most, now that I am in Malaysia. I miss the Afiza who was nice. Because the current Afiza is not so nice! Hahah. Somehow, after coming back from Australia, I have retained my outspokenness but have not retained being nice. Perhaps because Malaysians are not always nice too….they are not always ethical…they don’t have values of respect or punctuality or cleanliness or efficiency…. they can be lazy…  they can trample on your rights… and if I am too nice and not outspoken enough, I will be oppressed. And I don’t want that.)

***

Allah had planned my life so beautifully, Alhamdulillah.

At 18 years old, I was grieving the death of my friend. Looking back, maybe I had an existential crisis at that time because I was so shocked by the fragility of life. That my friend could die at such a young age! I wondered, what was this life all about? For two years, I was wondering to myself about existential stuff, but afraid to vocalize them out for fear that they would label me “tak kuat iman”. And then Allah sent me to Australia where I met religious people who could answer all my questions. Alhamdulillah, my existential crisis resolved then. I became a firm believer. I came across someone in Melbourne who answered my questions patiently, systematically… scientifically, even! Suddenly, I felt a sense of spiritual awakening that I had never experienced before that summer, which was my first summer in Australia. I knew then that Islam is logical; that it makes sense! If things do not make sense, you must double-check whether it is truly religious in the first place. I was ecstatic and grateful for all that I had learned that summer.  It is nice to have real faith!  (I was so relieved! Finally, the horror of the Israilyat stories I had to swallow in KMB can be vomited out once and for all without feeling any guilt. That’s why I will always love Australia, the place where I had experienced an exponential growth, mentally and spiritually! There would never be a time when I think of Australia without a sense of nostalgia. It’s just not possible. Some of the things I had learned in Australia STILL influence my behaviour until now!)

I believe, some Muslims would have an existential crisis after witnessing this current heartbreaking incident. Some of the family members of the deceased might experience what I had experienced during the period of grieving. They would start questioning… why are there so many dreadfulness in this world? Why do people do evil things? Why didn’t God do something about it? Why didn’t He intervene? Why is this world so unfair? Why was I even created? What am I supposed to do in this life? Is Islam really the right religion? How do I know that? What if I am in the wrong faith… what will happen to me when I die, then?

They might have all these questions as they deal with the death of their loved ones. And hopefully, they will go through the cognitive process of finding the answers… and finally be at peace in their faith. You cannot bury these questions and silence your conscience. Repressing your doubts will not help you find peace. You must actively engage with your intellect and answer the questions that you have about the religion, about faith, about life after death. Otherwise, you will always be in doubt. And it won’t be real iman. You will not experience true peace that comes with firm belief. You will not feel confident to take any action, to speak up, to do what you believe is right… because you are not even REALLY sure if God is real and that He will help you out of any trouble.

So, don’t bury your internal existential crisis or your philosophical conflict. Answer them! Seek and you shall find! And believe me, what you find will be beautiful and priceless!

1771957-Yasmin-Mogahed-Quote-Your-life-is-nothing-more-than-a-love-story

 

***

Screenshot 2019-03-16 22.45.22
My Facebook status on the act of terrorism at the two mosques in Christchurch.

I have been busy preparing for my CASC exam these days. As usual, I am at my most neurotic self while preparing for exams, LOL. I would start thinking about how much money will be lost if I fail my exam. I would start thinking about “ah, aku dah tak larat nak study! I just want to be a chronic MO.” Hahha.

Sometimes, I mourn my lack of time for fiction reading. It is ridiculous how much I sweat the small stuff.

I forgot that there are other more important things in life other than being a nerd and passing your exam. I forgot that my fiction-reading are trivial, picisan stuff! Stuff of amusements and ‘main-main’.

Siapa yang melaksanakan kewajiban, mereka diberi PAHALA, dan bag

In other parts of the world, people are fighting for their lives!

On the same day that the mosques in  Christchurch were attacked, Israel had also launched series of airstrikes across Gaza! We have thousands, if not millions, of our Muslim brothers and sisters in various parts of the world undergoing physical and mental suffering… all at the same time! And I am worried about exams? And about reading fiction? Gosh, Afiza… you are preposterous!

Screenshot 2019-03-17 08.22.45

Sometimes, I have to admit, I can be really stupidly ridiculous. I am done worrying about trivial stuff! Because there’s more to life.

For as long as I can remember… everytime I was overwhelmed by my study, some sort of tragedy would be breaking news and made me realize that my struggle was not significant at all in the general scheme of things. For example, in 2010, while I was preparing for my final General Medicine exam, the Turkish ship Mavi Marmara, which was a civilian ship bringing aid to the Palestinians, was attacked by the Israel Navy in May 2010. The attack by the Israel Navy was bravely resisted by the civilians on the ship; nine activists died and many were wounded. I was worried sick about my exam at that time. But after reading about what had befallen the Mavi Marmara ship, I had felt similarly ridiculous as I am feeling now for being too worried over small stuff when people are fighting for something greater than even their own lives!

I composed a poem for Mavi Marmara at that time entitled FORGIVE MY SCOWL which I had uploaded into the poetry section in this blog. I composed that poem after taking a pause from studying my General Medicine notes in order to clear my muddled head and to lift up the overwhelming heaviness in my chest.

This is also why I am taking a pause from my CASC studying and writing this post today. To clear my head. To lift up the heaviness in my chest. Because I just couldn’t cry. Because to compose a poem, it would take a much greater mental strength than I possess. Because I am too mentally exhausted by all the bloodshed.

I pray, that all Muslims would unite together and peacefully respond to this sad calamity in a positive way. I hope, there will be no revenge bombing by Muslims because it would only make matters worse for our brothers and sisters in the West. Trust me, I had enough experience of how terrible it is to be in the West when so-called Muslims commit an act of terrorism somewhere. (Nak masuk lecture hall keesokan hari pun rasa nervous! Rasa malu! Belum lagi rasa takut kena attack bila terpaksa jalan berseorangan.) Please, no revenge bombing targeting innocent people, be it Muslims or non-Muslims. Please, no more bloodshed.

***

I leave all my readers with a reminder to live in this world like a traveler or a stranger. Because, really… isn’t that what we are? Until we reach our final destination, we are only a traveler along the path of life. Hopefully, we will find something precious and beautiful along the way.

stranger

Values For A Balanced And Well-Ordered Life

When I was an IB student in KMB, part of the World Literature component that we had to study was the novel The Great Gastby, authored by an American novelist, F. Scott Fitzgerald.

Though at that time as a teenager I was not that enamoured with this magnum opus of F. Scott Fitzgerald, the FIRST TWO SENTENCES of this novel had stayed with me until now.

In my younger and more vulnerable years my father gave me some advice that I’ve been turning over in my mind ever since. 

“Whenever you feel like criticizing any one,” he told me, “just remember that all the people in this world haven’t had the advantages that you’ve had.”

We had to analyze the novel as a student. And I just kind of wrote in my literature analysis that we shouldn’t be judgmental towards other people because we don’t know what other people have gone through in their lives to cause them to behave a certain way now. By the way, I got an A for my literature analysis of The Great Gatsby at that time. But all I wrote in my essay was some wishy-washy namby-pamby crap that I feel embarrassed to be recalling now.

Trust me, I have changed my mind. I think the longer I am in psychiatry, the more objective I become about things that I read and what I should tolerate and not tolerate. Or maybe it is just the effect of me being older and wiser.

I believe that what happened to you in your past DO affect your life now…. but only up to a point. Whether or not you let the past haunt you, it is ON YOU. It is YOUR DECISION.

If I could go back in time and do the literature analysis all over again, I would probably change  the tune of my essay and write something like this instead: “We all have different life story. OF COURSE none of us will have the same kind of advantages and disadvantages. That’s just life. It doesn’t mean you can excuse yourself when you do something bad or maladaptive. Instead of wallowing in your disadvantages in life and comparing how other people’s lives are much more advantageous than yours, you should move forward and think about how you could make your life better, isn’t it? Mr. Gatsby deserved what he got in the end! He should have moved on a long time ago and stop pining for a married woman.”

Trust me, I have no sympathy for the great Mr. Gatsby.

***

As a psychiatry MO, I am going to be honest and admit that I have favourite cases and favourite patients. I mean, that is only natural. That’s why we have subspecialty, right? Because we don’t always like all types of cases even though we DO see and manage them all to the best of our ability.

And, let’s face it. We do have favourite patients, don’t we? We don’t discriminate our patients in terms of treatment and resources but there are certain patients we like to see MORE than others. That’s just human.

So, what sort of patients do I like? Well, I like patients who help themselves because it makes it all worthwhile. Because without the patients helping themselves, there is nothing much I can do to help them that would work long term. We can psychoeducate till kingdom come, or do daily home visits, or call them every day to update on their progress, or we can repeatedly give them compliant therapy…. over and over again…. but nothing will stick long term until they accept their illness, and make THAT VITAL DECISION to take the meds and perform all the non-pharmacological measures we tell them to do. My whole investment in effort and time to make  their mental health better depends LARGELY on the fact of whether or not they themselves will do what I have told them to do! I can do my best… but it won’t work if THEY don’t do their best. We are not going to be there for them 24/7. And we shouldn’t have to. Part of the responsibility should be shouldered by the patients themselves and their family members.

So yup… I do have favourite patient’s family members too. The more cooperative the family members are, the bigger the smile that I bestow towards them as a form of greeting at the start of the conversation. LOL.

It is kind of disheartening sometimes. When the reward for our hard work (seeing the progress of our patients is a reward) depends on the patients themselves taking that leap of change…. it can be disheartening because some of them just refuse to take that leap.

So when patients (or their family members) ask me about their prognosis or if they will ever get better, I said truthfully “You will get better. Not all conditions can be cured… but they do get better. But how much better you get depends on YOU.”

And that’s the problem. And that’s also the solution.

YOU are the solution. Regardless of your background! Regardless of your advantages and disadvantages in your past! Regardless of what had happened to you in the past and the present, YOU are the solution to your own problems. Make that decision to take your medication. Make that decision to not let your past determine your future. Make that decision to put some effort in doing all those lifestyle changes! Make that decision to do your CBT homework! Make that decision to feed your thoughts with positive self-affirmations as you were taught to do in your CBT sessions. Make that decision to practice that deep breathing exercise and the relaxation techniques taught to you. Do it for you!

Because I cannot do it for you.

***

What are the values you must internalize in order to move forward DESPITE your past and  your disadvantages?

Because trust me, if everyone can behave badly by citing random disappointing things that had happened in their lives as the cause of their depression/borderline personality/ antisocial personality/addiction, then everyone can get away with crimes because “oh, it is not my fault. I had a deprived and disadvantageous childhood, you know”.

“Oh, I murdered that guy because he reminded me of an ustaz in a Maahad Tahfiz who had sexually abused and sodomized me when I was younger! It’s not my fault. Don’t judge me if you don’t know my past.”

But when you are arrested by the police and subsequently sent to be evaluated in Hospital Bahagia Ulu Kinta, we will only determine whether or not you were of sound mind when you had committed that murder and whether or not you are fit to plead! Regardless of whatever bad past experiences you had, we are only going to be interested in the soundness of your mind! We are only interested to know whether you knew what you did was wrong and contrary to the law! That’s it! We might be interested in your past… but only up to a point. The court may take note that you used to have a disadvantageous childhood… but you will STILL be punished. It is only right for you to be punished. Your bad past will not suffice in the court of law to justify your crime!

Facts! Reality!

Regardless of whatever childhood adversities you have experienced, by the age of 18 you will be treated like an adult in the court of law! You would be assumed to have had the maturity of an adult and you are accountable for your own action. You cannot turn around and blame your parents when you are addicted to drugs… because your siblings who are NOT addicted to drugs ALSO have the same parents as you! The judge in court will not entertain wishy-washy, sappy sob story of an excuse like that! Even in Islam, we are accountable for our sins at the age of puberty! The reality should not be distorted to adjust to YOUR subjective experience! Instead, regardless of whatever bad experiences you have had, you must make the effort to adjust to the reality. If anyone can be excused based on ‘subjective’ experiences of childhood disadvantages, then that’s it! There should be no law and order. Everything must be grey and blurry, then!

Likewise, the reality is such that when you behave in a counter-productive manner or in a socially inappropriate manner, most people will reject you. Regardless of your past! People who are going to deal with you day in and day out are not going to care about how difficult your past was after a certain point! Their sympathy can only go so far. So the onus is on YOU to rise above your past and change your behaviour if you want to lead a fulfilling life. And we are here to help you do that. But you must be willing to put in some effort without always blaming others for every single thing that goes wrong in your life.

In Psychiatry, we also learn that there are certain risk factors that predispose someone to having depression or other mental illness. But some people do cope well with life despite having those risk factors! How come?

So my take home message is  this: Your past DO affect you… but ONLY up to a point! You are not totally helpless against your past! Because the rest of your life is determined by what you are going to do now in moving forward.

And you can turn over a new leaf by internalizing certain values in your life that I am going to enumerate below. Please take note that I am not disregarding or invalidating all your past experiences and all the injustices that had happened towards you. I am just giving you a way to move forward.

Effort

“Doktor, ingat senang ke nak usaha? Pesakit depressed memanglah tak larat nak exercise, nak buat behaviour activation semua. Bila doktor cakap kena usaha… macam stigmatizing. Ada doktor suruh pesakit kencing manis usaha supaya pancreas diorang keluarkan insulin? Tak kan…”

“No, I won’t tell type 1 diabetic patients to put in an effort to force their pancreas to produce insulin. However, I do tell them to put in an effort to take their insulin, to control  their diet, to exercise and keep a healthy lifestyle. And this is what I am telling you to do too. It is not stigmatizing. It is factual.” This was my answer to the patient (who also had some component of personality on top of her depression). Very matter-of-fact, very reality-based.

To be honest, I NEVER like the ‘mental illness stigma’ poster that compared depression with diabetes. It is so inaccurate, and we should stop saying “Jangan stigmatize pesakit depression. They cannot help their behaviour. They lack serotonin. Just like pancreas orang yang ada diabetes tak boleh keluarkan insulin, orang depressed pun tak boleh keluarkan serotonin. When you tell depressed people to put an effort, it is a stigma! You don’t tell diabetic patients to produce insulin, do you?”

Ugh! Gosh! I cringe inwardly whenever I hear misleading things like that.

I agree that we should not stigmatize mental illness! But I disagree about depressed patients not having to put in any effort in dealing with their depression! Asking people to put in some effort should not be construed as stigmatizing! In ANYTHING we do in life, effort is vital! In ANYTHING!  Stop trying to tie our hands from telling our patients to put in some effort! What do you want me to say then…. tak payah usaha langsung?

As a Muslim, Allah will not help us without us putting in our effort! To Muslims, that’s a fact! I am not going to distort reality just to align myself with the content of a bad poster. I am not going to distort facts just to appear FALSELY empathetic and sympathetic when the reality is different! If we cannot tell them to put in some effort, then how about asking them to go to occupational therapy? Doesn’t that require some effort? How about asking them to attend their CBT sessions or their psychotherapy? Doesn’t that require effort for them to do their homework?! How about asking them to practice deep breathing exercise and do some physical activities? Doesn’t that require effort?

The only condition that doesn’t require your effort is when you are in a state of coma! You don’t tell ICU patients to put in any effort, sure! But for the rest of us, the requirement for a good, healthy and balanced living is our effort. The faster you internalize this idea, the faster you will improve your life, Insya Allah.

So, please! Please stop promoting mental health awareness by comparing depression with diabetes! That’s like comparing apples and eggs. They are not even in the same category! (at least, comparing apples and oranges can fall under the category of fruits! But apples and eggs are two different categories altogether, get it?). For one thing, there is no component of the ‘mind’ in the Pancreas! There is no intertwining interpersonal conflicts and ongoing social stressors in the development of Type 1 Diabetes! So Type 1 Diabetes patients really cannot change anything much in the way they behave to help their condition. But this is not the case in depression! So, how is this a good and fair comparison? Neither the diabetic patients nor the depressed patients are treated fairly by this comparison.

And Wallahi, this comparison should cease to exist! (Adoi, penat! Too much emotion has been invested in writing about this alone, LOL. Pheww!) 

To quote Kevin MD: 

Diabetes is a disorder of insulin metabolism. Insulin is produced in the pancreas. The (depression-diabetes) analogies disregard the intimate intertwining of brain and mind. For the pancreas, there is no corresponding “mind” that exists in the realm of feelings and relationships.

I prefer to compare depression with having a fractured lower limb in terms of how effort would improve your outcome. “Katakanlah awak mengalami kemalangan jalan raya dan kepatahan kaki lalu tidak boleh berjalan.  Lalu, saya pun beri kepada awak tongkat untuk bantu awak jalan. Sudah tentu berjalan dengan tongkat dengan kaki yang patah lebih susah berbanding sebelum kaki awak patah. Tetapi tongkat itu serves its purpose untuk bantu awak bergerak walaupun memerlukan lebih banyak tenaga. Tapi jika awak masih duduk di kerusi dan tidak mahu berjalan walaupun sudah diberikan tongkat, maka tongkat itu langsung tak berguna! Bila awak duduk dan baring sahaja, ini akan membawa risiko mendapat bedsores dan secondary infection yang lebih teruk lagi. Apabila saya berikan awak tongkat dan suruh awak berusaha untuk berjalan, tak bermakna saya menidakkan kemalangan yang berlaku dan kesakitan yang awak alami kerana patah kaki. Tetapi saya bantu awak untuk move forward WALAUPUN ya, saya akui awak kemalangan dan ya, saya akui awak memang sakit dan patah kaki. But the tongkat is here, isn’t it? Are you gonna take it and walk or are you going to just sit down, not using the tongkat and instead repeatedly go back and forth questioning why the accident had happened to you? And why aku patah kaki dan orang lain tak patah kaki? Because think about it….How is that going to help you? Now… let’s get back to your depression. I am giving you your medication and I have scheduled CBT sessions for you with our clinical psychologist… will you take it? When I told you to put in some effort to do all these measures, to try to go to work… I am not denying your depression and I am not saying it is going to be easy! It is hard! Of course going to work while being depressed is ALWAYS going to be much harder than going to work without any depression… that goes without saying! However, now I have given you some medication, and you will be seeing our clinical psychologist for CBT sessions….these things are the tongkat! Yes, it is still harder to go to work compared to when you were not depressed… but now, going to work is becoming more achievable, isn’t it? Compared to when your depression was not treated at all, now even though it is STILL hard… it can be achieved right? Just like it is still painful for a man with a broken leg to walk with a crutch, but at least with the crutch, the man with a broken leg can now walk, isn’t it? Will you at least try first?”

Most patients who already have some spark of optimism inside them can relate with the ‘patah kaki’ analogy FAR BETTER than the diabetes analogy, in my experience.

Really… I am not a vague, wishy-washy person. I am always the ‘bottom line’ kind of person! I want to know the truth, the reality, the actions that I need to do and what is the possible outcome I can expect. And therefore, I don’t like to comfort people with half-truths. I do adjust my style of giving away the real truths to my patients depending on their personality and the appropriate context…. but I am not gonna give them empty words of comfort. I am not gonna tell them it is okay when it is NOT okay. I am gonna tell them, “What happened is not ideal but what are you gonna do about it? Let’s face it and deal with it! It will be hard but it can be done. I will help you… but again, it will only work if you help yourself because a lot of things require effort on your part!”

And most patients recognized the truth and they gravitate towards it! The sunnahtullah is such that deep inside, all of us want to know the truth. And when we give the truth to them, it builds trust because they know that this doctor is not lying and pretending to care about them! Sure, some of them don’t like to hear the truth and they might hate us for awhile. But the seed of doubts regarding their actions has been planted in their minds…. and eventually they will think and evaluate the matter again.

But patients who STILL persisted in playing the victim card (usually a personality component is involved here), will continue to deteriorate. And my heart sinks.

As a psychiatry doctor or a therapist, among the first thing we should do (after allowing them to ventilate and express their distress), is to get them to internalize the value of effort! We will not get anywhere if they still persist that they are victims of their past and therefore they will always be ill and flawed because their past can never be changed and therefore there is no use for them to put in any effort.

That is really such a tragic way to think about life. We must pull them out of that mindset before anything can ever change. But unfortunately, it is STILL their decision to change their mindset! At the end of the day, we can only do so much to help them. The ultimate outcome lies in their decision. 

 

Having A Growth Mindset

The opposite of having a growth mindset is having a fixed mindset. The worst thing that can happen to anyone is to have a fixed mindset. Having a fixed mindset would wreak havoc in your life because you have basically internalized learned helplessness. Learned helplessness is bad, folks! With learned helplessness, people can be driven to suicide because they believe nothing they do will ever change the situation and there is just no hope left. 

 

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Biologically, we learned about brain plasticity which is the ability of our brain to change through life with our experiences and our training! It correlates perfectly with the value of having a growth mindset.

From the psychological point of view, Piaget’s theory of cognitive development talks about how our mind and our mental schemas are always adapting and accommodating…. for the rest of our lives. So we are not always stuck in our bad childhood memories. Provided you put in some effort, you can overcome your disadvantages! 

While I do think that me hearing out your feelings and allowing you to ventilate your problems do help to de-stress you while you are facing your crisis, I am more interested to know what you are going to do about overcoming your limitations in life? That’s the BOTTOM LINE always.

With a growth mindset, you will have a positive and optimistic outlook in life because YOU JUST KNOW that whatever it is that is happening to you, you can master the steps that you need to take to overcome the challenges! You just need to grow your mind by expanding your horizon with new skills, new set of positive thoughts and new set of behaviours. When you have a growth mindset, you know you can learn and re-learn and un-learn your way into a better coping mechanism. 

You won’t say things like “Dah aku memang macam ni. Family aku dulu ajar aku macam ni. Memang dah tabiat aku. Memang aku tak boleh nak ubah… nak buat macam mana?”

I am not saying that it is easy to change your habits! A person with a growth mindset ALSO might be resistant to change because they are already comfortable with their own habits and personality. But when it is important for them to change and adapt (perhaps, there is something at work that they have to be in-charge of that requires a new set of behaviours and habits), they will make themselves change their habits and behaviours because they know that the only constant in life is change! And if they have to do it, then they have to do it!

So, will you continue to practice? Will you continue to study and acquire knowledge and skills for the betterment of your future? Will you be willing to put in some time and effort (goes back to effort, doesn’t it?) to do what has been taught to you during your CBT sessions so that your new skills slowly become second nature and would be automatically activated in the future with much less effort than what you have to put in now?

You will do it, when you have a growth mindset.

If you have a fixed mindset… don’t worry. This is the beauty of the concept of having a growth mindset. You can unlearn that fixed mindset NOW, and start to learn to have a growth mindset.

Having An Internal Locus Of Control

In psychiatry/psychology, locus of control is defined as the degree to which people believe that they have control over the outcome of events in their lives, as opposed to external forces beyond their control.

locus of control

If you have an internal locus of control, you believe that events that happen to you is the result of your own doing rather than the external forces outside your control. For example, when you have an internal locus of control, you would believe that you had passed your exam because you had studied hard and went to all the lectures and tutorials that were given at the uni and because you had prepared accordingly. You did not think it was the external factors beyond your control that had made you pass. You did not think that it was just luck or because other people were doing even worse than you or because the teachers like you better than your other classmates. You are less likely to conform to your surroundings when you have an internal locus of control.

If you have an external locus of control, you believe that you had no control over the events that had happened to you and there was nothing you could do to influence the turn of events. For example, you believe that you would never pass the exam because the subject was too hard and the lecturer did not like you. So there was nothing you could do to pass your exam. You believe that the result of your exam somehow depends on all other external factors except your own effort. Having an external locus of control makes you more likely to conform to expectations and environments because you want your life to progress smoothly.

In general, when it comes to motivation and drive, having an internal locus of control is much healthier than an external locus of control. 

However, having too much of anything is never good. Having a much too internal locus of control can also cause you to blame yourself and will make you feel unnecessarily responsible for something that you could never help. And that can also predispose you to depression. See the diagram below to see what I mean regarding imbalanced locus of control and why it would be bad to have too much of either.

locus

 

The key word here is balance and reality check! I have mentioned before that I like the truth! I like reality check! Those are the two words I use a lot with my patients. You are entitled to your feelings and you have a right to them because it is YOUR feelings…go ahead and have them. But at the end of the day, your feelings do not necessarily reflect the reality. And if adjustments need to be done, your feelings must be compromised to give way to the truth or the reality! You must start learning to feel the right thing! (yes it can be done!) Because your feelings, even though you have a right to them, are subjective. But the truth and the reality are the objective facts! It will make your life much easier and less turbulent if you can learn to feel the right thing. 

As Muslims, we know that things that happen to us are decreed by Allah. But because we don’t know the decrees of Allah yet (I don’t know whether I will pass my exam or not, for example) we are ORDERED by God to put in some effort to attain what we desire. So the locus of control is balanced here. You are neither too sad nor too happy about things that happen to you in this life. Because you know that whatever bad or good things that happen to you have already been decreed by God and eventually anything bad and good will simply run its course! It will pass! There will be a next challenge to conquer and then the next, and the next…. until you breathe your last air! Bad events hurt… but give it time. Put in some effort, work at it again! Continue! Persevere! Feed that internal locus of control.

And when a disappointing outcome arrives… recognize that some things are out of your own control but it does not nullify your effort at all. It’s just life!

For example, someone passing their viva is a combination of effort, studying and doa (internal locus of control) and examiner factor, your health issues during the time of exam, and the type of case  you get (external locus of control). That is the reality! Nothing in life is TOTALLY in your control. And nothing in life is TOTALLY under the control of the external forces. Perhaps, when you realize this fact, your feelings about anything will be in moderation.

324472-My-Heart-Is-At-Ease-Knowing-That-What-Was-Meant-For-Me-Will-Never-Miss-Me-And-That-Which-Misses-Me-Was-Never-Meant-For-Me

Read Up

I suggest that people take up reading as a hobby. Not because it is my hobby and I am very much in favour of that habit (haha… mungkin ada juga komponen biased sikit. Because I will always think that reading is superior to any other hobby hahah… so yup, ada biased sikit) but because it is the one good hobby that will benefit anyone regardless of gender, social status, and whatever past experiences you have had.

Even if you read commercial fiction like Harry Potter, you will feel like “Wow…. this kid could fight the evil Lord Voldemort by the virtue of his effort and perseverance. Setakat kena marah dengan consultant, that is nothing to be scared about. I will turn up to work and finish my housemanship regardless of how bad I kena marah. I can overcome this!” Hahha. Okay… that is an extreme example. After all, Harry Potter is a fictional character and most people don’t try to relate their lives with fictional characters to sooth their feelings. So, you might not think that reading Harry Potter can ever motivate a disillusioned houseman (though actually it works with a lot of ardent readers out there! It certainly works with me!)

But you can also read biography/autobiography of really inspiring people. Autobiography books are real-life events! In my last blog post, I talked about the biography of Muhammad Ali and how inspiring he was. If you are a Muslim, you can read the seerah of our Prophet and his companions (I have mentioned before that Umar Al-Khattab is my favourite superhero). Read about the history of Jerusalem and the oppression committed by Israel towards the Palestinian people who are still persevering and fighting for justice and freedom (Netanyahu is worse than Lord Voldemort, okay!). Read the biography of Mahatma Gandhi and Nelson Mandela and the sort of sacrifices they had to make for the sake of freedom and social justice.

I am not saying that reading protects you from depression or neuroticism. But it broadens your horizons, knowing that people are always struggling sometime, somewhere. You get to live the lives of many people through reading, and you get to find out how all these various people cope with their own mistakes and  their own troubles (After all, the best way to learn is to learn from other people’s mistakes and troubles…. rather than making the mistakes and having the troubles yourself, right?).

If you just read (the right material), you will have a better coping mechanism. It improves your logical thinking and your abstract reasoning which will make it easier for your therapist to work with you. Some of your CBT homework require some reading too. You are more likely to do it if you already love reading.

If you don’t like reading, don’t worry. Focus on getting a growth mindset, first… and then you will know that you can adapt your brain into loving to read… and it WILL benefit you.

For Muslims, it is no coincidence that the first verse that is revealed by Allah to our beloved Prophet Muhammad (PBUH) is to read! Iqra’, remember? Get some knowledge! Internalize the values that you read and use it as your guidance in making any decision! Our parents can only teach us so much… because they have only their own experiences to tell you about. Their way of doing things and their experiences may not be applicable to you. And so, we read in order to experience the lives of many people so that we can have a big arsenal of weapons to choose from whenever life strikes us hard. 

iqra
This is the first verse of the Quran that was revealed to our beloved Prophet Muhammad (PBUH)!

***

And as a therapist, sometimes we need to set up boundaries with our patients. We have to let them experience the consequences of their own behaviour. We should not be enabling and reenforcing their bad behaviour by always giving in to their demands for attention and validation when what they are doing are obviously wrong and maladaptive.

They have to stick to their appointments and learn to deal with the consequences of being late to their  CBT/Psychodynamic session. When they throw a tantrum, we should ignore them until they are willing to behave well and until they can state exactly what sort of problems they want to discuss with us in a rational and calm manner. Behave like an adult and we will treat you like an adult.

Some patients will manipulate their counsellors or their therapists or their doctors. It is important that we recognize that behaviour and not accidentally rewarding them.

A few years ago, I myself had terminated a therapeutic relationship with one patient when he had thrown a tantrum at the nursing counter in order to see me. My late HOD, Dato’ R, happened to be at the counter at that time and managed the situation by telling him that I was covering addiction clinic and he must see other doctors. The patient should have come during his allocated appointment time but he didn’t.  He had come earlier than his scheduled appointments so many times in the past and I had told him not to do it. I told him that he had to learn to deal with his feelings by the techniques that had been taught to him. And I told him that he should go to the ED for any emergency that crops up in between appointments. I was hoping that by making myself less accessible, he would learn to deal with his distress by himself using the techniques that had been taught. But he still didn’t.  A few days later, he came to  the clinic again (again, without an appointment) and I decided to see the patient one last time to terminate the therapeutic relationship. I told the patient that what he did at the nursing counter a few days ago was unacceptable and I think he should see other doctors. I was very firm. You must follow the rules, or bear the consequences. After I terminated the therapuetic relationship, he did not see any specific doctor since then and was placed in the general pool for any doctor to see. As far as I know, there is no issue since then.

One day, I happened to bump into him at the supermarket. He was polite and did not try to detain me when I said that I need to excuse myself to finish shopping. That was a huge improvement! A few weeks later he came to the clinic, and he had requested to see the doctors in room 2 (happened to be my consultation room on that day). The clerk at the counter was firm and said “But you didn’t follow appointment. Pergi bilik 5. Lepas ni kalau nak request doctor mana, datang on time.” And he abided by that instruction without insisting to see me in Room 2. Very good behaviour that he had displayed there! So, I have made a decision that if he ever comes on time later on and requests to see me, I will grant him his wish as a reward for his much improved behaviour.

I am very particular about time and sticking to agreed rules and negotiated terms. That is one of the ways I know that the therapy is working. I have an aversion to being manipulated and controlled. I don’t like it and I won’t allow it in my therapeutic relationship with my patients. On this, I am very firm. I don’t think it is healthy to be there for your patient 24/7.

At what point is your patient going to be able to learn to think for themselves and  solve their own problems if you are always there to be depended on whenever they are in crisis? Once we have agreed on the negotiated rules and terms, we must stick to it. Early in the treatment, there might be some adjustments and hiccups along the way. But by the time the adjustment period is over and the patient is still crossing all sorts of boundaries… then a serious talk must be conducted to establish what is okay and what is not okay in this therapeutic relationship. Any more crossing of boundaries is no longer healthy for either party and perhaps we should pass the case over to our colleague.

And that’s what I did.

Maybe as I grow older and mature into the profession, I might learn differently about what to expect and what to tolerate with regards to therapeutic relationship with my patients, but being controlled and manipulated and being forced to give in to that kind of behaviour will not be something I will passively tolerate. I don’t think that will ever change about me.

On the other hand, another patient of mine who had successfully internalized the values of effort, and having a growth mindset and having an internal locus of control (unfortunately she STILL hasn’t internalized the values of reading, haha) had successfully managed all her crises in the 3 months when I was not around in the clinic (because I was doing my forensic attachment in HBUK at that time). When she saw me shortly after I returned from HBUK, she had said “Doktor tau tak dalam masa 3 bulan ni banyak sangat benda jadi kat saya. Tapi saya boleh handle sendiri, doktor. Doktor tau tak saya dah berhenti kerja yang dulu. Waktu tu saya sangat stressed dan nak sangat jumpa doktor… tapi nurse kata doktor pergi attachment. So saya pun pendam sajalah and handle sendiri. Alhamdulillah, sekarang saya dah dapat kerja baru. Dan gaji saya lagi bagus dari kerja saya yang dulu.”

I was overjoyed that she could handle things for herself. I said to her something along the lines of “Bagus! Memanglah semua masalah kena handle sendiri. Kalau saya ada pun, apa saya boleh buat? It’s your job, it’s your life… you have to make your decision and stick to it and then put in the hard work. And then, there will be another challenge… and you will handle it again just like you have handled it in the past. These things will continue for the rest of our lives.  Memang awak boleh buat pun. Congratulations! Lepas ni bolehlah bagi appointment 3 bulan sekali pula.” I teased.

“Dua bulan dulu lah, doktor!” 

I laughed. “Saya tak ada tiga bulan hari tu, awak okay jer! Pernah dengar tak, necessity is the mother of invention? Bila benda dah jadi dan kita terpaksa handle sendiri, waktu tu lah kita discover our real abilities. The situation NECESSITATES us to grow! We must start creating opportunities for you to handle crises yourself in between appointments. You can do it! In fact, you have done it when I wasn’t around!”

I cannot wait until I can give her a four monthly appointment. Hahah. Yes, she is one of my favourite patients. Because she internalized those values I had listed above, she is much better now. So, I like seeing her because I feel like all the time spent in my session with her was not in vain. Not wasted. But eventually, it is our responsibility to make sure our patients can be confident to let us go. One day, I might have to move elsewhere, work in another state. I am not going to be there for them 24/7. It is an unrealistic expectation to be placed on any doctor or any therapist! And I refuse to do it for any of my patients. It is kinder in the long run that we maintain boundaries and make them self-sufficient. It is the kindest thing you can do to anyone…. to provide them with a fishing rod instead of a limited supply of fish of uncertain duration. That kind of uncertainty will create unconscious distress in them because they will always be wondering “Can I survive without my therapist?”

So, I have told her that next time, we are going to try for a 3 monthly appointment regardless of whether or not she feels ready. She just smiled… because she knew I always do what I said I would. Or maybe it was a smile of someone who is confident enough not to worry too much any more.

Why worry when everything has been written and all you have to do is to go through it and do your best until you breathe your final breath.

I leave you guys with one of my favourite songs by Sami Yusuf. This song teaches us that when it comes to dependency, there is only ONE entity that we REALLY cannot live without… and that’s the way it should be in this life. That’s the reality. All the dramas in your life should take a pause to acknowledge this fact once and for all. And trust me, you will be happier for it.

 

The Gudjonsson Suggestibility Scale & The Legendary Muhammad Ali

Muhammad Ali Book
The biography of Muhammad Ali, written by Alan Goldstein

#BookReview  #GudjonssonScale  #MuhammadAli

Dear readers,

Last month, I had read  a biography of The Legendary Muhammad Ali written by Alan Goldstein and Masya-Allah, I was blown away. It was a truly absorbing read and I finished reading the book in 3 days. Muhammad Ali’s life was nothing short of inspiring.

I knew that Muhammad Ali was this great boxing legend who “floated like a butterfly and stung like a bee” but in my opinion, his greatest achievement was not made in the boxing ring. There was no specific arena… no particular moment while fighting in  the ring… in which I could say “Yup, that’s it! That’s when he was at his best.”

It was just the way he led his life… the way he stayed true to what he believed regardless of what other people said about him. The way he had stuck to his gun regardless of the risks of losing his money and  fame, and even regardless of going to prison. That was some heavy-duty powerful faith there! How many people would rather be in prison rather than sacrificing their principles? These days, I assure you, not many!

float and sting

When people persecuted him for his staunch principles, he stood firm and fought back with witty words that spoke volume of his wisdom. I didn’t know before what was the big deal with Muhammad Ali. I only knew him as this great boxer who also happened to be a Muslim. To me, ah… ok fine, just another famous Muslim celebrity.(What can I say? I was never into boxing and Muhammad Ali was famous way before my time. Now, I am acutely embarrassed of my previous ignorance of this legendary persona!)

But after reading his biography, I was in awe.

I remember, whilst reading the book, that Muhammad Ali would have no problem with the Gudjonsson Scale if the test was administered to him. He would stick to his gun and to hell with what other people say to the contrary.

Want to know what I mean? Read on!

***

So what is the Gudjonsson Suggestibility Scale?  Well, this is not a very well-known test in psychiatry. When they are used, they are usually used in the forensic setting. It has been used in court cases in several jurisdictions but has been the subject of various criticisms.

I am not sure whether this scale was ever used in Malaysia. I certainly never came across it when I was doing my forensic posting.

But I had to study this scale when I was doing my Part A MRCPsych exam. I remember feeling slightly troubled when I thought of how my performance would be if the scale were administered to me.

According to Wikipedia, this scale was created in 1983 by Icelandic psychologist Gísli Hannes Guðjónsson. The Gudjonsson Suggestibility Scale consists of reading a story aloud to participants, who are then asked to recall as much as they can remember. Subsequently, participants are probed with 20 questions pertaining to the story, 15 of which are misleading. When the 20 questions have been answered, the participants are clearly and firmly given a negative feedback on their performance. Specifically, they are told that they have made a number of errors and that it is therefore necessary to repeat the questions to obtain more accurate answers. On the basis of participants answers to the misleading items, a total suggestibility score can be calculated.

I remember thinking, would I ever change my mind, even as I know that I was right, if the pressure towards me was administered just hard enough? Would I break? Or Would I bend? Would I stand straight or would I fall in heaps and pieces?

Imagine someone administering the Gudjonnsson Suggestibility Scale to you.

Let me walk you through the simplified version of the scenario (you can read the actual details on how the scale is administered in Wikipedia)

So an examiner reads you a story and after hearing the story to its conclusion, you are initially reasonably sure that you have understood the story correctly. The examiner then proceeds with asking you a few questions to test your comprehension. You are confident with all the answers you have given the first time. Then, the examiner asks you some of the questions again and again… the examiner acts as though he thinks your answers are not quite correct…. so….would you slightly alter your answers to accommodate the expectation of the examiner? If the examiner asks you repeatedly “Are you sure that was how the story goes? Are you sure? Is that REALLY what happened? Could you perhaps be mistaken?Is that REALLY how you understood the story?”…. would you then doubt yourself?

Or would you stick to your gun and say “I know what I heard. That’s how I understood the story. I could be wrong. But that was what I heard and what I understood. And I am not going to change my answers no matter how many times you question me. Period!”

Seriously, in my own experience, MOST people would accommodate expectations (subtle or non-subtle) regardless of how wrong the expectations might be or how right their answers initially were.

Heck, it happens to our politicians all the time. It takes someone with strong conviction like Tun M to oust Najib out of his political throne because everyone else around him were as fickle as the weather when it comes to speaking up for the truth and fighting for justice.

It happened to me when I was a junior doctor. It happened to many other of my colleagues. It happened to even specialists and consultants when they were dealing with their own superiors.

It happens in our ward rounds and teaching sessions ALL THE TIME. For example, you might KNOW that you have given the right answer to your specialist’s question…. but when your specialist tests you by deliberately questioning your answer (or maybe the specialist himself also did not know that you were actually correct), you would change your answer to accommodate the expectation of your specialist. And even if you don’t change your answer, you will still start to doubt yourself even as you give the same answer… but this time, your answer comes in a less convincing manner.

One of my close friends had answered correctly regarding what are the anti-depressants licensed for OCD. She rattled off “Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline.” Her answer was correct and spot on! Of course she must have read it before doing her presentation and she should have been confident with her answer. But someone in the audience had questioned, “Are you sure Sertraline was licensed for OCD. I am not sure… but I think, Sertraline is not licensed for OCD, right?” And EVERYONE fell silent regardless of whether they are HOs, MOs, specialists or consultants. Maybe everyone was also not sure at that time and it was too easy to assume that someone who was brave enough to question the presenter must have been correct. 

But me and Dr. T…. we have this curiosity that is not easily satisfied. We used to read that Sertraline is licensed for OCD. Our Part A MRCPsych notes had a list of all meds and their licensed indication. And we kind of vaguely remembered that Sertraline is licensed for OCD but we were also not very sure when someone had questioned our friend’s answer.

By the time, me and Dr. T had finished extracting the information from the pdf version of Maudsley Guidelines and had confirmed that my friend’s list of answers were correct, the audience had moved on to a new topic of discussion.  And me and Dr. T didn’t feel like it was appropriate to point out to everyone that my friend’s answer was correct and the person who had questioned her was the one who was mistaken. I mean, people make mistakes and if we can let it go, we will let it go. But rest assured, if the CME gathering was still talking about the same topic, I would have offered the correct information for the benefit of everyone in the audience. My close friend deserves to have the credit of having given the correct answer. It is only fair for her to receive that recognition, in my opinion.

After my friend had finished her presentation, I went to her and said, “Mesti kau dah prepare sebelum present. Kau tahu kan jawapan kau betul. Just be firm and stick to your answers. Lepas ni, tak kisah siapa yang tanya…. specialist ke, consultant ke…. if we know what we know…. we stick to it!” (Bab mengajar orang suruh rebel, memang boleh bagi kat aku. Hahha)

She told me “Aku baca sekali lalu saja… takut aku tersalah.” This friend of mine is the nicest, the most humble and the least aggressive among my close circle. She is the angel to my devil. Hahha. So, I know she would willingly accept the appearance of being mistaken even when she was right. I am her exact opposite. And I think, Dr. T is also like me. When we believe we are right, we are going to question you regarding what made you question our facts in the first place? (As in, how dare you question me when you yourself are not sure! Now, face our wrath! Hahaha. Okay, just kidding.)

Look, it can happen to anyone. When an ‘authority’ questions you, you become uncertain of yourself. Most people are like that. As stubborn as I always am, even I used to be like that too when I was a HO or a junior MO.

Now, I am more certain and more confident of myself in general. Yes, I still doubt myself, but much less than I used to. If I don’t know, I will say I don’t know. BUT… If I know what I know, there is NOTHING you can say that will convince me that I was wrong. I accept only evidences and references. You must give me more than words before I will accept I was wrong. I had invested time and effort to read my academic materials to come to a conclusion of certain facts, and for you to say that I am wrong, you must give me enough reasoning and evidence for me to change my mind. I would love to learn the right thing…. but I am not suggestible. I might pretend to accept what you say just to keep the harmony… but I will not accept anybody’s dubious words at face value without doing my own research.  I will go back home and verify your answer until I am satisfied. 

But even I sometimes feel unsure whether or not I will ever be as staunch and resolute the way Muhammad Ali had been.

In his life, Muhammad Ali provoked his opponents with razor-sharp words that rhyme and comical one-liners that hurt. But what made him an iconic cultural figure was his quotes on achievement, social justice, religion and war. And what made him greatly impressive was his rock-solid stance in his principles.  

***

Why did I say Muhammad Ali would have passed the Gudjonsson Scale with flying colours?

Well, because he was the epitome of faith and belief in himself and in his religion that there is just no room for him to doubt himself on what was the right course of action. He knew what he knew and even if the whole country was against him, he would not budge.

muhammad-ali-motivational-message-and-quotes-4-638

He held firm to his principles and his belief NOT to fight in the Vietnam War waged by the Americans towards the Viet Cong. Because he was persistent in sticking to his belief, he was exiled from boxing, ostracized by his peers and fans, and stripped of his crown as the heavyweight champion of the world. He was pressured right, left and center. People called him as a coward for refusing to fight a war he did not believe in. He lost almost everything – money, fame and reputation – and he also had to face the risk of prison for refusing to go to war… but he remained firm in his decision.

Muhammad Ali had declared himself as a conscientious objector and refused induction into the U.S army, famously saying, “I ain’t got no quarrel with them Viet Cong,”. He also had said “No Viet Cong ever called me a nigger,”

vietnam war

 

He was also recorded to say, “Why should they ask me to put on a uniform and go ten thousand miles from home and drop bombs and bullets on brown people in Vietnam while so-called Negro people in Louisville are treated like dogs and denied simple human rights?”

I am free

I especially love Muhammad Ali’s beautiful words in defending his stance: “I believe in Allah and in peace. I know where I am going and I know the truth, and I don’t have to be what you want me to be. I am free to be what I want. You can’t condemn a man for wanting peace. If you do, you condemn peace itself. A rooster crows when he sees the light. I have seen the light and I’m crowing!”

Beautiful!

But his words had upset the US Government. So, the US government then tried to send him to prison. He was put on trial and sentenced to 5 years in jail and $10,000 fine.  He was also banned from travelling and was not allowed to participate in matches outside the US. To this, he had said, “They want to stop me working, not only in this country, but out of it”. He must have suffered greatly at that time but he pushed on. 

He was 3 years in exile from boxing. And he almost had to serve his prison sentences, but fortunately, the US Supreme Court later overturned his charges. Muhammad Ali praised God on hearing the news. “I’ve done my celebrating already. I said a prayer to Allah.” 

He added, “They did what they thought was right, and I did what I thought was right.” To him, it was as simple as that.

Muhammad Ali had no higher education. He came from a poor family. But when he spoke, it was full with conviction in his faith and belief system. 

After 3 years in exile, he then resumed his boxing career after the Supreme Court had overturned the charges. Amazingly, he returned to the ring stronger than ever, winning match after match, strengthening his reputation in leaps and bounds.

History later had proven him right. Vietnam War was an embarrassing failure to the US. The US had lost the war and its veterans returned home to taunts and abuse by their own countrymen who were frustrated by the cost of the war to the US economy and to the morale of the country. Influential Hollywood celebrities started to protest the war which Muhammad Ali had condemned much earlier from the very beginning. University students had begun to protest the prolonged war with pickets and demonstrations, cementing the fact that Muhammad Ali was right not to be enlisted even at the risk of being imprisoned.

The truth had prevailed and Muhammad Ali’s wisdom had shone crystal clear and bright.

See?

As I had said, even though he was this great boxing legend of the world, his most impressive achievement was not made in the boxing ring. It was in the way he stood up for what he believed as right, no matter what!

Years later, Muhammad Ali’s name on the Walk of Fame was placed on the wall, instead of on  the ground as in the case of the rest of the other famous celebrities. I am sure, his name was supposed to be on the ground initially… but knowing Muhammad Ali, he must have insisted that his name should be placed on the wall… or NOT AT ALL. And his wish was accommodated since his name is so great that it would be preposterous and ridiculous to leave his name out of the Walk of Fame. So finally, when his name was placed on  the Walk of Fame…it was on the wall, as he had wished, instead of on the ground like the rest of the others!

 

When asked regarding why he wanted his name to be placed on the wall, he had said, “Because I don’t want the name of Muhammad to be stepped on.”

This, my dear readers, is the greatness of Muhammad Ali. May Allah be pleased with him.

Ali
May Allah be pleased with you. Amin.

MRCPSYCH, The Road Less Traveled

A few days ago, a couple of medical graduates who are currently waiting for their housemanship posting had asked me to brief them about the MRCPSYCH program and how it compares with the Master program.

In my conversation with them, I addressed a lot of issues regarding the specialty training in Malaysia and the issues surrounding our training. The stigma, the challenges, the difficulties, the hard work.

This post is inspired by my interaction with them.

***

The thing is, my behaviour has always been consistent. I have always spoken up about the same kind of issue, over and over again. 

I don’t agree for anyone to persecute a whole group just because they are ignorant or biased in their views. I don’t agree for anyone to persecute a whole group out of a mistake done by a few people in that group. I don’t agree for anyone to badmouth a whole group for incompetencies committed by some in that group. Because racism and Assobiyah is a sin in my religion!

If we are Muslims, we surely can relate. When Bali bombing happened in 2005, many Muslims in Australia felt the heat. Islamophobia and hate-related crimes increased. It was not surprising to encounter some rednecks shouting at us “Go back to your country, you turban-head!”

My experience in Australia shaped me so much, to the point that I have perfected a very sharp vision of how not to overgeneralize a whole group for some idiotic things committed by some of the people in that group.

***

When I was a HO, I felt so angry when I heard some of the consultants in the hospital talked badly about Russian grads or Indonesian grads or Ukraine grads. I was an Australian grad, and therefore I was spared the stigma. But even then, it was said “Overseas grad are not as good as local grads. They are not good at setting brannulas. They are not exposed to procedures as much!” Pffft! But one month into your first posting, ANY HO can set the brannula regardless of where they grad! One month into medical posting, ANYONE can do procedures for Peritoneal Dialysis and short lines and long lines. So, what exactly is the big deal here?

So when I was a junior MO, I wrote a long blog post defending the Russian grad. (It can be read H.E.R.E.) I wrote that, contrary to people’s belief about the Russian grads (that Russian grads had achieved bad SPM results and should not have been qualified to go to a medical school) those who were government-sponsored to Russia were actually the cream of the cream in our SPM batch. They went to Russia based on their trial results! It was the government policy AT THAT TIME, to send brilliant people to Russia. I went to Australia based on my SPM result… not my trial! So these government-sponsored Russian grads were actually excellent students.

A lot of the Russian grads (some of them my friends) had widely shared the post. It became viral in no time. I was quite surprised.

And now, we have had many specialists and even consultants in various fields who were Russian grads. In fact, there are still many MOs who are currently doing their master training who are Russian graduates and they are just as good as the local grads or the UK/Ireland/Australia/NZ grads.

See? All your skepticism and your ‘budget bagus’ statement and yes, your arrogance!! have been proven wrong! Any incompetency, attitude problem or lack-of-knowledge in a Russian grad, they are personal to that particular person! You are not being fair when you overgeneralize the whole group! Yes, you had PERSECUTED the whole group just because they were weak and disadvantaged

When there were so MUCH brouhaha about how HOs in the shift system would never be as good as us who were doing our housemanship in the on-call system, I had been very consistent in defending the HOs in the shift system! Even though I was a HO during the on-call system, I NEVER act like I have a crystal ball to see the future and automatically KNOW that none of them will be just as good as me.  I defended the shift system many times! Because I don’t,  and NEVER WILL condone anyone to persecute a whole group or a whole system for any mistake or attitude issues done by some people in that group or in that system! How can you be so small-minded and so certain that the whole group in that system will never be a good doctor just because they have a different training than you! I have many friends doing internship in Australia, UK, New Zealand and Ireland… all of them are good doctors now even though the shift system is implemented there. In fact, the irony is, we send our undergrads to learn to become a doctor in those countries who have been doing the shift system for decades! And then we have the cheek to bash the shift system?!

In my department now, we already have MOs who did their housemanship when the shift system was already implemented. And they are just as great a doctor like the rest of us seniors! In fact, banyak lagi senior yang baloq liat compared to them! Again, all your ‘budget bagus’ statement that this shift-system will produce bad MOs have been proven wrong! Any bad MOs prevalent in the environment stems from their own personal issue and again, it is ridiculous to persecute a whole group based on mistakes done by some in that group!

***

External Pathway Vs Master Pathway

There have even been a lot of ‘budget hebat, aku paling terer’ statement when it comes to bragging about systems in specialty training.

Nowadays, there are already many specialists and consultants who were the product of MRCP, and thus they received less criticism then us MRCPSYCH. But still, you can hear people saying things like “MRCP is not as good as master”.

But the reality is, there are NOW many consultants who are the products of MRCP, some of them are cardiologist, respiratory physician and gastroenterologist ALL OVER THE WORLD. When you say they are not as good as the physicians in the Master pathway, what exactly do you mean? On what basis do you say that? Is the Master qualification recognized all over the world outside Malaysia like MRCP? No! Do you have an objective scale in which to measure how better the Master pathway is compared to the MRCP? No! Or are you just giving an emotional statement just because you disagree with the MRCP physician’s management? Or maybe you have had an inter-departmental issue or disagreement that would have existed anyway regardless of whether the physician is an MRCP product or a Master product?

This is what is happening with MRCPSYCH too. Unlike MRCP, we are only just recognized in Malaysia around 2013/2014. So everyone is having an adjustment disorder about the whole thing. And of course the most logical thing to do – in their opinion – is to bash the MRCPSYCH system and comparing them with the master system in an unfavourable manner, despite the fact that the MRCPSYCH system is recognized the whole world over!

Now, my question is, how sure are you that MRCPSYCH system which is world-recognized will never produce good psychiatrist like the master system? Do you perhaps use a better and different book than us? Do you use special Malaysian-made books that cater specifically to Malaysians psychiatric diseases? (Or do you, in fact, use UK-based books and some of our MRCPSYCH notes too, hmm?) Do you perhaps have a larger amount of greater professors and lecturers compared to the rest of the world? Do you read different journals than us? Or do the people doing the master pathway are somehow less forgetful, more diligent, more up-to-date in anything compared to the MRCPSYCH students? I mean, WHAT?

Oh yeah… maybe the master students were more ehem, GUIDED by lecturers compared to us who were so-called ‘study sendiri-sendiri.’ But then I have checked with several master students too… not just in psychiatry but also in other fields…. they were always told “La ni kita adult learning ya. Bukan semua kena spoon feed. Kena belajar sendiri and tahu apa nak belajar.”

Hahah. So what is the difference, then? Kau belajar sendiri, aku pun belajar sendiri! And nowadays, how many percentage of your time are spent at the uni, especially if you are an out-campus student and also doing various rotations all over KKM facilities? The same KKM facilities that we the MRCPSYCH students use!

Oh yeah… master students have to do thesis! MRCPSYCH tak payah.

So what? I am not going to be a researcher. I am going to be a clinician! You choose master, you deal with YOUR requirement. I choose MRCPSYCH, I deal with MY requirement and the requirement set up by KKM. I pay using my own money to train in MRCPSYCH pathway. If you want MY requirement to be the same as YOURS, then maybe the amount of financial support by the government to MRCPSYCH candidates should be the same too. Everything should be the same then! Tak payah nak buat two different pathways if you guys are so KIASU to question why MRCPSYCH candidates don’t have to do any thesis. My question is, why didn’t you choose MRCPSYCH if you had cared so much regarding how we don’t have to do any thesis? Does doing the Master thesis help you being a better clinician? How much difference does it make? I want to know. And if you think doing this thesis makes you into a MUCH BETTER clinician than the MRCPSYCH candidates, then you shouldn’t feel so bad that you get to do it. Shouldn’t you want what is best for your adult learning despite what other people are doing in another pathway? 

One last point about doing thesis! It would be UNFAIR and VERY UNJUST for anyone to suggest that the MRCPSYCH candidates should do a thesis, just like the Master candidates. When you are doing a master program…. OF COURSE you have to do a thesis! All master students in OTHER FIELDS also have to do a thesis to be eligible to get a MASTER DEGREE! That’s why nama benda ni MASTER PROGRAM! Whereas, MRCPSYCH is a MEMBERSHIP program! We don’t get a MASTER degree despite the fact that our syllabus are the same with the master program. If we ever want to pursue a PhD in the future, we have to get a master degree first before we can do a Phd! But for you guys who are already doing the MASTER Degree, if ever one day you want to do a PhD, you can straight away do it because you already have a Master Degree! Get it? Faham tak beza Master dengan membership program? Semua Master degree kena buat thesis, regardless of their fields… faham tak? How is that FAIR and JUST for you to suggest for us to do a thesis when we are PAYING OUR OWN WAY for an exclusive world-recognized membership program and NOT for a master degree? Semua nak sama rata… tiba-tiba at the end of the day, korang dapat master degree tapi kami pula dapat membership of Royal College of Psychiatrist? Nak sama rata celah mana?? (Gosh, aku  tak faham how some people utilize their minds! So weird how they want everything to be fair … as long as in the end, it STILL favours them!)

So, if you are a smart person who JUST KNEW DEEP IN YOUR HEART that you don’t want to do a PhD in the future and you don’t want to become a lecturer or a researcher and you just want to be a CLINICIAN, you would have chosen the MRCPSYCH program! Simple decision making, isn’t it? Tapi kalau kau nak jadi CLINICIAN tapi nak juga ambil Master Degree, that’s YOUR choice! Mungkin kau rasa Master Degree lebih hebat, lebih seronok, lebih banyak pengalaman…. for whatever reason… that is YOUR choice! Jangan nak suruh kami pun nak kena buat thesis! Siapa suruh kau pilih Master?? Lepas tu nak jealous dengan kami pula? Kemudian at the end of the day kita sama-sama buat thesis, tapi kau dapat Master Degree, kami dapat Membership! Banyak cantik! Fair sangat lah tu? How biased is that!

In many parts of the world, most doctors only do a Membership program rather than a Master program because as a doctor and a clinician, that is already ENOUGH. Malaysia should have its own Membership Program for post-graduate training without having to go through the Master system. Maybe this is something we should start looking into! UK has it (RCPsych UK), Ireland has it (RCPsych Ireland). In Australia and New Zealand, they have a regional membership program called The Royal College Of Australia and New Zealand and their candidates also don’t have to do any thesis! Semua orang yang buat membership program, memang tak payah buat thesis! Faham tak? Please get this into your head.

If we have our own local membership program, only then it is fair for you to do some comparison between MRCPSYCH and the local membership program. Candidates can even decide to do BOTH the local membership program as well as the MRCPSYCH program just to get an extra international recognition. (Maybe we can set up a Royal College of Psychiatrist of Malaysia? Or maybe we can collaborate with regional countries and make it into an ASEAN College of Psychiatrist or something. Tak payah dah KKM nak bayar duit kepada universiti untuk train specialists! Besides, most of  the KKM facilities are being used for master training, anyway kan?) Let’s just keep the master program for those who want to become trainee lecturers. Of course trainee lecturers have to do a Master program (and therefore a thesis) if they want to become a lecturer or a researcher or an academician.

Look, at the end of the day, all of us have a choice! We choose according to our own views about what is beneficial for us and how it would fit our commitment and lifestyle. You had a choice too. Once you have made your choice, you really should stop questioning regarding how greener the other side is.

And before I forget, please remember that people who live in a glass house shouldn’t be too quick to cast stones.  The Master system is also very vulnerable to criticism. At least, I TRUST the integrity of the MRCPSYCH pathway. I mean, we NEVER heard any incidence of someone getting hold of leaked questions. We NEVER heard other candidates complaining about how they were disadvantaged because  they did not know about the leaked questions until after the exam… because that kind of thing just does not happen. There is a reason why MRCPSYCH is world-recognized. Because we adhere to a very strict exam guidelines standard and  procedures. Can we say the same about the Master system? Think about it before you say anything disparaging about another system. There are good and weak points in BOTH systems. You are welcome to point out the weakness in my system, but you too must be ready to hear your weakness being pointed out in return. Fair, ok?

***

Now, let me be very clear why I chose MRCPSYCH over Master.

It does not have much to do with the fact that MRCPSYCH is recognized all over the world, even though that is a really good aspect of doing MRCPSYCH! I don’t think that having a world-standard recognition automatically makes MRCPSYCH better than the master system (yup, unlike some people, I don’t feel the need to belittle other system. I think belittling others is a sign of insecurity! But if you belittle mine FIRST, I will certainly retaliate. So jangan nak jolok sarang tebuan unless you are prepared to be stung. Because I will sting you!) Like I said, we use the same books, the same syllabus, the same DSM-5 and the same ICD-10. MRCPSYCH is not better than the master system or vice versa. Please be CLEAR on this!

The reason I chose MRCPSYCH is because I am already used to the freedom and the ‘adult learning’ in the western system! I am free to explore knowledge and form my own opinion without having to navigate politics in the uni. I don’t like those things! I am very outspoken too. I don’t think I can tolerate the Malaysian mentality that outspoken-ness is equal to arrogance (Not all Malaysians are like this, and not all workplace have mentality like this. Even my workplace is generally nice and supportive. I need to put this disclaimer so that no one ends up with their feelings unnecessarily hurt).

I avoid any type of environment that would try to regulate or institutionalize my thinking and my ability to speak up about anything that is wrong or unjust. That is THE ONLY REAL reason I chose MRCPSYCH over Master.

I have heard some disturbing stories about the master system (not necessarily in psychiatry but in other fields as well. I don’t think this is the norm in the master system… but it can and does happen). My friend had told me regarding one student who was quite outspoken regarding her dissatisfaction in the master system, and because of that, she was barred from taking an exam. I asked my friend “Perhaps, she has an attitude problem? Was she always late or did not perform her responsibility well? Was she MIA? Maybe she didn’t finish her assignment?”

My friend said, “No, she was just more vocal about what she found wrong about the master system. So she made a few enemies. She had no knowledge issues. When she takes her exam in the next sem, she passed with just one attempt… she is quite intelligent actually.”

I was bewildered by that story. How can you bar someone from taking an exam just because she speaks up against the system? How dare you! I told my friend “Kalau aku kat tempat kawan kau, I will sue the uni! And I will send complaint letters to many people in KKM! See me in court!”

My friend laughed, “Lagi teruk dia kena nanti. Kami semua ‘yes boss’ ja la,”

There was also another story regarding how ‘adult’ the learning really is. You just did everything and you had to pay for it too. “Kami yang organize kursus. Kami yang dok organize lecturer mana nak bagi talk. Kami yang kena jadi MC, kami yang kena jadi usher… tapi kami pun kena bayar RM500 untuk kursus tu, Padahal kami yang organize. Ramai orang tak puas hati… tapi senyap jalah.”

Wow… how, ehem, unique is that arrangement? In the Western country, the trainees would have raised hell if they are treated that way! Instead of barring the students from having exams, they would be scrambling around doing damage control to their reputation. When you pay for something, you are the service-user or the participant of that course! Somebody else should be organizing it! Not you… who had PAID for it! There is an emphasis for getting the value of your money when you are doing any transaction in the Western country! That is just a simple concept of fair dealing!

***

screenshot 2019-01-17 12.25.49
My Facebook Status on October 12, the day when  Dato’ Azman came to HSB for a session with MOs.

Another issue in the Master system is regarding what happens if you want to quit your master program. I had raised this issue myself when Dato Azman came to HSB even though this has nothing to do with me and more relevant to the master students (So jangan ingat aku asyik tulis saja. Bila ada peluang nak cakap dengan orang atasan, I do it, okay! I just need to feel annoyed enough and then I can REALLY speak.) And Dato Azman was quite nice in listening to all the issues I had raised. I applaud his patience in giving us, the MOs, a fair and transparent platform to speak up.

Another friend of mine who was doing a master program in another field had told me that if she wants to quit her master program, she has to pay RM250,000 to the government.  I was aghast!

“Takkan sampai RM 250,000 kau spend untuk belajar kat uni for these few years?!”

My friend told me, “Dia cakap sebab kita ambil tempat orang lain. So dia nak penalize kita dengan RM250,000 tu. Padahal satu semester RM 8000 saja. Kalau lapan semester baru 64,000.”

I shook my head in disbelief. RM64,000 vs RM 250,000. That is almost QUADRUPLE the amount that you actually used to do your master. How can they justify penalising people QUADRUPLE the actual amount of money used? In my head, I went “This is even worse than usury! Riba kot! Even worse than hutang dengan Along! Just because the master pathway had the MONOPOLY in the business of specialty training, it doesn’t make it right for them to impose unjust deals and rules!” (That is why monopoly is bad in any sector. It encourages unethical abuse of power and the consumers have no rooms for negotiations of their rights because they have NO OTHER ALTERNATIVE!)

So on the day of the meeting with Dato’ Azman, I went down to where the mic was and I said, “Many people are interested in  the master program. But you made it so unattractive to us with oppressive deals. When I am doing MRCPSYCH, I know what I would be getting for everything that I have paid. When I pay RM1300, I get the course notes. If I want to join online classes/tutorials, I can pay for it and I get classes/ tutorials. When I want to do mock exams, I pay for it and I get to do mock exams. When I want to do my actual exam, I pay for it and I get my exam. If I fail the exam, I just need to fork out MORE MONEY to pay for another attempt and I will get another attempt. There is no ‘penalty’ whatsoever. The system is so much more transparent, money-wise. I get what I pay for and I KNOW what I am paying for! No one feel cheated or short-changed! So…how can we justify QUADRUPLING the amount of the actual money used just for the sake of penalty?”

Seriously, I was quite outspoken in that meeting. I mean, think about it! Why don’t you penalize the person by asking her to pay another RM64,000 on top of what the person already owed the government? Which means, get the person to pay RM128,000 (RM 64,000 for her own study + RM 64,000 Penalty for the place of others that she had taken = RM 128,000)  That is more reasonable, isn’t it? (but still unfair. In contrast with the MRCPSYCH system, you only pay for what you want or for what you use. It is fair and transparent!)

We call ourselves as Muslims and Malaysia is a so-called Muslim country! And yet in ANY ‘urusan Muammalat’, the Western non-muslims are more fair and more just and more transparent in all their dealings and transactions! That is the truth! And that’s why when I see intelligent, fair-minded Muslims, my heart softens towards them because they remind me of Australia, the place where I had learned to become more mild-mannered after I was impressed by their intellect and their patience and their fair dealings. In their system, they are MUCH MORE Islamic than us! (Bila balik Malaysia, my disposition has suffered a relapse. Hahah. Hopefully, with the new PH government, the environment in our institutions will change accordingly and my manner will become mild again. LOL)

I told Dato Azman, “I am actually doing the external pathway… but I am just speaking up on behalf of my master student friends scattered all across the fields. What is the RM250,000 money for? They learned mostly by themselves just like us in the external pathway… what is the money paid for then?”

Dato Azman raised his eyebrows “They learned by themselves?” He sounded surprised. And Thank God, there were a few MOs (I didn’t know which of them in the audience) had shouted yes! (Hahha. Thanks guys, whoever you guys are, for the support! I needed it at that time! You guys rock!)

I went on to say, “When we were doing our undergrad study, RM250,000 might be a somewhat justified amount for us to pay back. We got a lot of lectures every week, we got tutorials, we got quizzes every month! We could roughly see where the huge amount of money was spent! But with ‘adult learning’, I do not understand what is the RM250,000 penalty for.”

Dato’ Azman had noted what I had said and he said he would think about it and look into it. I hope, he really does. He also gave his email address and he said we are welcome to write to him directly for any issue. He was quite nice actually despite having to hear a lot of issues and complaints by many MOs that afternoon. Some MRCP candidates had also spoken up and supported what I said regarding our issues in the external pathway. MRCP candidates and the MRCPSYCH candidates kind of conquered the mic that afternoon. Hahaha.  But Kudos to Dato’ Azman for remaining calm. (Actually there were so many other issues I had gone to the mic for but not all of them are relevant to this post. Aku antara orang yang paling kerap guna microphone on that day. And seriously, Dato’ Azman was very patient in handling my questions. Tabik spring!).

I think, this is what leadership is about. Listen and respond.

The era of autocracy is outdated and should have been long gone! Dialogue is in! When someone criticizes your system, you don’t bar them from exams! Instead, you engage them in an intellectual discourse and settle your differences. You remain objective and fair towards them. Be matured! We are all adults here! But once you use autocracy in a cruel and unjust manner, you will one day encounter a student who may fight you back and will never stop fighting until she/he wins against the system! The probability is such that when you use the same method over and over again ENOUGH TIMES, one day you will encounter an EXCEPTION to the norm. When that time comes, you would wish you have never used autocracy against the student and had used intellectual discourse instead. Because trust me, some students may have the courage to fight you all the way to the court. Just imagine the kind of damage it would do to the reputation of the system. It is already happening in housemanship  and now our housemanship training has gotten a terrrible name already. So, please use the method of engagement rather than autocracy in anything you do. Because in this generation, the current maxim is “Be fair or Beware”.

***

Some people had also said “Bila ada external pathway ni, kita tak boleh nak control who are the candidates that become our future psychiatrists. Who knows…orang tu ada attitude problem ke… mungkin diorang tak sesuai nak jadi psychiatrist. Kalau dalam master program, kita boleh stop dia jadi psychiatrist from the very beginning kalau kita rasa dia  tak sesuai.”

Wow…. this is SO Malaysian! Do you think NONE of the master graduates had ever had any attitude problem? I can name a few, too! But do I go around saying “See? What kind of bad psychiatrists the master program is producing? And look at the products of master program in other specialties! Some of them molested HOs. Wow… such a splendid ‘attitude screening system’ you have in the master program, huh?And with those who didn’t molest HOs, they simply remained silent out of sheer selfishness and cowardice! What kind of specialists are the master program producing!? Look at how institutionalized their thinking is that they would ignore any wrongdoing just because it comes from someone of a higher hierarchy than them… perhaps because they are so used to it in the master system. Asyik senyum and cakap, ‘yes boss’ or ‘yes, prof” all the time!” Did I say any of that? Ada ke aku keluarkan kata-kata overgeneralization macam tu? Ada aku generalize semua master products as cowards based on that notorious incident? Tak, kan?! Because I am fair in my thinking and my judgment! I don’t over generalize people. In psychiatry, over-generalization is a cognitive distortion, ok? 

Should there be any issues with the attitude of your future specialists, you deal with them when they come along! Just like in anything in the world, you intervene when there are issues! You shouldn’t PRE-EMPTIVELY discriminate the whole group with your snide remarks based on your bigoted, discriminatory unfounded fears! But now, what  we did was the EXACT OPPOSITE! (klasik perangai orang Malaysia! Suka buat benda tak logik!) When there are serious issues with your specialists, you remain quiet and silent because you “nak jaga nama jabatan!”. Bila specialist dah ada isu, kita pula pi buat senyap! Sampai HO pun boleh kena molest for MANY YEARS! (Tapi ada hati nak condemn the external pathway sebab kita tak boleh nak, ehem, ‘pre-emptively screen their attitude’! Wow! Amazing reasoning! Boleh tak kalau ada isu, deal with it then and there?! It is a more logical approach, isn’t it? Tak payah nak kalut risau pasal the future, sedangkan benda yang kita boleh intervene STAT, kita tergamak buat senyap for MANY YEARS! What is that?! How dodgy is our priority!)

If an MRCPSYCH candidate does not perform well in the department, you can talk directly to the candidate and tell the person to improve. The candidate’s particular issues should not be generalized to the whole system! If a specialist asks an MRCPSYCH candiate something that she/he doesn’t know… maybe it is the candidate’s personal lack-of-knowledge and incompetency issues. It doesn’t mean the whole MRCPSYCH candidates are not good. Likewise, I have seen quite a few Master candidates who are not that good… some of them are already a specialist and they can still be confused about certain aspects of patient management. To me, that is just human! I do not generalize that to the whole Master program, do I? We read, we take exams, and then we have a tendency to forget a large chunk of it! That’s why we have CMEs! So that we can refresh our knowledge, get it?

So, when you come up with a statement, please be fair! You might get away with it when your audience are not as out-spoken as me or if they always feel the need to kowtow to people and please the authority. But I am not like that. That is just my personality.

personality

I reiterate that I am not bashing the master system. I  think they produce very good psychiatrists, in general. But my personality, my principle against unjust contract, my aversion to oppression, and my personal inclination, had made me choose the external pathway, instead! It is MY personal choice. And you can openly judge me for it… don’t worry, I will just argue against your points. If you can openly judge my choice, I can openly judge your choice too! It will be fun! But if I speak and answer you back in a way that might hurt your feelings, don’t think I am arrogant. You had it coming. And I am the sort of person who fight ALL THE WAY once I am angry enough!

I have always spoken up against the persecution of any underdog. My behaviour is CONSISTENT. If MRCPSYCH is considered the underdog program, heck, I don’t mind speaking up about it. I have spoken up (written up) for others before… and so, believe me, I have no problems speaking up or writing up for myself.

I will continue to do it until MRCPSYCH is as established as MRCP and any issue will then become redundant background noise! 

***

“Don’t worry, Afiza. Kalau depa dok buat payah, kita pi ja la kat Singapore ke Brunei ke…UK pun boleh. Terus jadi orang sana. Gaji pun lagi banyak. System pun lagi bagus.” Said my friend.

That is true. But it will be sad for Malaysia isn’t it? I understand now how the ‘brain drain’ phenomena befalls Malaysia. People get upset by some bureaucratic red tape and they just pack up and leave! And Thank God, that option is always available for MRCPSYCH candidate

Yup…. with MRCPSYCH, I retain my freedom. Free to speak up. Free to move out. Free to address my concerns and the concerns of my colleagues. I will not exchange that freedom for anything in the world. And if people ask me why I choose MRCPSYCH, this is why!

If you have different values than me, you do you! Live and let live! But if you try to belittle my pathway in front of me just because we have different priorities in life and different lifestyles, get ready for my rebuttals. Because I will give them! This is my promise!

Disclaimer:

This is my personal blog and my personal opinion on Malaysian specialty training. It does not reflect the opinion of anyone in KKM or in my department. Please also refer to my blog disclaimer on the bottom right side of the page. My blog has been around since 2009 and it has always been dedicated to me recording about my life as a medical student then, and my life as a doctor now. I have always been very outspoken about things even when I was a houseman. My blog is a place for sharing of life experiences, life-philosophy, world-view and opinions as well as for advocacy of the causes I believe in. So, if you disagree with me, I encourage you to have your own blog and advocate for your own point of view. I also encourage you to leave a comment if you disagree with me and we can debate the matter. This is a free country that respects the rule-of-law since Pakatan Harapan won the General Election last year. Which means, everyone can have their own point of view and advocate for what they believe in. Any assumption, presumption, speculation or hurt feelings that result from what I had written are the responsibility of the readers themselves and they are accountable for it in its entirety. 

My Problem With Anything Vague

The question I always have in psychiatry relates to the psychodynamic area of psychiatry.

“If something is unconscious to the patient, then how can you be reasonably sure that THAT is the reason for how she is feeling at the moment? You are just the therapist. If it is unconscious EVEN to the patient who had experienced it herself, then how do you know that you are right when you point out, oh, the childhood experience of this and that are the reasons for what the patient is feeling now?”

I kind of feel unsettled by the vagueness of it all.

****

I think many people who are involved in psychiatry DO have similar questions about psychodynamic stuff like this. But perhaps, unlike me, they don’t really feel the need to vocalize their confusions (or maybe they are not confused about it. Maybe I am alone in this bothersome affliction. Oh well…). 

I never get a satisfactory answer.

Or maybe… my benchmark for what is a satisfactory answer is higher than most. I was like that since I was a child. I would ask the same question to my parents repeatedly until I was satisfied. Of course, as I grew into adulthood, I learned to suppress my questions and pretend that I am satisfied with an answer… just to cut the interaction short. I suppressed my dissatisfaction at the answer that I received so that I could simply leave the discussion. And then I went back home, forever googling. Hahaha.

There are times, when I wonder, why should I bother being so open about my dissatisfaction? Orang lain belajar, jawab exam dan lupakan! Tak payah nak ruminate or question something that is already in the syllabus!

But questioning is how I learn! Debate, discourse, arguments… that’s how I learn. I need to know. Not with ABSOLUTE certainty; just with reasonable certainty that are backed up by scientific evidence.

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I have to admit that my arguments can be very tiresome. Don’t take it personally, ok. That’s just my learning style. Convince me! Break my argument! Then, I will learn where I went wrong. If you cannot rebut me, then I will go away believing I am right.

When I was a teenager, I even questioned the so-called religious stories that were fed to me and my friends. And trust me, among traditional Malay community, questioning anything that sounds religious is taboo. They can jump to conclusion “Your faith is weak! Questioning something religious… you should make taubah and say astaghfirullah. It is the Satan whispering evil doubts to you.”

Kesian kat syaitan. Tak pasal-pasal dapat nama! When it is actually THEIR respresentation of religion that is faulty!

I had asked my naqibah, “Is that religious for her to ‘cungkil’ her eyes just because a man was attracted to her eyes? She had covered her aurat, even wore a purdah. But just because a man, who could not control his own self, was attracted to her eyes, she was supposed to ‘cungkil’ them out to demonstrate to us of her piety? Aku tak faham! How is that religious?”

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In one narration, this woman ended being dead! And this story has been propagated as the story of a pious woman that all women must aspire to become! And only MUCH later did I find out that, it’s a fake story!! And this story is still circulating in dubious blogs and among ustaz/ustazah who could not be bothered to check their references.

I was 18 at that time, doing my IB studies in KMB. I was just a teenager; albeit a curious one. When adults (like ustazah who endorsed the content of the ‘talk’) do not even question the ‘religious’ story, what authority did I have to even question it?

But question it, I did. 

I couldn’t help myself. It was deeply ingrained in my psyche to express my discontent at things that do not make sense.

I was SURE many students MUST have had similar thoughts, but they didn’t feel the need to voice them out. Kita dengar, kita balik, kita lupakan. That was the maxim!

And I used to be like that too. Religion was a mere ritual, separated from any logical understanding whatsoever. I prayed, I fasted… I was good enough, I thought. That was enough, surely! I would have been just like other teenagers….EXCEPT…. at that time, I was dealing with the death of my ex-classmate. I was interested to know – more than I ever did before – about religion, about philosophy, about life after death.

And they fed me these illogical stories?! (I knew it was not intentional on their part. They believed the story themselves! To them they were speaking the truth. But shouldn’t they have cross-checked their references before they gave talks to others. If I were the one being asked to include such a nonsensical story in my religious talk, I would probably ask about the authenticity of the story and investigate the sources until I was satisfied enough! You nak bagi talk, you prepare betul-betullah, kan!!)

If  they had known, how MUCH such fake stories would SHAKE!!! the foundation of someone’s faith, especially in the context of someone who was grieving and was searching for the TRUTH, they would NEVER think that their fake Israilyat stories were harmless and were just for  “Pengajaran saja. Bukan maksudnya kena cungkil mata. Kita nak tunjukkan potret seorang wanita yang berakhlak mulia.” Ugh!!

I was incredulous and very upset when I heard such an answer! What the hell, berakhlak mulia pi cungkil mata tak pasal-pasal? (In psychiatry, that is like deliberate self-harm! And we use the term deliberate self harm even for someone who simply cut their wrists. But this is cungkil mata, okay! Imagine if we have a non-muslim psychiatrist hearing this story, he would NEVER be interested in Islam kan! He would say Islam endorses deliberate self-harm! This is why the Prophet (PBUH) made it so CLEAR, that ‘sesiapa yang berdusta atas namaku, dia telah menempah tempatnya di neraka’. That is a huge warning, you know! Some people could not imagine how stories like this can turn intelligent people away from the religion! They could not imagine that …because in the first place, they were not deep thinkers! So why would they ever question anything, right? They assume everyone is as simple minded as them! And anyone who question them is just not religious enough!)

Glad INTJ argues

****

Let’s create a made-up scenario here to demonstrate how easily we can be wrong in our assumptions.

Let’s say… an imaginary psychiatrist, who is not well-trained in psychodynamic, finds out that when I was 11 years old, Ustazah S at my primary school was upset at me for secretly reading the school magazine in her class while she was teaching. This imaginary psychiatrist also finds out that Ustazah S had scolded me fiercely and took my magazine away from me and then she hurled the magazine out of the classroom door until it fell all the way to the ground floor of the building. (I was just flipping through that school magazine in her class because I couldn’t wait to find out whether my short story was placed in the ‘karya murid’ section.  Hahha. My fault for being unable to delay my gratification, I admit. But she didn’t have to throw my magazine down the building, right? Marah aku sudah cukupkan?! Tak payah lah nak rosakkan majalah sekolah aku, right? Hahha. I was ready to admit my mistake for reading the school magazine in her class. But when she threw my magazine all the way from the 3rd floor down to the school garden, I could feel my anger flare almost instantaneously. Instead of looking downward to demonstrate my remorse, I looked up and stared back into her eyes and refused to look away. It was a staring match I was determined to win. Hahah. She became upset and scolded me even more. “Kenapa jegil mata kat Ustazah? Tak puas hati!?” I remained silent but I held her gaze still. In my heart, I went “Memanglah aku tak puas hati! Kau baling buku aku kot! Kalau rosak, kau nak ganti ke?!” Haha. Seriously, I loved all my books! At that age, I had to collect my school money to buy myself any book and magazine that took my fancy. Every single book was precious to me at that time. So, of course I was angry! Ustazah S decided that I should stand at the corner of the class for the rest of the period because of my insolence for staring at her eyes. I defiantly held her gaze while walking to the corner of the classroom. In the end,  I won the staring match. LOL. Until now, my hilarious siblings who knew the story would take one look at me and said, “Weh…mata kak ngah dah mencerlang tu. Dia dah marah tu. Lariiii!” hahah.)

stubborn INTJ

 

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Hahah. I am not this bad. I don’t think I have a sinister smile.  LOL

The psychiatrist who finds out of my history with Ustazah S would probably say, thinking that he is applying his psychodynamic skill, “Hmm…maybe this is why you are hypercritical towards religious figures? Because of this ustazah? Maybe this is why you always like to question religious stories? Maybe this is why you don’t like anyone who speaks  like ustaz or ustazah? Because of what happened to you in your childhood with this ustazah….”

I would probably go…. “This psychiatrist is so ridiculous. He just didn’t get it! Such a faulty psychoanalysis!”

This imaginary psychiatrist is ignoring every other thing that was relevant to my behaviour in KMB when I questioned that ‘cungkil mata’ story. He is ignoring the fact that in the first place, the religious story was fake! When I questioned it, my question was right. I did not question it because the speaker reminded me of my childhood Ustazah S! I questioned it because I wanted to know whether the story was valid… because it sounded so dodgy, okay?! He is also ignoring the fact that, there ARE religious figures that I actually like especially those who are logical and sensible. So how does my terrible childhood experience with Ustazah S can explain my ability to like certain type of religious figures? Surely my sentiment and my dislike towards anyone is more logical than just being solely influenced by my brief childhood experience with Ustazah S. Human beings – when they are not psychotic, at least – are logical creatures!

This psychiatrist, if he jumps to such conclusion, is not being thorough in his assessment! For example, he might also be ignoring the fact that as teenagers, our formal operational stage was on the way to its peak! (Google Piaget Theory of Cognitive Development, guys!) Our logical sense was at its peak when we are at the teenage stage, especially when all our lives, we are surrounded by intelligent cohort from our previous school and all of them study science! Of course, we would question something as stupid as the ‘cungkil mata’! And do not forget the context of me dealing with the death of my friend. The urgency of me wanting to know existential, philosophical stuff like this was at its most passionate at that time. 

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Piaget Theory of Cognitive Development

 

When you put all those into context, the childhood Ustazah S really is not that significant to explain my abrasive manner in questioning religious authority, is it? 

So, my point is, not everything is about your terrible childhood, right? Childhood experience cannot explain everything that you are feeling or going through now! People who you have met and disliked in the past do not necessarily have such power over you that you would illogically and instantly dislike anyone who you meet in the future that reminds you of them!

I don’t believe that psychodynamic is that simple!

Oversimplifying things like this is an error in judgment!  We would be underestimating the power of our brain to learn from other non-childhood experiences. Our brains are always continuously learning, adapting, and assimilating our mental schemas (Piaget’s theory again) until we reach a cognitive equilibrium! And this process goes on for the rest of our lives.

You are not defined by your childhood alone. You don’t stop learning and adapting and accommodating… and you don’t always get stuck in a rut just because of your terrible childhood experiences. Our brain is so much better than that when it comes to adaptation!

Give our brains some credit!

I created that ‘imaginary psychiatrist scenario’ simply as an example of how easy it is to jump to conclusion and construct a connection which is NEVER actually there. And trust me, in those who practice psychiatry, sometimes they DO have the tendency to make assumptions, thinking that they are applying their psychodynamic theory that they learned VERY superficially during their Master days.

Heck, one case protocol….does NOT a psychodynamic expert make!

And yes, sometimes making assumption is necessary to help you direct your thoughts in formulating your case… but you MUST verify it! Otherwise, your assumption is pointless in the general scheme of things; your assumption would be worthless to the case and at worse, it only makes you come across as judgmental to the patient. 

If you have learned psychodynamic and you think assumption and interpretation can be made lightly, you don’t understand it enough! You don’t respect its grey complexity enough! And therefore, you should not be applying it haphazardly! I don’t like psychodynamic, but I have a lot of respect for it sampai aku tak berani pun nak guna that approach and pandai-pandai buat assumption pasal orang. Because I understood how very easy it is for me to be wrong when something is as vague and as unscientific as this! Psyhodynamic is an art…. more than it is a science. Some people are good and talented at this art… but for those who are not good at it, they shouldn’t even bother to make assumptions ‘tak semena-mena’, thinking that they are simply applying their psychodyanamic, ehem, ‘skill’.

I prefer the straightforward approach. If I observe something about the patient that I do not find the real origin for, I will clarify it with the patient. The patient deserves the chance to either confirm your assumption or deny it! You owe your patient that much. You owe it to your patient to make an effort to come to a correct understanding of their position!

“Afiza, for those who are well-trained in psychodynamic, I am sure they won’t simply jump to conclusion based on flimsy observation.  Psychiatrists who are trained in psychodynamic would take everything into context lah! Macam yang you nak dan macam yang you cakap tu!”said a friend of mine with whom I discussed the matter over. 

“Okay, kalau macam tu, we as psychiatry doctors should be trained very well first in psychodynamic.We should first KNOW which type of cases and which type of patient warrant psychodynamic approach. Kalau kita just psychiatry doctors biasa yang tak expert in psychodynamic, kita tak boleh pandai-pandai buat assumption kan? Some patients are intelligent, you know! And they might take it personally when we cannot connect the dots properly and simply repeatedly go back to her childhood yang mungkin langsung tak signifikan! Lepas tu bila dia annoyed dengan kita, kita cakap dia ada transference dengan kita pula! Padahal mungkin dia memang ada valid reason nak annoyed dengan kita!”

My problem is: I don’t like vague things! And psychodynamic feels vague to me. I will never be good at it, I humbly admit. And that’s why I just bought a book on psychodynamic. I want to settle these doubts in my mind once and for all. 

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I just bought this book via Book Depository. It cost me RM232. I wanna cry!

***

I am just an MO. So if I said something or expressed my criticism towards a certain concept or worldview in psychiatry, I am just not credible enough, right? Not everyone is like INTP/INTJ who respects someone NOT based on position, but based on what you have to say. Some people need the stamp of titles and authority to push them to reevaluate their thoughts.

INTJ and authority

Kalau HO/MO cakap tak betul atau tak dipersetujui oleh orang atasan, mesti akan dikritik. Kalau specialist cakap, tak betul pun kita akan senyap. That kind of ‘yes boss’ attitude is prevalent everywhere and I have kind of adapted to that and have stopped expecting Malaysians to be less of a coward who can actually be honest with what they really think and just speak them out. (There is a lot of psychodynamic in this paragraph, and if you are the psychodynamic type you might be able to see it… But rather than going back to my non-existent childhood trauma, you can just go back to my first posting as a HO. Haha. See? Not everything is about childhood! My attitude towards authority began slowly as part of my INTP/INTJ personality but it escalated to this point after my first posting. Our brain is not so weak that they are stuck in childhood forever. Some people do get stuck with their unresolved childhood conflict… but some people get upset due to some recent things they genuinely and validly SHOULD be angry about. So, verify, verify and verify! Verify your assumptions with your patients!)

Imagine my delight when I read the book written by Jeffrey A. Lieberman (the former president of American Psychiatric Association) earlier this year, and he concurred with what I had always believed about psychodynamic. I don’t generally read a lot of non-fiction (I have been trying to increase my habit of reading them over the years) but this is one non-fiction book I actually enjoyed and I found it very relevant to my career.

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Well, Dr. Lieberman who was also one of the people involved in constructing DSM III which was a MUCH more systematic DSM than the previous two DSM…. well, he criticized psychodynamic quite heavily himself in this book.

Dr. Lieberman went through the history of psychodynamic and psychoanalysis in his book. He explained the history of how it came all the way from Europe to be practiced in the US, and how it then affected the psychiatry practice in the US.  He said that, initially Freud’s psychodynamic had brought respect to the psychiatry field until they feel they owed a lot to Freud/psychodynamic in general…. but as the sciences became more influential, as biological and behavioural approach took center stage, others started being openly critical towards this approach, and slowly but surely they departed from this approach.

I love this book! I have been having the same thoughts about the imprecise and unscientific nature of psychodynamic approach for so long (since I got into the psychiatry department) that when I stumbled across this book, I felt like “Yes! Finally there is someone who call a spade a spade. Finally, someone influential had written a book that concurred with my thoughts.” (I am sure there are others who have probably written the same thing over the years, but none that I have personally read myself. So yeah, I was pleasantly surprised when I read this book. I was so impressed by Dr. Lieberman’s book, so much so, that after I returned this book to my friend who had lent it to me, I went online and purchased it for myself so that I could have the copy of the book for my own keeping. So this book flew all  the way across the vast seas for me. I recommend this book for everyone interested in psychiatry!)

One of the best feeling that a  reader can experience  is when we read the written thoughts of someone else we have never met and yet…we can feel… “You and I could have been good friends if we are not separated by time and space. You explain my thoughts so precisely in a way that I would never be able to do. I would love to meet you.” (I feel that way towards Charlotte Bronte, Anne Bronte, Jules Verne and Jane Austen. And many many more authors. I have had hopeless crushes on book characters for so many times that I have lost count on how many different ways my heart is divided. Haha.)

***

I am not saying that psychodynamic approach should not be practiced. Some of the theories are actually understandable (id, ego, superego is one example of psychodynamic aspect that I can understand…well, sort of. Fruedian slips do make sense in a way. Free associations can be useful in therapy, I suppose. The negative therapeutic reaction described in psychoanalysis is comprehensible enough.)

I am saying that when it comes to making assumption about our patients (or about other people in general), we have to keep in mind that psychodynamic is not precisely accurate. There is a high chance that we are wrong in connecting the dots especially when we are not trained! I repeat, “when we are not trained!”

If we want to practice it, we should do it properly.

Further your training in psychodynamic if you like it so much. Do it right. Don’t just make assumptions in every case you see thinking you are applying your psychodynamic approach, and at the same time you never even make the effort to actually verify what you assume about the patient. Because people who really know what psychodynamic is about would find our casual manner of doing it as quite haphazard and an insult to the REAL way psychoanalysis is supposed to be done.

I am sure that psychodynamic psychiatrist would inwardly cringe when they hear their colleagues jump to conclusion improperly and would feel “this people would give this approach a bad name; more bad name than it already has.”

Some assumptions are not psychodynamic. Some assumptions are just nonsensical baloney. And we in psychiatry should know that. If we want psychiatry to gain some semblance of elite status in medical field, we can start by being serious and methodical in how we come up with our thoughts about our patient.

My take home message is this: If you want to practice psychodynamic, you do it right and do it properly. Intelligent people can hear what you say and they can break your assumption to smithereens when they are annoyed by your jumping to conclusion and they will walk away thinking psychiatry is full of baloney. Is that what we want? For intelligent people to feel psychiatry is bogus? Just because we are psychiatry doctors and are ‘supposedly’ an expert in human behaviour and motivation, it does NOT mean that we are correct in our assumptions all the time. It does NOT mean that we can make assumptions based on flimsy anecdotes when we are not properly trained. And then, we go around giving excuses “oh, this is psychodynamic approach.” *shakes head* Aku rasa psychodynamic psychiatrist pun akan bengang! Be fair to the patient…. be fair to the reputation of psychiatry. Be fair to yourself! 

The Association of Time & Respect

My exam is in 5 months time. I am freaking out!

My mom was telling me how 5 months was plenty of time to get ready for ANY exam. “Tapi kalau asyik kalut baca buku cerita, kalau ada masa setahun pun takkan sempat, Kak Ngah,” LOL *sarcasm detected*  

It’s not like I don’t know how precious time really is. I do know it. Allah Himself had sworn by Time in Surah Al-Asr.

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But knowing something is not enough to move me into acting on it. Because… how else can I explain my inability to stop wasting my oh-so-precious time and just study consistently from now on (and stop buying anymore fiction)?

Knowing something is just not enough prodding for me to resist the lure… especially when the temptation (in the form of book reviews by Goodreads/Amazon/BookDepository) proves too hot to resist? Once upon a time, when online shopping was unheard of, I could resist book reviews easily because there was just no other alternative. A Kedahan like me could only rely on Popular to supply me with new releases of books and what Popular didn’t sell, I wouldn’t be able to buy. Temptation was manageable then. (We don’t have MPH, Konokuniya or Borders in Alor Setar and thus Popular monopolizes the Alor Setar’s scenery of book selling industry until now. But alas, Popular has never been exactly great at updating their stocks of recent book releases.)

These days, temptation is impossible to brush off. I just bought myself a book by Mathew Reilly, The Three Secret Cities, via online shopping when I could not find the book in Popular despite the fact that it has been released since November. (I TOLD you Popular is SLOW!) So feeling exasperated by the long unfruitful waiting, I decided to go online-shopping to take care of the itch. Now, I am patiently waiting for the book to arrive on my doorstep.

Which means that when the book arrives, I won’t be studying, LOL. Yup, wasting my precious study time, I admit. But it’s not like I can concentrate on my studies anyway when I know the book is somewhere inside my house still awaiting my touch. Might as well I just get rid of the temptation and hopefully, I can then focus on my study… Amen.

***

But my time is MINE to waste it in any way I like. If my time were to be wasted anyway, I might as well be the one who DECIDE what I am going to waste it on. And since I am going to waste it regardless, I might as well waste it doing something enjoyable, right? (like reading fiction, hahah) Logic, si?

However, I resent having my time wasted by others, especially in cases when I have no say nor control on how it should be wasted on. I am not gonna tolerate having my time wasted by ANYONE unless I absolutely have no choice about it for some obscure reason.

For example, I tolerate people wasting my time by being late when they first show me how to hike a new track. Because I need them at that point. But once I have mastered the track and have stopped depending on people to show me the way, I prefer to go hiking by myself. I find it troublesome to wait for them when they are late… and I am not going to. If you are late, I will go without you. Next time, I won’t go hiking with you anymore unless you can prove to me that you are not going to make me wait. The reason I always try to make myself independent and self-sufficient as soon as possible is because my time is precious and it is MINE to waste it in however way I choose. I am not gonna waste it WAITING on people. If I were to waste it, I wanna waste it reading fiction, ok?

And so it goes, that I almost always hike by myself. Occasionally, when my friends ask me whether they can join me hiking, I make it compulsory for them to be on time. I will wait for them up to 10 minutes if they are not on time, and then that’s it! I will go without them and I am okay with that. I am okay doing things alone. If you are not okay to hike alone like I am, you follow MY time.

All my close friends know this about me. If they are close to me, chances are they are a punctual person, themselves. Even when they are not naturally a punctual person… at least when they have planned an activity with me, they made themselves punctual for me if they are my friends. Because they know, I can do most activities myself and I have no problem doing things myself. They are the ones who usually feel awkward doing things alone and ask me for company, so they have to abide by my rules. I can eat alone, walk alone, shop alone, … I don’t mind it. What I do mind, is waiting on people when I could have done something else with that time. 

Does that sound cold-blooded and inconsiderate? “You must do things my way because you are the one who need me and I don’t need you as much. So you must follow my rule if you are going to depend on me in doing this activity.” Hahha. Yeah, when put it that way, it does sound cold-blooded, isn’t it? And so insensitive, right? But I am just being honest, here.

In my opinion, for you to keep me waiting when YOU KNOW I must have been waiting, you are PURPOSEFULLY disrespecting me. In MY view, YOU are the insensitive one, here! Not me. I made the effort to see you on time even though I don’t really need you… because I respect you and I honour my obligation and my promise that I have made towards you to arrive at a specific particular place at a specific particular time. But you didn’t make an effort to arrive on time to see me even though you were the one who were asking for my company? (In my mind, I will be like, “Damn… I could have read a few more chapters of my latest fiction in my comfortable bed rather than waiting for you. What makes you think you are more enjoyable than my novel that I will be willingly waiting for you without feeling angry when you fail to be on time? Don’t you know that there are not many people whose company I enjoy more than my books?”) When you fail to be on time (+/- 10 mins are still acceptable; I have learned to tolerate that much) in my opinion, I am no longer obligated to be sensitive towards you and I will make my displeasure known. My cold-bloodedness… well, you earned it. You will be lucky if I ever agree to make any plans with you again. 

One of my friends (the nicest one hahah), said, “Afiza, relationship requires compromise. You have to meet people half way. Not everything must be done your way.”

I was like, “Oh? You mean, if my way is the punctual way, which is the right way… and the other person’s way is the non-punctual way, which is the wrong way… I must compromise MY right way for HER wrong way?”

“Is there always a wrong way or right way of doing things…. that’s dichotomous, isn’t it? What I am saying is, you must meet people half-way.”

I laughed. “Half way? You mean, if I am punctual… and that person is always 2 hours late… we must meet each other half-way by being one hour late instead?” *sarcasm detected* (and to answer her question… yes in certain things, there ARE the right way and the wrong way of doing things. If you think your way is more right than mine, engage my intellect by debating the matter with me and make me see. I will change my view if I am convinced. I am willing to change to follow the right way. See? I am willing to learn… to do things the right way or the more efficient way. Not because it is YOUR way or MY way…. but because it is the right way. When it comes to time, being punctual is OBVIOUSLY the right way. Otherwise, why bother specifying the time in doing anything?!)

My friend shrugged after hearing my answer. She knew I have made up my mind and there was nothing she could say that would change it. Yes… when it comes to being punctual, my mind is made up! The debate is closed! 

In my opinion, unless you are facing an emergency situation, there is NO JUSTIFICATION for you to be non-punctual! There is NO JUSTIFICATION for you to keep people waiting especially WHEN YOU KNOW that person is waiting! And if it happens multiple times, well, I am not going to tolerate it and my mind will conclude that “Obviously, there are discrepancies in our habits and attitude towards time, and therefore we cannot be friends. I value my time more than I value any relationship with a disorganized person.”

***

So when do I tolerate people not being punctual?

Obviously, I will tolerate them when I STILL need them (like in the case of people showing me the right track for hiking). To me, that is just simple strategy on my part. Since I need you, I will have no choice but to tolerate your annoying habits. But once I have mastered the skills that you have and is fully able to be independent, I will no longer tolerate your bad habits. I am not being disloyal… trust me, I would have been really honest about my dissatisfaction regarding your bad habits… but if you persist in doing them despite my clear communication of dissatisfaction, what else am I supposed to do? Eventually, after my obvious dissatisfaction is being brushed off, I will take that as a sign of disrespect and I am just going to have to say “Look, it’s been nice learning things from you… Thank you so much. But for now, I am just going to say good bye and do my own things for awhile…. well, unless you are willing to be on time when we next go for a hike. Otherwise, I will see you around, yeah? No hard feelings, ok!”

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That’s why I appreciate people who are on time! 

I don’t abandon my friends lightly. I do care about them. But the least they can do to show that they care about me in return…. is by being punctual. That’s all I ask (and of course, other than that, I also want them to have general good principles that align with mine. I am not going to be friends with murderers, thieves, psychopath, work-slackers…. well, you get the idea. Hahah) Luckily for me, my friends are mostly punctual. (Like I said, if they are not punctual as a habit, we would not have come to the stage of being friends in the first place. I would have abandoned them when we were at the stage of being acquaintances.). But even friends are allowed to have lapses and make mistakes. Tertidur, terlupa, unforeseeable emergency that crops up… those are understandable rare occurrences when my friends are late. I can tolerate that. These are the friends I keep… and they will enter my ‘inner circle’. To them, I will be loyal and supportive and transparent in my thoughts and my feelings. So, I am not that cold-blooded, am I? I do know how to be loyal and supportive and ehem, ‘nice’, but I am not like that for just anyone.

In fact, why should I?

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And trust me, NO ONE should be loyal and supportive and nice to EVERYONE. Who got the time, man? Why do you want to waste your resources like that? Be selective in whom you should be loyal/supportive/ nice to! Be that way with family and real friends who respect your principles and your boundaries! Invest your time where it is most beneficial to you. We don’t know how much TIME we have left on this earth and we should spend them wisely with people that matter. And with the rest of the others, just be generally polite and professional, abiding by the rules of social conduct (which includes being punctual) and fairness (which includes being honest) but not more than that. Don’t drain yourself with unnecessary obligations that will take away your resources. And believe me, your time is your resources. 

Time is not just gold and money. Time is LIFE!

 

***

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I also tolerate unpunctuality from superiors. Why? Because in order to complete our professional activities, subordinates need superiors. So, of course I will tolerate unpunctuality from them. Well, for awhile, at least. But again, eventually, I would make my dissatisfaction known.

When I was doing one of my clinical attachments in one particular hospital, I arrived to my first meeting with my supervisor 20 minutes late because in the letter I had received, I was told that I was supposed to report to Unit Sumber Manusia first. I didn’t know that it was customary to see the supervisor first before going to the Unit Sumber Manusia. How was I supposed to know the custom of a place I had never been to before? (Anyway, if that’s customary, it should be clearly communicated in the letter, shouldn’t it?). My supervisor told me “I am a punctual person, please try to be on time.” I was also quick to reply, “I came half an hour early and had reported to Unit Sumber Manusia as instructed by the letter given to me. I didn’t know I was supposed to see you first.” I hoped, I had made it clear that I was just as upset by the lack of proper planning and the bad communication that had taken place. I am always quite sorry when I am late… but NOT when I am late through no fault of mine! I am not willing to take a blame that is not mine to take.

I like structure, planned schedule, and having a timeline. To me, that’s professional work ethic. I can understand that sometimes the roster might be tight and superiors can be late in arriving on time especially if they have to cover multiple wards or workloads from their colleagues who are on leave. But if schedules are planned, and rosters are not that tight and many people are available, there is NO JUSTIFICATION for you to keep your subordinates waiting.

As an MO, I am in the middle position of being someone’s superior and also someone’s subordinate. So, I can totally identify with the difficulties of being either of them. Superiors have their own limitations and so do subordinates. But come on, having limitations when you are a subordinate is always going to be more difficult than having limitations when you are a superior. Because by the very definition of subordinate, he/she will always be dependent on his/her superior for decision making. The subordinate is always subject to the superior’s dictation and instruction. And that’s why I make it a point to not make my HOs wait without telling them what to expect. When I do think I might arrive late, I whatsapp them beforehand to let them know that I am going to be late and I will tell them what I want them to do in the mean time. Because I believe, it is MY responsibility to tell them what to do when I am not around for the activity that I should be doing with them. It is not their responsibility to have to check with me whether or not I will actually arrive especially when it involves an activity that has been routinely scheduled! When something is routine, there is already a tacit and implied understanding that I should be there. Any failure on my part to arrive to a routinely scheduled activity means that it is automatically my fault if I fail to inform them about it. I do NOT think that superiors have any rights to keep their subordinates waiting any more than it is okay for subordinates to keep their superiors waiting.

Respect is the key point here.

We should respect our subordinates just as we should respect our superiors. We should also respect our patient’s time waiting for us to come and review them! Should we not be available to conduct our professional activity in the clinic or in the ward, it is our obligation to passover the matter to our colleagues of the same rank. If rosters are tight and there is no one else in our own rank we could passover our obligation to, we can tell our subordinates to go ahead and run the activity on our behalves. Of course, it is not ideal but if circumstances cannot be helped and we trust our subordinates to run the activity on our behalves, that must be clearly communicated. It is not okay to let our subordinates to wonder to themselves about what to do and whether or not we will ever arrive and whether or not they should just go ahead and run it themselves. If we want them to start any activity first without us, tell that to them. If we want them to wait for us anyway even though we are going to be late, tell them clearly so that they can apologize to the waiting patients and persuade the patients to wait for our arrival.

It shows respect and decency. You don’t have to be someone’s close friends to respect his or her time. You just have to be an overall decent person.

And that explains why I will not tolerate people who are not punctual. I respect people’s time even when they are not my friends. So, for anyone not to respect my time or other people’s time, well, that is bewildering to me and I will take it personally. 

But I was told that “Afiza, hang kena baik sangka. We are a product of our environment and upbringing. Not everyone was raised to be obsessed about punctuality.”

Okay, I do give people chances to redeem themselves. I will tell them that I am not happy about them not being on time. But if they do it again despite my explicit communication of dissatisfaction (and trust me, most of my communication is explicit anyway), then I no longer have any obligation to ‘baik sangka’. My obligation to clarify the matter is done and whatever ‘sangkaan’ I have about you is accurate from that point onwards.

And that’s that.

***

My staff nurse told me one day “Dr. Afiza jalan laju sangat. Awat kalut sangat ni? Dok ligan apa?”

My colleague replied something like this, “Dr. Afiza hanya jalan lemah-lembut bila dia tengah tak sihat. So kena bagi dia tak sihat selalu kalau nak tengok dia ayu.” I was having URTI at that time and was feeling generally lethargic. So, they were teasing me about my slower walk and how I look more demure when my face was less expressive than usual. Haha.

Yes, I do walk fast. My nickname when I was in high school was Fifi Ferrari. (Created after the like of Maria Mercedes, a popular Mexican soap opera at that time. Haha. I had really creative friends, back then!). It’s because I value my time. I don’t know how people get bored because I always have things to do. Upon waking up, I have to pray, get ready to go to work. From the parking lot, I have to rush to punch in. And then, I have to go to my ward and review my patient. And then, I have to go to my clinic and start my clinic. The routine is already established. There are always THINGS to do that it doesn’t make any sense for people to walk sedately as  though they are aimlessly wondering what is their next task for the day. It always annoys me when I have to slow down my pace whenever the people in front of me are walking slowly. In my mind, I would be like “Ni nak berjalan ke nak jalan-jalan? Ni tempat orang kerja, bukan tempat melancong tengok permandangan nak jalan slow-slow.” Hahha. (Okay, I know this is just my personal pet peeve. Everyone is entitled to their own pace of doing things. If you want to walk slow, that’s your rights to do so. I am just venting out that I couldn’t stand walking behind someone who walk slowly and aimlessly.)

When would I be walking sedately? Well, maybe when I am walking at the beach….or when I am on a holiday and trying to soak in the beautiful scenery of a new place. Yes, I can walk slowly then. Because my PURPOSE at that time is to enjoy my holiday and learn a new culture and absorb the beauty of the new surrounding… and therefore I act accordingly and walk slowly to fit the PURPOSE of my activity.  Another time I would walk slowly is maybe when I am walking with friends who are slower than me. Or when I have just arrived at a new place and not yet sure where places are and need to stop and read the signs to know where I should be heading. But once I am familiar with the place and with the routine in that place, I like to get things done in the day as fast as possible.

At my clinic, my routine is established. From the moment I go out of my car in the parking lot to head to the punch card machine to punch in… until I punch out at 5.00 p.m, I always have things to do. Whether it is to see my patients in the ward, start the clinic, or go for lunch and start the p.m clinic or go for a departmental CME…Why should I dilly-dally, walking sedately and aimlessly when I already KNOW what things to do one after another?  Doesn’t it make more sense to get your task done as quickly as possible and settle everything one by one so that you get to relax as soon as possible?

Again… it’s about time. I cannot even tolerate wasting it by slow walking. That is the reason I always wear pants to work and very rarely do I wear baju kurung. I couldn’t walk fast in baju kurung. Lagi awal aku siap kerja, lagi awal aku boleh study, lagi awal aku boleh relax, lagi awal aku boleh baca buku cerita, get it? Hahha. As simple as that.

So you want to see me relaxed and not kalut? See me while I am reading my fiction or when I am sleeping. I am at my most relaxed then.

time

The Musings of An Obsessive Book Lover

It’s been a long time since I last talked about my favourite topic ever…. ehem…. BOOKS!

I am obsessed with books. If I ever become a hoarder, trust me, I will be hoarding books. If you come to my house, you will see my 4 big bookshelves. And now, I am in need of a 5th one. (Maybe, I am already a hoarder haha).

Once you have stepped into my house, you will feel like you have entered a small-scale community library! And if you love reading, you will love spending time in my house (ok, tengah perasan rumah sendiri best hahah. But seriously, “rumahku syurgaku” is the right sentiment for me, Alhamdulillah. I can stay in my house for weeks… kalau aku tak perlu keluar kerja dan cari makanan LOL!)

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The cramped ‘situation’ in the shelf of my living room. Sampai buku-buku dah spill over onto the coffee table. Adeh!
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Bookshelves below the stairs…. tinggal satu row saja lagi ruang kosong! Stressed! Tu pun ada space sebab aku double-layer kan some of  the rows!
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This is the bookshelf on the 2nd floor. One of the doors pun dah tak boleh tutup sebab terlalu banyak buku!
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The ‘situation’ on my bedside table. These are the piles that I haven’t read. My TBR (to-be-read) pile. Really need to catch up on my reading and STOP BUYING ANY MORE BOOKS!
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The ‘situation’ at my study desk! This is the main reason I am behind on my fiction reading…  because of the academic reading I MUST do at THIS DESK!

 

As an obsessive book lover, this is my #Confession #Rants

And this confession was brought on by someone who still has not returned my book. (The stress is real, folks). And also brought on by some issues in the social media that disturb my peace of mind. 

***

#Confession

Aku kedekut! Super kedekut!

Aku kedekut untuk bagi pinjam buku kepada orang. This is the one type of kedekut that I still find it hard to change (Dulu kedekut lagi dahsyat. Makanan minuman tak nak share langsung sebab geli. Now, at least, I can share some.)

Zaman duduk asrama dulu, bila aku pinjamkan buku kepada orang, apa yang akan terjadi adalah samada buku aku hilang atau pun orang tu ambil masa yang sangat lama untuk pulangkan. Atau pun bila dipulangkan, habis lasam buku aku macam buku buruk! Padahal waktu aku pinjamkan pada dia, buku tu masih baru dan cantik. I wanted to cry!

In my mind, I will feel like “Why can’t you buy the book yourself? I bought my book myself, didn’t I?” My friends could buy an expensive perfume or Body Shop toiletries (zaman sekolah menengah, this was considered luxury item, ok!) or eat at a cafeteria everyday (instead of at the Dewan Makan) and could prioritize buying just about anything else… except their own fiction! But then, they wanted to borrow mine! 

I was so stressed. In my heart, I was like “Aku tak pernah pun nak pinjam kau punya Body Shop perfume ke or whatever it is yang kau dok beli selama ni. Barang-barang mahal kau boleh pula beli. Tapi kenapa buku kau tak boleh beli? Aku menabung lama tau nak beli buku ni! You had no idea how much I love this book… and you just wanna borrow it like that? Iys!” Haha. You guys had no idea how difficult it was for me to hide my displeasure when I had to lend my books to people when they asked (in order to be polite to them). Memang aku terpaksa mengaku, aku tak ikhlas nak bagi pinjam. 

You see, part of the pleasure in buying and reading books is in discussing them. So when I was a teenager, I usually would discuss with people about certain books I had bought and read so that they could be interested to read the books too and then we could analyze the content together! Get it? Readers just LOVE discussing books… it’s just how we are wired. We are nerds through and through  (but we have learned to disguise our nerdy-ness as we grow up LOL).But then, I learned that whenever I did that book discussion with people, somehow it would end up with me having to lend the book to them. I remember, aku sampai fobia nak cakap kat orang buku apa yang aku beli. Hahah. So, I kept my excited thoughts about books to myself after having learned people’s tendency to just wanna borrow my books instead of buying the books themselves.

Disebabkan aku ini sangat kedekut nak bagi pinjam buku kat orang, aku sangat hargai bila ada orang sudi bagi pinjam buku kat aku…. and as a show of appreciation, I will return the book within a few days (paling lama aku pinjam pun hanya seminggu, tu pun sebab cuti sekolah and tak dapat nak return stat). I would just finish reading the book as soon as possible sebab aku tak nak pemilik buku tu tertunggu-tunggu bila buku dia nak dipulangkan semula. (Whereas with my friends, they took MONTHS to finish a 400 page book. Gila slow! Kalau kau tahu kau jenis tak boleh concentrate nak habiskan buku in one seating, atau kau ni busy gila sampai tak dapat nak habiskan buku cepat-cepat… then please don’t borrow the book yet. Wait until you have more free time to read the book before you borrow it. Tak lah owner of the book rasa stress)

I think this is just adab. You don’t understand how an obsessive book lover think! They are in distress every time they are apart from their books. This is not an exaggeration… at the back of their mind, there is always that constant wondering of when the book will be safely returned.

Cannot empathize? Cuba orang minta pinjam Iphone korang? Get it, now? It is almost the same thing to us. 

To a book lover, every single book of theirs is as precious as an Iphone. Please understand. 

As I grew older and had my own money (initially from MARA scholarship and then nowadays I got my own salary), I became less stingy with my books because I could buy them so easily now without having to menabung as I used to. (When I was in school, I depended on my allowance from my parents only! And I didn’t like asking them for more money than what they had already allocated for me. So I had to save my allowance to buy books. Tu pasal aku kedekut… sebab susah payah aku berjimat nak beli buku cerita, ok! hahah) But seriously even with my current financial independence, I STILL don’t prefer to lend my books to people. When I discuss about any book with you, please don’t think that it is an invitation for you to borrow it. It is NOT. It is just me being a fellow good reader, trying to guide you on your next purchase. I am just trying to be helpful on what sort of good books are out there for you to buy and enjoy. That’s all.

****

Perhaps one the best things about me being a book lover is that, I don’t care about branded stuff. I will probably enjoy having them…. if I have them. But not having them is neither here nor there to me. I am indifferent to it.

I go for quality rather than brands. Sebab itulah sampai sekarang aku tak pernah cuba membeli Iphone (because for me, I will only use it to make a phone call, to message or whatsapp… which are the things that ANY smartphone can do.  And  I also use my phone to snap pictures…. so the only deciding factor on which phone to buy will be the camera feature. And with Huawei and Oppo in the market… Iphone becomes even less relevant to me camera-wise)  But I did purchase a Macbook… because Macbook has the most ‘value for money’. (My Macbook very rarely hangs! I don’t even have an anti-virus for my Macbook. I have been using my Macbook since 2014 and it works just as well as when I first bought it!).

So, it really weirds me out when I saw news such as below.

 

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Apparently in the UK, students are banned from wearing expensive coats to prevent the poorer kids from feeling ashamed of their inability to wear the same branded coats. I really cannot brain this.
And then I was more aghast when in Malaysia, apparently the parents are stressed out about their kids asking them to buy an expensive Smiggle item just because their friends at school have the same Smiggle item. WTH??
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I have heard about how expensive Smiggle items can be and I have read about how parents were complaining about it, before. But the issue on Smiggle resurfaced after the news on the banning of wearing expensive coat in British Schools hit the social media. Some people believe that maybe Malaysian Schools also should ban certain items from being worn/brought/used in school.
One such example of a parent who had lamented on this Smiggle issue can be read  below:
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While I can see the concern of this particular parent and indeed sympathize with his dilemma, I really find myself slightly bewildered by the whole thing. I just fail to see why we can’t simply go ahead and tell our children NO when they ask for something that we cannot afford to give?
Aku tak faham. All of us used to be a kid too. But we handled our jealousy and disappointment ourselves, didn’t we? Tak perlu pun nak kena ada peraturan “semua orang tak boleh pakai benda branded” just because aku tidak mampu pakai.
Like I said, I don’t buy branded stuff in general. Tapi waktu kanak-kanak dulu ada ja kawan-kawan pakai barang-barang branded… dan ada juga aku rasa teringin. Tapi bila kita minta kat parents and parents kata tak boleh, then we accepted it and WE LEARNED TO DEAL WITH OUR OWN EMOTION!

Kenapa pula kita nak kena suruh orang lain jangan beli benda yang kita tak mampu beli? One day these children will grow up and need to handle their emotions including jealousy and disappointment. And during school is the best way to learn that, and of course, guided by parents.

Ibu bapa yang senang dan berada boleh ajar anak-anak how to be compassionate “Even though I bought you a Smiggle bag, it doesn’t mean you can mock other kids who don’t own one. If you do that and I happen to find out about it, I will throw your Smiggle in the bin! Be kind!”

Ibu bapa yg tidak mampu pula can teach kids to be grateful “Even though I cannot afford to buy you a Smiggle bag, but I will make sure you have enough food on the dinner table, a pair of school shoes and two sets of school uniforms for you to attend school.”

Ajar sajalah anak-anak. Talk to them. Jangan nak ajar value ala-ala komunis “semua kena sama rata”.

Do not create an asinine blanket rule that does not stand reality check.

#EveryHardshipIsAnOpportunityToInstillValues
#JustTalkToYourKidsAndTeachThem
#DoNotMakeBlanketRulesThatDoNotStandRealityCheck

 

So when you go shopping for school stuff with your kids and one of them ask for a Smiggle item, you can say “Look, mommy only have RM 50 to buy 2 pencil cases; one for your sister and one for you. If mommy buy you a Smiggle, your sister would not have a pencil case for herself; that wouldn’t be so cool, right? I am sure, you being such a kind brother, would rather your sister get a pencil case of her own too rather than a Smiggle for yourself, wouldn’t you?”

See?

Engage with their minds! Ask them to evaluate…. which one is better? One Smiggle pencil case or two pencil cases that look just as nice but very much cheaper? Teach your kids not to be selfish by asking them to think about the needs of their other siblings too. And furthermore, teach them about fairness … tell them resources must be fairly divided between all the children according to needs and urgency. You talking to them and discussing issues like these with them is how they get to develop their judgment. This is the sort of conversation that you can employ to teach them the right values. Perhaps this would be one of the conversation that your kids would always remember you by.

Because the truth is when you are long gone, they will remember the values you taught them…. not the toys you bought them.

***

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Mak Ngah is so proud of you Eshan!

Alhamdulillah, today my nephew Eshan has received an award for being the first in his batch (Anugerah Terbaik Keseluruhan Darjah 1), the best in Math (Anugarah Terbaik Matematik. Not surpising as my Kak Long’s doctorate is in statistics LOL) and Headmaster Special Award (Anugerah Khas Guru Besar). All of us are so proud of him. The first member of the 3rd generation in Azmee’s family has really done us proud.

I told Eshan that I wanted to buy him a present as a reward for his excellent academic performance. So I asked him what he wanted for a present. He said, he just wanted a book. A Star-Wars book! LOL.

I laughed. I was like “Yeah, I should have known.” Genetic/Nature is one thing (my father loves reading, and so do all of my siblings and now even the grandson has followed suit) but the environment/nurture plays just as much importance in developing the habit of your children.

My Kak Long was asked by other parents regarding how she gets Eshan and Aayra to love reading. She was stumped. To her, there was no fancy technique that she had to employ to get her children to read. There is NO TECHNIQUE. Your children pick up that habit from you! Do you spend the bulk of your time reading and writing? If you don’t, then do not expect your kids to do the same thing!

In her own words, while she was commenting on the Smiggle issue on my Facebook status, she wrote “Bagi aku senang… salah mak bapa tak pandai guide. It might sound harsh but it is the truth. I mean everything starts from home. On a different issue, a friend of mine was talking about the techniques on how to improve children’s’ interest in reading. I honestly think there’s no fancy technique. Soalan aku senang ja, mak bapa dia into books ke dak? Children just imitate what the parents do. It all starts from home. So sama juga dgn Smiggles ke Kinder Bueno ke.. mak pak jadilah parents untuk anak-anak. If you can afford, you buy; if you can’t, just tell your children. It’s ok.”

YOU are the parents! Kenapa pula kamu yang nak kena susah hati bila anak-anak minta Smiggle dan kamu tak mampu bagi? YOU set the rules… not them! THEY need to know that the household has got some sort of structure! Kalau you lenient tak tentu pasal, it doesn’t provide them a sense of security or a secure base. They need to know you are consistent and reliable, even as you are saying NO to them. Just tell them you cannot afford it! Tell it as it is! Be honest! Don’t worry, the children can handle it if you start that honest pattern of parenting soon enough in their childhood. It might even teach them empathy… because they get to know and appreciate their parents’ difficulties and sacrifices. I could handle it when my parents said no whenever I wanted even more story books than what they had bought for me. I handled it by saving my own money and buying the books myself (and hence aku kedekut nak bagi pinjam aku punya buku, hahha. I never sold any of my medical books to my juniors when I no longer used them. I kept them all until now…. ehem, like a hoarder. Hahah)

I can just imagine what my father would tell me kalau aku cakap kawan-kawan aku ejek aku sebab tak ada barang-barang Smiggle. He would probably say something like this, “Kalau diorang ejek Kak Ngah, Kak Ngah cakap sajalah Kak Ngah tak perlukan Smiggle untuk dapat nombor satu dalam kelas. And prove it by getting number one in class.”

And I would  go, “Good idea, Dad. I will say it exactly like that!”

See? Every interaction, every difficulty in life… is an opportunity to instil values! In this case, he would be teaching me how to respond to hurtful taunts and stand up for myself! But you MUST talk to your kids! You must coach them how  to handle life’s situation and then let them handle it themselves.  Don’t create A DIFFERENT REALITY or ANOTHER RULE just to protect your kids’ feelings. You are not doing them any favour that way! They will never grow up.

And this is the reason that me and my siblings are not on board with Dr. Maszlee’s idea that Tahap 1 students will not have exams next year. Aayra will go to school in another year and she is so looking forward to exams. “Aayra nak dapat nombor 1 macam Eshan. So, Mak Ngah kena beli hadiah kat Aayra juga.” She is so competitive.

I didn’t have the heart to tell Aayra that she might never get the chance to get number one like Eshan next year… because there will be no exams, my dear.

Some parents said, “Weh, bagus juga tak ada exam. Anak-anak stress. Kecik-kecik darjah satu dah kena pergi tuition!”

What? Siapa suruh you hantar anak you pergi tuition? My sister never sent Eshan to any extra class or any tuition!  YOU as the parents are the ones who stress them out about exams! YOU are the one who send  them to all these classes to get them a good result. Academic jadi tak fun and exam jadi menakutkan because of you. Kalau diorang just pergi sekolah, balik sekolah and face the exam (without going to any more extra classes) they get the chance to handle the life situation of facing an exam! They get the opportunity to face the anxiety and deal with it! At the same time, they still have enough time to play and enjoy their childhood when they don’t have to attend all these unnecessary extra classes at the tender age of seven!

I am all for children enjoying stress-free childhood. But not at the expense of their education. Reduce their stress by employing wise parenting in deciding what extra classes are necessary and when! Not by abolishing exams!

Exams are good indicators of students’ understanding of the syllabus. There is a purpose for having an exam! Undeniably, the pressure is there but it is manageable. The UNMANAGEABLE pressure comes from you, the parent! You send them to tuition classes after school hours, and then YOU tell us they are stressed? And then, you salahkan exam kat sekolah pula? This is so skewed, God!

Unless your kids have ADHD / Autism / Learning Disability, there is NO NEED for them to go to other extra classes other than the ones they have at school while they are STILL in TAHAP 1. I can still understand if you send your children to tuition classes in their UPSR/PMR/SPM year, but not in other schooling years. Because they need to learn how to live a life and how to be a functioning happy human being too… not just learning the syllabus. Other than one month of intensive private tutorial for Add Maths at the end of my Form 4, my parents did not send me to any regular tuition throughout my schooling days! They believe that tuition class is not necessary if you can focus in class and do your homework properly. Kids learn resilience when they have to face the disappointment of not getting the best result in their exams and the jealousy of seeing their friends getting a better result than theirs. That disappointment and jealousy must be handled. I can only imagine how Eshan would feel in the future when he may no longer get number 1 in class or may not get an A in some subjects…. we all had faced that situation too; it was disappointing, but we handled it, guided by the response of our parents and our family.

So parents, BE A PARENT! Read to your kids, discuss the moral values of the books you have read with your kids, interact with them at an intellectual level and instil values in your kids. Talk to them, reason with them. You will find out that these children of yours are smart and they can handle stuff … if you can be a parent!

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I leave all my dear readers with videos of my Eshan telling an imaginative story about Galaxy’s New Planets. He is so creative, Masha Allah. My favourite planet is the Chocolatey planet. What’s yours? 😉