Ethics And Justice: What Can We Do When Ethics Don’t Produce Justice As Its Final Outcome?

I am emotional. But I am emotional about principles and facts. I know,  I cannot always behave like “it’s either my way or the highway.” But some things are so obviously wrong and when people defend it, I go ballistic. 

But I flip out when people don’t get their priorities and their facts right. In that sense, I might be a bit autistic. It feels like my world come tumbling down when things don’t go according to the principles I know to be correct and facts I know to be true. It irritates me. In that sense, I can also be a bit offensively manic in my irritation.

If someone says that the world is flat, and since it is his opinion that the world is flat and I should respect it, I will totally go insane with anger. 

***

I attended a course one day. One of the speaker works in the management side of the MOH. He talked about documentation and medicolegal issues. 

At the end of his talk, I asked him (I have forgotten the exact words I used, but the gist of it were as such) “What can MOH do to help clearing up the reputation of a doctor in the case where a patient goes to the social media with wrong accusation against the doctor? For example,  there was a case where a patient who had an allergic reaction to a medication went to tabloids and viral it in the social media that the doctor had given him the wrong prescription? The patient had already broken his own confidentiality, so can the doctor correct the facts in the same social media to regain his reputation?”

He basically said that obviously, the doctor cannot correct the facts in the social media because the doctor is bound by the ethics of confidentiality. Basically in his own words “we can only stay silent. Malaysians are forgetful, anyway. The hype will go away”

“So, KKM won’t help to clear up the doctor’s name?” I was getting warmed up, hahah. (See? I can be really annoying)

“What can we do? What’s your suggestion?” the speaker asked.

“Well, we can do health promotion. We can issue a statement that in the case of such and such, investigation has been done and we have since found out that the allegation towards the doctor is false. We have to viral the statement that we issued to the same extent that the accusation was viralled against us.  Otherwise, the public will never learn the truth of the matter and there will be more unfair accusations being viralled.”

The speaker said “But when you respond to such accusations, sometimes you are giving more weight to the matter. Silence is golden in this case.”

(The word “silence is golden” grates my nerve endings)

“If the doctor wants to counter-sue the patient, will KKM help?” I asked

Again, the answer is disappointing.

I ended my interrogation with “So, there’s no solution.” Then I passed back the microphone to other audience.

I don’t blame the speaker. It was not his fault. He was only representing our own mindset in MOH and our general conduct in our passive culture. I am sure, he himself would be frustrated if he were in other doctors’ shoes. But sometimes it’s hard not to blame the messenger.

***

I am grieved by injustice. Not just against me, but against anyone. 

We Muslims, used to have better standards in how we expect other people to conduct themselves.

I hate it when people said things like “We have to look at the management point of view. Even though your point of view is correct, the management also has their own take on this matter. They have to do a lot of damage control, money that can be spent elsewhere have to be spent for legal fees etc etc. ”

Okay, let’s look at EVERYBODY freaking point of view. And then what?? 

What is the bottom line?

The bottom line for MOST people is “We have to look at the management point of view. And since we have now looked and understood the management point of view, we can follow what THEY decide.”

Sure sounds diplomatic. Management love people like this. Kudos! 

People like this want to please everybody. They will say everybody’s point of view is correct, but then they will give MORE WEIGHT to the management point of view and follow whatever unfair decision made by the management. They think they are being less rigid, more holistic just by saying ‘everybody is right’ but at the end of the day, they will go with the management. 

If that’s how you want to think, then next time, just cut the diplomatic act short, by just saying the management is right.

That’s why I get irritated with diplomatic people. The only diplomacy I display is with my depressed patients because it is therapeutic and that diplomacy serve a good purpose. (unless the patient is like me and can tell bullshits apart) But in my day-to-day dealings with people, I am direct and some people have interpreted that to be rude. Because in my day-to-day dealing with people, diplomacy does not serve any better than simple straightforward talk does.

And in my experience, diplomacy can sometimes be another form of dishonesty. Some management people are good at that. 

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***

The point of ethics is to serve justice. You shouldn’t stick to ethics just for the sake of ethics, without serving the real purpose of justice.

Not just for patients, but also for doctors!

If a patient has spread in the social media about his/her own disease and then wrongly accuse the doctor of not treating her well, then the doctor should no longer be bound by the ‘confidentiality’ clause. Why? Because, justice will fail to be served. That’s why. And therefore, the ethic lost its purpose of being adhered to, in the first place. 

The confidentiality clause was made with ‘protection of patient’s rights’ in mind. But when the patient himself/herself breaks it (in the social media where it spread like bushfire), then the purpose of the confidentiality clause is already gone. There is no confidentiality anymore!  Therefore, the doctor should no longer be bound to it when he has to defend himself. 

But see, some doctors don’t think that way. They think conventionally and cannot analyse beyond the point of what they have already known.  There are so many others who cannot think flexibly and still said “Patient can break his own confidentiality but the doctor still can’t.” (and ironically, I was the one being accused of inflexibility. I am flexible. Believe me I am SO flexible, that I can be a rule breaker when I don’t agree with the rule. Just because I stick with my principles for justice doesn’t mean I am inflexible. People who cannot change their ethical reasoning when presented with different scenarios…they are THE ONES WHO ARE INFLEXIBLE!)

Yes, in general, patient can go around telling anyone about her own disease and the doctor cannot tell others about the patient’s disease. “Suka hati aku laa aku nak habaq kat sapa pun aku sakit apa. Doctor yang  tak boleh pi habaq kat orang lain”.

Okay, setuju!

But when you ADD IN another factor where the patient ACCUSES the doctor of misconduct in the freaking social media, the purpose of ethics to serve justice cannot be realised if the doctor is STILL BOUND by confidentiality. This sort of ethic is an ethic that has lost its soul (justice)

And if you CANNOT think this way, then there’s something wrong with your justice reasoning.

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***

I am all for justice. Not just for the patient but also for the doctor.

My suggestion is:

-Investigate each accusation in the social media that has been viralled.

-Come up with a fair conclusion after that investigation

-And viral the outcome of the investigation in the social media, regardless of whether the accusation was true or false.

If the accusations is true, issue a statement saying, “With regards to the case of A accusing Dr. B of so and so, our investigation showed that, Dr. B was guilty of so and so. We have asked Dr. B to apologise and compensation will be awarded to patient A.”

If the accusation is false, issue the statement, “With regards to the case of A accusing Dr. B of so and so, our investigation showed that A had an allergic reaction which could not have reasonably been expected for Dr. B to know that A would develop such reaction. We hope, patient A will apologise to Dr. B and correct the impression he has given against Dr. B in  the social media.We in MOH fully support Dr. B should he decide to pursue legal action against patient A if patient A fail to extend his apology.”

The statement, especially if the accusation is false, should be viralled SO THAT the reputation of Dr. B can be regained which is only the fair thing to happen. 

But what usually transpires is, the accusation was viralled throughout Malaysia. But the outcome of the investigation that clears up the doctor’s name was not viralled to the same extent as those of the accusation. So the public will still be under the misapprehension that the doctor is wrong. In this case, AGAIN justice is not served. What is the point of investigating an accusation if people don’t know the outcome of it? 

Viralling the outcome of the investigation is also good for these purposes:

-For public education and health promotion about diseases, in general

-serve as a lesson for the public not to viral the things that they don’t know before they clarify with their doctor or complain to the right channel. 

-serve as a lesson to doctors not to repeat the mistakes of other doctors.

So, I am not suggesting this just to ‘hentam pesakit’ because I am fully aware that I might be a patient too one day. I want justice to be served for everybody; doctors and patients both. Because I also believe that we should not hide misconduct done by doctors.

Fair is fair, is fair, is fair.

Fighting for justice is human instinct. But we have dulled our instinct when we douse our instinct in diplomacy and fear of hierarchy.

diplomacy-and-virtue-do-not-make-easy-companions

***

“O you who believe!  Stand out firmly for justice, as witnesses to Allah, even if it be against yourselves, your parents, and your relatives, or whether it is against the rich or the poor…” (Quran 4:135)

“God commands justice and fair dealing…” (Quran 16:90)

“O you who believe, be upright for God, and (be) bearers of witness with justice!…” (Quran 5:8)

“…If you judge, judge between them with justice…” (Quran 5:42)

Why Doctors Are Losing In The Social Media Game

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I welcome the statement made by our esteemed DG regarding the use of social media by health professionals.

I agree in parts. Disagree in others. Neutral in some.

I agree that ethics and professionalism need to be maintained in the use of social media when it comes to certain aspects of our work. When it comes to confidentiality, there is USUALLY no compromise to it, I agree.  (there is a reason why I CAPSLOCK the word ‘usually’. Read on and I will elaborate)

But I am more interested in this particular paragraph written by our DG:

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I would like to elaborate on this, in particular. Because I know the older generation has NO IDEA how social media can be used effectively. We cannot blame them. We are the ones who grow up with social media. They (the politicians and leaders) took up social media as part of the evil necessity in this current age, but they don’t know how to effectively use it.

We do.

They need help. But they have to help us to help them.

***

Before I elaborate further, I would like to tell you that any game cannot be fairly played when there is no level playing field.

One side will always lose when there are different rules for one team, and another set of rules for the opposite team, when they are playing THE SAME GAME.

In chess, my king can move the exact same minuscule step as your king. My queen is as powerful as your queen. My cavalry and my pawns have equal strengths as your cavalry and your pawns. See? Chess is the fairest game in the world. They eliminate all biases and all other factors that could influence the outcome of the game. Discounting luck, takdir’ or ‘qada and qadar’, the winner MUST be the most strategic, and the most brilliant. No biased referees, no other judge. (not even courts can be THIS fair). I was never a sporty person, and the only game I could play were chess and carrom when I was in school. (And I was not even that good but I like it because it’s fair. I lose fairly. And I win fairly).

In any other sports, you cannot guarantee that each player in one team has his EXACT equivalent in the other team. So they have to buy players into their team.

Social media is not like chess.

Social media is a sport. And to make it worse, it is a sport with different rules for different people. And someone will always be at the losing end.

At the moment, the doctors are at the losing end. ALWAYS!

1) Confidentiality

The patient with allergic reaction can breach her/his own confidentiality when they go to the newspaper and claimed “doktor salah bagi ubat”. Can the doctor go to the same media and breach the patient’s confidentiality to clear up his name? He can’t. He has to abide by different rules. His hands are tied. He suffers by the unfairness and the indignity of it all. And what can we say to him. “Tough luck, mate!”

Is that it?

It happened to my own colleague! Someone snapped her picture and accused her of nonsense. It was viral in the social media. The whole Malaysia talked and commented about her. Inquiries were made by the Pengarah and the DG. But when all facts have been laid out, and accusations against her have been cleared, who in Malaysia knew about it except her colleagues and her superiors? The facts were not even published in the social media. So the whole Malaysia STILL THINKS she was wrong. If you are a decent human being, the injustice of it all would grieve you. I can never tolerate injustice against others without commenting scathingly, let alone against myself!

Are patients the only one who have the rights to be treated ethically? That is NOT the ethics that I learn in medical school. Ethic is a guide. In general, you can’t commit murder; But you can in self-defense. In general, you can’t breach confidentiality, but if it were to happen to me, I will breach confidentiality to defend myself and my honour. I will sue the media and the patient! And I WILL viral it to the same extent the accusation was viralled against me. It’s not a threat, it’s a promise. I am very protective of my good name. And I think, everyone should too.

The problem is, MOST health professionals don’t like to GO ALL THE WAY when they are fighting against these sort of injustice. They rather take the attitude of “malas nak panjang-panjang”.

See? We are too kind. Our inherent goodness is also ANOTHER reason we are always losing.

2)Intellectual Capacity

Another reason why we are always at the losing end.

Doctors are generally brilliant people in their own field (non-doctors are brilliant in their own field; have to clear that up just in case some people think I am being arrogant. Been accused of that too many times). We can explain things brilliantly because some of us were also elocutionists and debaters and public speakers when we were at school.

Unfortunately talking and debating about diseases is not the same thing as debating about “whether or not school uniforms should be abolished in public school” in a school-level debate competition.

It’s not that we are not brilliant speakers in our own rights. It’s just because whatever brilliant explanation we can give will always be lost to translation. Medical terms are most accurate in its Latin form and English form. And informed consent is only as good as the patient’s level of understanding.

3) Unequal ethical rules between doctors and the ‘natural healers’

For this point, I think my esteemed colleague (now, already a psychiatrist) has nailed it in the head with this part of his facebook status. Below is the print-screen of his brilliant elaboration of something I could not explain as clearly. His facebook status has got many shares and I took it for granted that he wouldn’t mind  one more share in this humble blog of mine.

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Dear doctors in any generation,

-We are losing!

-You are no longer practicing medicine in the golden age of 50 years ago, or even 10 years ago.

-We have to revise how we use the social media.

-We have to learn the ropes. We have to adapt. And we have to do it quick.

-Even medical ethics need revision. At least some of them. Not merely the clinical guidelines that need revision.  (Don’t be so scandalised. Ethics and laws are revised according to the passage of time, provided it does not go against the law of God. This is nothing new)

Let the younger generation help you understand the social media, a little bit more.

***

We Need To Understand The Social Media Format

I will give you a simple analogy. Hopefully it will help demonstrate where I am coming from.

In our schooling days, we learned how to do essays, no? We learned how to write formal letters and informal letters. Language used in the informal letters (overt expression of tender feelings, peribahasa bagai, flowery words) will not give you high marks when they are used in the formal letters. Formal letters have to be succinct, precise and to-the-point.

On the other hand, if your task were to write an informal letter to your girlfriend…. using dry, unadorned, uninspired style of language will NOT give you an A. In real life, your girlfriend will say “you are a dry, stick-in-the-mud bore. Our relationship is finito!”

Writing a case report is the equivalent of writing a formal letter. The scientific, dry and to-the-point style is best used when we are speaking among health professionals and doctors.

In the social media, the general public who does not have the slightest idea about medicine will NOT read what you write if your facebook status is as dry and yawn-inducing as all that.

So when the DG wrote : “Inappropriate, emotional and irrelevant uses of words are not welcomed” when it comes to posting in the social media, we need to properly qualify what does ‘inappropriate, emotional and irrelevant’ means.

If it means we have to use the case-report style of language when posting in the social media, with all due respect, I have to disagree. (Read on, and I will elaborate)

We Need To Understand The Purpose Of Using The social Media

The point of using the social media is not to educate. It is to advocate. There is a fine line between ‘educate’ and ‘advocate’. The line is thin, but it’s there.

To simplify the matter, I will say that to educate is what the teachers are for. The textbooks, the case studies, the journal articles are all the tools being employed to educate. They belong in the class room. Not in facebook. Teachers are great people, but students don’t always listen to them.

To advocate, is what the celebrities and the artists are for. The celebrities and the artists are attractive, beautiful, appealing! Underneath all the make up, they have their flaws. But they magnify  their strength and downplay their weaknesses.

We all do it in our own way. When I go for a holiday, I don’t show people the pictures of me being tired and grumpy and hungry. I show them only the fun things I do, the good food I eat, the beautiful sceneries I have seen.

Do you understand?

Doctors have to know how to coach their facebook status in a manner that is attractive and appealing for it to go viral enough to be read by the public and the target audience (not just by their fellow colleagues).

Sarcasm has its uses. Emotion has A LOT of uses (take it from the psychiatry MO).

Sarcasm has been (mistakenly) thought to be a sign of intelligence. It’s not always so, I know (sometimes, it only means you are rude, ill-mannered and uncouth). But the majority of people ARE entertained by sarcasm and they DO THINK sarcastic people are intelligent. In the battle of the social media, we need to be perceived as intelligent for our words to attract attention, and in turn, having the power to influence.

It’s all about perception. 

Being dry will not even cause anyone to READ your status, let alone influence them to think favourable of you. Perception is everything. Some people manipulate perception for a bad purpose. At least we are manipulating it for a good purpose.

I say, where appropriate, use sarcasm!

I say, where appropriate, use emotion! Most people don’t decide based on reason, they decide based on emotion. This is true! The evidence of this is rampant in the psychiatric clinic when it comes to relationship and marital conflicts.

Now, when I say ‘where appropriate’ what do I mean? (read on!)

We Need To Understand The Power Of Context And Words In Our Argument

Absolute truth can only be known by God.

In real life, truth is very relative. In real life, logic is only patterns that have nothing to do with the truth.

Premise 1:  A is B

Premise 2:  B is C

Logic: A is C

That’s logic. It is ONLY true if Premise 1 and Premise 2 are REALLY true (if A REALLY is B, and if B REALLY is C). In life, premises are not as simple as ABC. Sometimes, you will never know whether the premises are ACTUALLY true in the first place.

The premises surrounding the (possible) truth is complex! So, let’s not try to explain it, if we don’t have to. (if we have to, we will do it. If we were asked, we should do it. Until then, simplify your explanation).

Just work with context and sharpen your vocab in any language you know. Learn human emotion and motivation.

The public claims they want to know the facts. But sometimes, the facts don’t MOVE them. The facts don’t affect their decision.

I make use of emotion when I want my patients to be compliant to medication. Yes, I make use of it. I, who always claim that I don’t like to be manipulative, actually manipulate emotion when it comes to dealing with my patients.

I started with a smile. In various subtle words, I showed that I care. I demonstrated the fact that I have no conflict of interest. “Gaji saya tiap-tiap bulan sama jer samada awak makan ubat ke tak. Saya tak dapat untung macam bomoh-bomoh tu. Kalau awak tak makan ubat pun saya tak rugi. Awak rasa kenapa la saya berleter panjang-panjang kat awak? Tu kat luar tu, banyak lagi pesakit dok tunggu.”

They will take the meds if they believe you genuinely feel a level of care towards them (why do you think doula is so populour?)

That’s emotion.

On the other hand, I have used sarcasm towards rude, demanding patients. And magically, they become less rude when I am more firm. They are more receptive to accurate information when we show who is the authority, here.  I cannot show inferiority with these sort of patients. Bullies will trample the weak among them. If I look intimidated, I will no longer be effective as their therapist. I know this! And I change myself and my demeanor, accordingly.

In fact, it is my principle not to kowtow to anyone who acts superior towards me without no other basis other than their social position. It is irksome, and I show my polite poker face to them. No more and no less. (In general, I don’t prefer dealing with VIP patients. Sometimes, when there is no specialist around, MOs will have to see these VIP patients. Some VIPs are polite and never try to impose. Some like to subtly show they are someone important by certain words and certain attitude that I deal by simply pretending that I don’t understand and don’t care to know).

That’s context.

In psychiatry clinic, we have depressed patients, manic patients, psychotic patients, kids with learning disabilities, adults with dementia, drug addicts, personality disorders (psychopaths, sociopaths and the likes). Context is so important. Versatile ways of wording your emotion are very important to influence different type of people.

To quote a fellow PSY colleague, “our words are our tool of trade”. And now, this is also true for other doctors wanting to use the social media.

****

Doctors are brilliant at scientific biological facts. Doctors are brilliant life-long learners. We know what we know. We know, what we don’t know. What we don’t know, we know where to find out (if we want to find out). Indeed, where I graduate from, we made jokes about the term ‘self-directed learning’.

Tutorials and lectures were given to inspire curiosities and questions which we will have to find out the answers to on our own. We will then discuss it in the next tutorial session. That’s why tutorials are so stressful, folks. Australian mates right and left spoke on top of each other’s voices wanting to show off what they had found out from their own research. The dumbfounded Malaysians were waiting patiently for these mat sallehs to stop talking so that we could share what we have found out too. But they never stopped talking. They sounded brilliant. The timid Malaysians went home feeling dejected and stupid for not contributing in the discussion. The tutor made a remark “The Malaysians are passive and not participating”.

Oh….memories!

Like everyone else with problems, the Malaysians gradually learned to solve them. We self-directed-ly learned to interject, interfere and cut other people in the middle of their speech. We stopped waiting. We self-taught ourselves to be ruthless to survive, even though by the mat salleh standard, we were still very timid and passive.

See? Doctors are brilliant at solving problems. In life, we do what we have to do. In work, we do what we have to do for the sake of our patients. No sleep? No worries. No time to eat? We will simply starve. Got scolded publicly by specialist? We will simply develop a thicker skin.

No sweat!

We do what we have to do.

If you are not resilient, if you refuse to evolve, if you don’t know how to be like the adaptable chameleon, you cannot survive as a doctor.

May I suggest, that we start being self-taught on how to be effective in the social media too?

In the long run, it can only benefit us if we can use the weapon of social media to our advantage. Remember, social media is a sport with different rules for different people. But like any other game, practice can only make perfect.

If you don’t know, you can learn. But learn it, you must.

That is, if you want to survive and stay relevant.

In Support Of The Doctor Who Speaks Up For All Of Us

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The above was the Facebook status of a very bright, young doctor relating about one aspect of the many ironies in life that a doctor experiences in the course of her work in the society.

I read her status, and it cheered my day. I felt vindicated and validated on behalf of many doctors working in O&G in specific, and on behalf of all doctors fighting against medical misinformation in general.

I shared her status. Many doctors did. Go and check up my FB wall. I have nothing to hide.

And then, THIS NEWS came up in my facebook newsfeed!!

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Dear doctors in the higher up,

Act like a leader, and support your subordinates who are saying the right thing.

So what is the big deal if the doctor had been slightly sarcastic in her FB post? I would have done exactly the same thing! Her facebook status hit the nail on the head. It drives the point against irresponsible practice of homebirth right home!

If I had the opportunity (of being on-called while that particular case had materialized) I would say what she said. It was the best example of the consequence of shunning modern hospital intervention and that example happened to be current.

OF COURSE I WOULD GRAB THE OPPORTUNITY TO EDUCATE THE SOCIETY WITH THIS EXAMPLE!!

Has confidentiality been breached? On what ground(s) was she punished?

Many doctors had shared the FB status of the brave doctor when she was being so-called sarcastic in her FB status. Myself included. Yups, I shared her status in my FB wall too. Many of my friends did. Why is she the only one being punished?

Is there anyone being made responsible to track every single doctor who has shared her status in FB and then punish all of them? Is there anyone being made responsible to track every single FB status THAT SUPPORTS the doctor’s FB status and then punish them too?

Is she the only one being punished for representing what we all believe in?

Be fair, that’s the least you can do!

All doctors should rally in support for the brave doctor! All doctors who have liked and shared the status of the doctor when she first posted it should support her against the unfair punishment. She said exactly what we would have been thinking had we been in her place.

***

It must be the generation gap.

Our generation is not politically correct. And we don’t want to change that part of our personality. We knew it, and we don’t care. We revel in it. Proud of it.

We know you shake your heads at us. We forgive you. Because at the moment, I am shaking my head at your children (who is one generation below us) who you mollycoddled and pampered far more than we ever were when we were growing up. (During my time, most kids were not chauffered by parents to school, we went to and from school by bus or by bike, we didn’t have smartphones or tablets. We went out, playing and roughing it around the neighbourhood with no fear of being kidnapped, abducted or raped. We fought our own battles without involving adults and my parents blamed me whenever teachers scolded me).

So let’s forgive each other’s generation snobbery. We all think we knew better. You did (and still do), I do, and the generation below me will do.

The truth is, we are not at all disrespectful of protocol. It’s just that my generation is easily disgusted by two-faced ingratiating butt-kissers of our generation (or in any generation). We don’t respect authority just because they are authority. No…there is more to respect than merely your position. Most of us prefer to say exactly what we think, preferably at the very moment we think it. If the moment doesn’t allow us the luxury of saying what we think stat (because the higher authority is not receptive to feedback and simply does not appreciate original ideas when they are given), we will postpone the saying later.

But it will get said (or written). It will be discussed among our friends and colleagues. Discussion and argument back and forth will ensue. We are exhilarated by the intellectual exercise of defending what we believe, when we believe it.

That’s us being expressive. Can’t blame us. We were brought up in the age where learning was supposed to be INTERACTIVE. Where feedback was encouraged. No courses is complete without feedback forms being distributed nowadays.

Yes, I know. During your time, you were not pressured to be interactive. You learned in the type of school where teachers could scold you and cane you and your parents would say the teachers were right. “You must have been naughty”, your parents concluded straightaway. Your side of the story would be ignored, not worthy of being listened to, let alone of being considered.  Being expressive and opinionated was not encouraged back then. It wasn’t the way you had to learn, DURING YOUR TIME.

Now, our time is the more interesting time of learning (but I might be sprouting generation-biased nonsense here, but then this is my blog.) Even when we have no idea what to say, we are asked to participate. Even when we don’t have that much of an original opinion, we are asked to speak up. You cannot attend a talk where the speaker won’t say “Saya tak mahu saya sorang yang bercakap di depan. Kita mahu sesi yang interaktif yadda yadda yadda.”

Ugh! ( One tip: if you are interesting to listen to, people won’t fall asleep even if the session is not interactive. Trust me! They will want to listen to you talking non-stop. They don’t need any other stimulation in the form of interaction, because you on your own is stimulating enough.)

When I went to Australia, I felt pressured to participate in the tutorial, to offer an opinion …when all I really wanted was just for the lecturer to tell me what I need to know and for me to just go back, learn it, rehearse it,  swallow it up and spit it out in the exam. (Yes, I was more traditional than what some people might think).

I had to rack my brain finding something to say to fill up my speak-up quota of the day. I felt embarrassed whenever anyone had commented “The Malaysian students are not participating in the lecture nor in the tutorials. Too passive. Too silent.” Because stupid me, I felt a responsibility towards my country that I should be making my country proud by my performance, however superficial it might be. I had to learn to be more extrovert and to be more forthcoming because in Australia, people are encouraged to speak up. It is tacitly being thought as the most superficial measure of intelligence. And I cared about Malaysia too much to let them think that Malaysians were simply passive, non-opinionated fools.

We come back to Malaysia not knowing how to suppress our thoughts to ourselves when we believe we are right. If we are wrong, we expect you to tell us point by point how are we wrong, and how you are more right than us. REGARDLESS OF WHO YOU ARE IN THE GOVERNMENT!

Because that’s how you wanted us to be, remember? Otherwise, WHY DID YOU GROOM US THAT WAY FROM THE VERY BEGINNING OF OUR SCHOOLING DAYS?

Don’t get me wrong. We know how to be polite. We can be diplomatic to those who deserve our kindness. We return smiles. We say our thank-yous and our apologies when they are required.

However, we don’t like to be false and pretentious.

We are ultra-sensitive to false information that belittle the effort of our fellow doctors in any department, and will fight those openly, without shame. And by fighting openly, I include the social media.

Social media was used to denigrate and libel the reputation of our healthcare workers, and therefore social media must also be used to defend our honours. Because the higher authority is hardly effective at defending the various issues that have cropped up against doctors for the past few years! For doing our parts in defending the doctors rights, we don’t expect your thanks. Just help us by not making it harder.

You see, social media started in our generation. We know how to use and manipulate it more effectively than the older generation does. Social media IS the modern and latest medium of advocacy. What the young doctor wrote on her facebook wall was a non-issue, in my opinion.

***

Another peculiarity of our generation is that, we always try to mean what we say.

I am not going to say sorry if I am not sorry.

I AM NOT SORRY FOR SUPPORTING THE DOCTOR WHO HAD SHARED HER TOUNGE-IN-CHEEK COMMENT IN HER FACEBOOK WALL ABOUT THE PATIENT WHO CAME TO THE HOSPITAL WITH THIRD DEGREE TEAR AFTER HAVING REFUSED HOSPITAL INTERVENTION AND OPTED FOR HOMEBIRTH.

I AM NOT SORRY FOR SUPPORTING THE OTHER DOCTORS WHO HAD SUPPORTED THE  DOCTOR. I AM NOT SORRY FOR WRITING THIS IN SUPPORT OF HER EVEN WHEN I NEVER KNEW HER.

AND I AM NOT SORRY THAT I AM NOT SORRY.

There are MANY, MANY of us who had either liked or shared her status. There are hundreds of us who had shared the status of others who had supported her.

Do all of us deserve similar punishment to her?

WHAT IS YOUR STAND?

Perhaps, the more accurate question is, DO YOU EVEN HAVE A STAND?

And if you do have a stand, do you have the correct one?

It Is The Principle Of The Thing!

I did the Myers-Briggs Test a few weeks ago. Just for fun.

I am an INTJ (the first time I did it) and an INTP (the second time I did it).

I don’t even know what those are, to be honest.

But what the result tells me is :my thinking is dominant than my feelings. I can make myself un-feel things that my thinking tells me as irrational and stupid. It is a matter of principle with me that when my feelings do not fulfil my thinking checklist, I will ignore my feelings and go with my thinking. In other words, I can mould and shape and bend… my feelings to follow my thinking. Hard evidence. Rational arguments. Facts.

I believe, in the long run, it will hurt less.

***

I think I am pretty easy to understand.

I always say what I mean, and I mean what I say.

I don’t play political games with people.

I am not passive-agressive. I don’t say one thing (just to pacify that person) and then do exactly the opposite. I will state my objection clearly, from the very beginning. When I was asked to do a task that I am just not very keen on (departmental audit came to mind) I wouldn’t hesitantly said “Tak apa. Saya boleh buat” like I was so happy to do it. I just went right out and said I was not happy; but if I had to do it then I would do it…but for the record, I was NOT happy and it is beneath me to pretend otherwise! Pretending is not something I do convincingly. I like plain speaking. In my opinion, that is more honourable than making empty promises I don’t mean to keep.

That’s integrity.

With me, you know where you stand. From the very beginning, I won’t keep you expecting things from me I am not willing to give. (You see, that’s why I can never be a playgirl. hahah. I don’t give pretty promises convincingly enough and men would know I am lying because I will look so uncomfortable giving those promises.)

When I am aggressive, there is nothing passive about it.  I am aggressive and people won’t have to wonder whether “dia ni marah aku ke tak?”

Nope. If I am angry, you will know it. I will give you so many signs that you must be severely autistic with impaired theory of mind not to know it. Furthermore if you ask me whether or not I was angry with you, I won’t deny “Tak adalah…saya tak marah pun.” (lepas tu muka macam merajuk tak habis lagi. Nope!)  Even if I would not verbally admit my anger, I would instead say “why do you think I was angry with you?”.

I don’t like to manipulate people (because only weak people have to manipulate others because they are not confident in the righteousness of their cause) and therefore I shred manipulative people to pieces. People who manipulate others operate on the basis that the people they are manipulating will be foolish enough to fall for their manipulation. It is an insult to be at the receiving end of such an attempt because they actually think you are that stupid. When anyone even attempt to manipulate me (even in nice, soft voice, praising me this and that), it makes me become colder than the north pole. The more my patients try to get UNWARRANTED MCs from me by weaving all sorts of sob stories, the more I am going to be firm about not giving it.

When I want to get what I want, I use honest reason and logic. Because I respect myself. And I respect you. Because if I don’t respect you, why would I try to reason with you? I would just tell myself “Oh, he’s dumb. I am wasting my time.” The fact that I am even bothering to get you to do what I want by arguing with you, should tell you that I respect your intelligence. That I believe in appealing to your reasoning.

That I actually believe you have some reasoning, to begin with.

Those who are close to me used to tell me “Hang kena diplomasi sikit, Afiza. Puji-puji dulu….baru minta apa hang nak. Use your charm. Senyum la.”

Pfft! I hate that advice. I really do. For example,should I smile if I am requesting for blood investigation being done for my patient, that the colleague from another department forgot to do and refused to do after I requested it? You didn’t do something you should do, and when I requested for it to be done, you refused?? I could NOT compute how else am I supposed to STAY nice? Should I perhaps say “sorry, but I have to trouble you for some blood investigation being done for this patient” when a) I am NOT sorry at all; I am annoyed   b)it is your job, anyway and you are the one who should be sorry that you didn’t do your job properly in the first place before referring to me.

I would smile…when I am genuinely amused. If I don’t smile, chances are good that nothing is amusing.

And why should I use my charm to get people to do what’s right, anyway? Shouldn’t they be flattered that I don’t consider them foolish enough to fall for something as superficial as charm, but rather I value their intelligence to consider my request on the basis of its merits?

Listen: The more I respect you, the more I argue with you. Because I wouldn’t have bothered, otherwise. I am an introvert, I limit interaction ONLY to what interests me and what is important enough. If you are not important, I would ignore you. I show my contempt to people by ignoring them; I won’t even bully them, I just won’t have anything to do with them. Period.

Listen: I NEVER show contempt by arguing. If I argue, I respect you…but it’s just that in my book, respect does not equal to agreement. I respect people who I disagree but can argue with.  

If you are a debater you would understand. You would know that debaters would come into a debate fully prepared because they respect their opponents. And they show those respect by reasoning with them. Debaters believe that their opponents can see reason….that is the WHOLE BASIS of what debate is all about. 

On the other hand, once you earned my contempt,  I would just say “dia memang macam ni”  and ignore you until further notice. Yup…beneath my notice. Is that what they prefer? That I just be dishonest and say yes to them in front of their face and turn back from them doing exactly what I want anyway?

Here’s a story:

On the day I was taking my driving test, a fellow student who was waiting for her turn to be examined made a small talk with me and told me, “Hang tau dak, abang JPJ ni gatal-gatal. Hang kenyit mata sikit, flirting sikit. Senang pass punya!”

Maybe she was joking but I was horrified by the very suggestion! I believe in my driving skill, ok! I believe, I could pass without condescending to such tactics (read: charms) at all. Furthermore, that’s like…ugh…. such a dirty trick!! (For the record I failed the first time, because I did not pull my handbrake at the T-junction and apparently that was mandatory. But please… who the hell pull handbrakes at the T-junction, in REAL life? I was too bloody honest! When he told me why I failed, I was not even tempted to smile or wink-wink at the examiner asking for his sympathy…I did not even bother to beg the examiner. I just don’t do that sort of thing and I don’t function that way. What I did was arguing : apsal pula kena tarik handbrake waktu kat T-junction? Saya kan dah tekan brake. The examiner said: bila dalam exam, awak tak boleh pandai-pandai suka-suka hati awak. BIla dah dapat lesen, buat apa awak nak buat)

See how I even respect the JPJ officer? If I tried to flirt and wink-wink at the officer, that means I’d already assumed that he was easily fooled. In my opinion, he would be insulted by that assumption and would probably fail me even worse.  If I were in his shoes, I would be pissed off that people think I can be so easily fooled.

***

You see, it is the principle of the thing!

I don’t demand for something that I don’t have a right to expect. And I don’t want you to give it to me just because you ‘kesian’ or you are ‘attracted to my charms’ (which is highly unlikely because I am not charming) or ‘you are naturally kind’.

OF COURSE, it’s good if you are naturally kind, but it’s even better if you are naturally kind AND ALSO you are able to give me what I want because you believe I was right in wanting things done that way.

“That’s your problem, Afiza. Hang asyik rasa hang betul. Depa tak rasa hang betul. So, kalau dah hang nak juga apa yang hang nak, hang kena use your charms la. Request lah a favour. Say it nicely.”

Grrrrr!!! I just….tak boleh!

Doesn’t mean I am not nice, though. I have a soft spot in my heart for an elderly pakcik who would ride his bike in the middle of the afternoon for miles just to come to the clinic to take meds for his schizophrenic son. That’s such a…pure sacrifice… that earns my admiration, because I know many people with a car would simply let their schizophrenic relatives default treatment. I have a weakness for people who need help but refuse to beg for it, so I would spare them the necessity of asking and offered it automatically. I don’t always adhere to the two-years rules for getting my patients the welfare money when they need it (but instead of demanding for it like it is their basic rights, they request for it with hope and looking so disappointed when I said no at first.) When they bear their disappointment without argument it makes me feel bad (feels like I have kicked my own cat) and I would then try to help them anyway by consulting with a specialist who I knew is more lenient about approving welfare money. I would smile at patients who suddenly become unexpectedly well after years of chronic symptoms.

See? I do smile at my patients, you know. I believe that smiling is therapeutic. And other than smiling because I am genuinely amused, I also smile when I greet my patients because I want them to feel comfortable with me. I also smile when I remember to do so because it is sunnah and just a nice thing to do to people that I know. In this case, I am not pretending. My smile is not at cross-purpose with my real intention.

But if I smile (sedangkan aku tengah bengang) just to get what I want by being oh, charming….that is PRETENTIOUS! And it’s WEAK! It’s like you don’t believe in the righteousness of your cause.

I don’t fight with people as my default modus operandi. I always request nicely, first. I argue reasonably. But once I have raised my voice and you still refuse to see reason, then I have to play dirty. No, not by using whatever little charms that I don’t have…but by going to a higher authority and pulling rank…which is something I HATE to do.

I don’t want you to give me the blood investigation I request because my specialist says so. I believe, even if the instruction comes from my houseman, you should weigh the request on the basis of its own merits. Not by whose order it comes from!  I respect you…to want you to comply with my request just because it is reasonable. Not because I had to get my specialist to talk to you.

“Afiza, you are too bloody idealistic, for this world. This world doesn’t work that way. Be realistic lah”

Fine! At least, I work for my ideals and choose my action with that frame of thoughts in mind. At least my ideals involve believing the best in people, (until they fail to see reason and I had to do something drastic). But that doesn’t mean I am above playing dirty when I have no choice other than to be realistic.

It’s just that when I had to play dirty, I hurt myself too.

So don’t push me! My idealism won’t stop me from violating my own rules if it can prevent me from abusing a more significant principle.

That’s fiqh Al-awlawiyat (fiqh of priorities).

It’s also choosing the lesser of two evils.

I am idealistic. But I am not a doormat people can push around. Once you have pushed my bullshit button, I have no choice but to go all out.

pressing-bullshit-button1

So, please. The take home message is : Just weigh a request on the basis of its needs and merits for the sake of our patients rather than our own convenient and our egos.What I want for my patient is usually reasonable and warranted, and that is the ONLY reason I want you to give it to me. 

I promise you, if my request was not fair in the first place, I would have been so embarrassed to ask, let alone demand it. And if I was made by my superior to ask for something unreasonable when it was not fair to you, I would be ashamed and would request for it humbly, phrasing the request on the basis of your favour towards me. What I would NOT do is, ‘pujuk-pujuk’ you using my charms trying to fool you or manipulate you into thinking that what I ask for is reasonable when it actually isn’t. Instead, I would be forthright and said “I am sorry. This may be a bit inconvenient and I would totally understand if you might not agree, but if I could request for….”

You see? Who says I don’t know how to be GENUINELY nice? It’s just that when I DO say sorry, I mean it. I don’t say it just to be nice while deep inside feeling all fiery. Like, I know my request is unreasonable but I have no choice but to ask, and therefore I really AM sorry. I don’t say ‘sorry’ just to charm you into giving me what I want.

I just….don’t work that way! Believe me I tried being charming a few  times….they worked a few times, but each time, I just didn’t like how I sound.

But sometimes my heart told me “If only you keep on TRYING  being more nice….you know how practice makes perfect. You can get what you want with less trouble.”

But that wouldn’t be me in 2015. Perhaps when I am much older, and more mellow….maybe….well…Erm….NOT.

Black, White and Shades of Grey : My Very Amateurish Reflection On Dichotomous Thinking

I have been reading on Psychology these days and I came across the concept of dichotomous thinking. It made me pause on my reading and reflect on it. There were occasions when I was ‘accused’ of dichotomous thinking, myself. But there were also times when I was accused of being too philosophical, too ‘loose’, too ‘relaxed, too ‘abstract’.

When I was not yet a PSY MO, I did not give a fig what other people thought of my style of thinking. I do what I do and I think what I think. I am not going to lie and said “I don’t care what other people think of me when I do or say something controversial”. Of course I care….but not so much until I would change what I say or what I do to please them. I do care…but only up to a certain point, and no further. (I guess, I have been at the stage of Kohlberg’s Post-Conventional since I was 18 years old. And to be honest, I have always been proud about my (style of) logical thinking and my ability to defend my stand. When I believe I can justify it, I will just do it. Drive my parents nuts at times…but they have become habituated to it.)

But now, knowing what I know as a PSY MO, having someone accused me of black-and-white thinking is really annoying and never failed to erect my defensiveness (At least, I am self-aware, hahah). This is because I now know that labeling  someone with dichotomous thinking has some sort of diagnostic implication in certain situation, especially when it is coupled with some other traits and behaviours. And thus, it makes me think even deeper on the whole Dichotomous/black-and-white thinking concept.

I am going to freely admit, that the more deeply I think of dichotomous thinking, the more confused I become.

And I am still weighing my stand and my judgment and my own thought on this. You see, I choose psychiatry EXACTLY because there are more room for my own flare of interpretation and style. (I have always been irrevocably in love with freedom, I am afraid) Otherwise, I would have chosen to work in other field of medicine. Even psychiatrists disagree with each other in certain things. I like the idea that –within limit and reason – we can disagree. That I can say you may not be right, even if you are a specialist. (I don’t mean to sound arrogant but this is what I honestly feel. I don’t subscribe to the motto that “boss is always right” and I never will. ‘Always right’ is too dichotomous, anyway kan? No one is that ‘maksum’). I would like to be able to say to ANYONE that my view on this issue is more accurate even though yours may not be wrong either. Of course I don’t go around defying my boss’s opinion all the time if I was not asked (I still have some form of social etiquette left, for which my mom thank The Almighty)…but if I were asked, I would tell them what I really think with as much respect as I could. In Australia, even a medical student is asked of her opinion about many issues especially on the grey areas of psychiatry, it was so liberating!

You see, I think deep inside those who work in psychiatry price their ability to reason and make a logical argument. Isn’t it funny? Not many people can claim that their mind is their passion! Passion is usually associated with matters of the heart rather than the mind. But really, the passion in psychiatry is the mind! We are interested in how people think and for communication purpose we give labels to those thinking styles. (I guess, some other people might argue that we are dichotomous in our own way.)

Below is my possibly faulty, amateurish view on this whole dichotomous thinking thingy. I thought that I might as well jot down err, type out what I  think about it now, so that if  I ever feel differently later (upon gaining further knowledge and experience), I might one day read this again and laugh at my old self. (You see, for all that some people seem to think that I can be quite rigid, I do keep an open mind that one day my opinion might change.) 

That’s something  I always love to do . I still revisit and reread some of my old posts when I was a 4th year/ 5th year medical student; the early days of my blogging years. Sometimes I cringed and thought ‘what was I thinking to be writing such an asinine nonsensical thing years ago?’. But there are also times when I feel like ‘Oh, I made so much sense even back then’. Hahaha (yup, my vanity at play again). But all in all, I like keeping a record of my thought process whenever I stumbled on a new idea/concept/worldview. It reminded me of the progress I have made and how my thinking is always dynamically evolving, and hopefully more refined over the years. It will be interesting to see whether or not I still believe the same thing later on.

***

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Black, white, shades of grey…

 

Someone who displays black-and-white reasoning is said to be displaying dichotomous thinking. It is considered immature, teenager-ish and sometimes, a trait of Borderline Personality Disorder.

The most common example of dichotomous thinking can be seen among politicians and their extreme supporters. They say only the best of things about their own party while every evil thing imaginable in THIS universe (and beyond) is bestowed on the other party. Sometimes dichotomous thinking manifests itself in a manner of self-serving biased statements, but not always.

In dichotomous black-and-white thinking, someone is either right or wrong. You only either really hate someone or really love someone. Life is either totally intolerable or marvellously beautiful. Housemen are all lazy and specialists are all self-sacrificing angels. Specialists are all bullies and housemen are all innocent victims. (sorry, I cannot help myself from giving the housemen-specialist examples. Everybody knows this is my favourite pet subject. Haha)

Let’s face it! We all – at some time or other – fell into the trap of dichotomous thinking, especially in certain issues we feel strongly about.

Dichotomous thinking, like everything else, has its pros and cons. But perhaps, more cons than pros.

Actually, someone who consistently thinks in black and white is going to be self-destructive and chaotic in most aspect of their lives. ‘Unstable’ is the simple word to describe it. She idolizes her boyfriend as the most ‘loving and caring person on earth’ when he gives her flowers for no special reason, and then hates her boyfriend as the most ‘evil, inconsiderate slimy scum of the earth’ when he forgets her birthday (this is not just sulking. I mean ACTUALLY hates her boyfriend, and breaks up with him and go through a lot of emotional drama for every simple reason). It is argued that a stable mature person should be able to see the world as more complicated than simple black-and-white complete opposites. In this case, she should be able to embrace all the good and the bad aspects that make the whole of her boyfriend without going up the wall at every slightest thing.

But remember. It is CONSISTENT dichotomous thinking that is destructive. Whereas, I would argue that occasionally appropriate dichotomous thinking is beneficial and even healthy (see, I am displaying non-dichotomous thinking when I said that not all dichotomous thinking is bad every single time in every single situation. Got it?)

I believe, having a principle is part of dichotomous thinking in certain situation. I believe, that is what principles are for. Principles are most important to adhere to NOT only during the time when it is easy (when we are naturally inclined to it, anyway), but the best usage of principles is to help us guide ourselves when it is so very tempting and easier to deviate.

For example, if there was a person named A who has a staunchly-held principles about a certain matter and would not budge from it, she is going to be viewed by person B (who has different principles) as non-flexible and black-and-white and dichotomous. But bear in mind that just because Person B was right in saying that Person A is dichotomous in that particular issue, that does not make Person A wrong in her views. Being dichotomous is not synonymous to being wrong and vice versa.  Because there may be other instances in other issues when the situation is reversed; Person A might then be more carefree and Person B is more rigid. Would it then be okay for Person A to say to Person B “you are just as dichotomous as I am when it comes to THIS issue!”?

Then we all will start telling each other that they are ‘dichotomous this’ and ‘dichotomous that’ in different issues! If that happens, it would be so funny! We are all going to compete and fight to label our friends as dichotomous anytime we have an argument with them when they appear more rigid than us. So someone can simply win an argument by ending their point with “you are dichotomous!”. The term will lost its diagnostic usage.

For example: Have you heard about how controversial it was when Dr. Mashitah answered the question on ‘pelacuran kerana terpaksa’ a few years back? (Do not behave like some people who condemned without really reading on the issue. We should strive to get to the primary sources of the issue before we make our judgement. I suggest you guys read it and come up with your own conclusion.)

Person A: Zina is haram

Person B: Sekarang darurat. Saya ada anak 5 orang. Suami sudah mati. Saya tak ada keluarga lain yang boleh bantu. Dengan duit menjadi pelacur inilah saya menyara anak-anak saya.

Person A: Takkan tak ada kerja lain yang boleh buat? Banyak lagi kerja lain. Yang haram tetap haram.

Person B: Saya tak ada kelulusan apa-apa. Mana ada orang nak ambil kerja. Nak berniaga, tak ada modal lagi.

Person A: Zina itu haram. Baitulmal ada. Zakat ada. Minta sedekah pun lebih baik daripada jadi pelacur. Bertaubatlah.

Person B: Awak tak faham situasi darurat saya. Bukan semua benda hitam-dan-putih. Kenapa terlalu menghakimi sedangkan awak tak mengalami?

 

Difficult isn’t it? Is Person A dichotomous?  She keeps saying ‘zina is haram’ and repeated it in her every sentence without even attempting to appear empathetic and understanding to B’s plight.

Or is B too relaxed, too grey? After all, someone’s darurat is not the same as another person’s darurat, kan? Why is it so ‘darurat’ for her?

How about in the case of riba’? Even Islamic banking is not free from this riba’…they just give it different terms. (of course, this has its own debate which I am not going to get into. I freely admit that by making loans (from Islamic bank, too) to purchase my car and my house, I have been involved in riba’ myself. But I don’t try to justify my action by saying it is halal, and in anyway try to alter the black-and-white so that it then becomes grey just so I will be able to live with myself. It’s just that I recognize that riba’ as a system is so very widespread that it is just so difficult to 100 percent distance yourself from it without making your life difficult. But it still does not make it right. This is me declaring my UNRESOLVED COGNITIVE DISSONANCE. If you are interested to read on how Islamic Banks are being deceptive and disguising riba’ simply by adding the cosmetics of ‘akad’ and changing certain terms , read  this link to the article https://umarvadillo.wordpress.com/2013/10/19/muamalaat-the-alternative-to-the-riba-system-exists/)

 

Person A: Sekarang ni rumah dan kereta adalah keperluan. Terpaksa juga buat ‘loan’. Nak tak nak pun, kena juga terlibat dengan riba untuk beli rumah dan kereta.

Person B: Well, mungkin aku ni seorang pelacur. Tapi aku tak pernah terlibat dengan riba. Riba kan haram. Tak tahu ke dalam Al-Quran Allah iystiharkan perang terhadap sesiapa sahaja yang mengamalkan riba’.

Person A: Weh, we live in the system! Tak boleh nak buat apa. Darurat kot!

Person B: Apa yang daruratnya? Boleh naik bas, kan! Boleh jalan kaki, kan? Rumah tak payah beli; sewa sajalah. Unless you are telling me that not having a transport is a life-or-death matter?

Person A: Kau ni hitam/putih sangatlah.  Situasi sekarang ni sangat kompleks. Memanglah riba tu haram, tapi kau kena faham juga situasi semasa dan faktor2 lain yang terlibat dalam masalah ni. Aku kena pi kerja. Public transport tak reliable. Kalau aku asyik lewat pi kerja, aku kena buang kerja. Habis, anak-anak aku siapa nak bagi makan?

Person B: Riba tetap haram.

 

I never knew anyone who is a prostitute. I would love to just talk to them and pick their minds if I have the chance. But I DO KNOW of a Muslim convert who is so very much against riba (he is in the legal profession) who used to travel with public transport until his company provided him with a car, and he only rents his house until even now (even though with his monthly pay check  he could have made loans to purchase a car and a house). He kept his money in a bank too, but he requested for the account with low or no interest. When there is an increment in his savings due to interest, he would painstakingly analyze his bank account statement and took the portion of the interest money away from his original savings.  I was told of his words by someone who knew him closely “Sebab saya tak ada transport, akhirnya company bagi kereta kat saya untuk guna. I didn’t need to make loans to use a car, after all. I think, Allah will help those who try his best to adhere to His law in unimaginable ways. Maybe because I am a convert, I feel about this strongly. Those who are born Muslims take for granted the very essence of what made this religion beautiful.”

For him, riba’ is not a grey area. Even facing with much difficulties, he will adjust his circumstances and his desires and his wants to meet the law (the black and white). He won’t try to manipulate the law to suit his own desires and simply say “Don’t be dichotomous!”

So tell me, is this exceptional Muslim convert is being dichotomous or merely principled? In every given situation, who is the best judge to say that either being more black-and-white or being more grey is the best or the right thing to be for that particular issue, at that particular time?

Who can give that judgment? Religious Imams? Political leaders? Judges?

Psychiatrist?

We are all liable to make mistakes in making judgments such as this.

***

As a PSY MO, I would NOT label someone as having black and white thinking when the issue is involving principles or religious beliefs or universal truths or facts. That’s what principles are for! Not to be adhered to only when it is easy to do so, but to cling on to when it is most difficult and tempting.

I would only say someone is dichotomous when the issue is involving:

1)Preferences.

“My way is better than your way.”

(however bear in mind that, if the person can say WHY his way is ACTUALLY better, and his reason is convincing and sound, then it is NOT fair to call the person dichotomous too! And also if that person is naturally autocratic, then maybe this is not about him being dichotomous but simply his leadership style.)

2)Personality Characteristics

“Extrovert is always better than introvert” (in what aspect?)

“Funny people is always more entertaining than smart people” (says who? I happen to be more entertained by smart people than funny people most of the time)

(But if he says “extrovert is better than introvert in THIS particular aspect” and what he said is proven by research and general self-evident  observation, then we should also NOT call the person dichotomous.)

 

3)Excessive Overgeneralization/Minimization/Maximization Statements

“I love you so much because you are ALWAYS kind and considerate to EVERYONE”

(‘always and everyone’ consists of a very large amount of people to be kind to. In fact, it means the whole human population of the world! Are you sure someone that exemplary really exists?)

“I will hate you forever. You NEVER do a single good thing to me in our 12 years together!”

(Whoa! 12 years together and NOT A SINGLE GOOD THING has been done? He married you…he gives you a ring/gold and jewelries…that’s two good things already at the start of the marriage. God only knows how many good things he has given you for 12 years, lady! Be fair!)

 

– Sometimes it is difficult to distinguish whether this is dichotomous thinking or overgeneralization or minimization or maximization. Or maybe just histrionic drama-queen tendencies.

See, how difficult this black-and-white, dichotomous thinking is! The more I think about it, the more confused I become.

Just hearing someone saying a black-and-white statement (and it is only YOUR opinion that what she says is black and white, others might actually think it is grey) is not enough evidence to say that she has a black-and-white thinking.

Describing someone as dichotomous should be supported with other characteristics of her personality, for the purpose of making a diagnosis!  Otherwise a dichotomous thinking may be confused with autocratic traits, principles ardently held, biasness, maximization/ minimization/ overgeneralized statements. In general, we can distinguish all these from each other. But at times, it can be difficult to say with much accuracy whether that person REALLY is dichotomous or simply having other forms of automatic negative thoughts.

You see, I actually think that labelling someone as having a black-and-white thinking without any clinical or diagnostic purpose is a futile and time-wasting effort. Why bother?

Or perhaps, you are trying to have the last word in an argument and thus saying someone has a dichotomous thinking is much easier than having to come up with a counter-argument when you have run out of points. (Hahaha. I do that myself, at times. We tend to divert the topic. Instead of saying what we think is wrong in his argument, we simply give his character and his way of thinking a certain label. It is easier than having to come up with our own argument to counter his. I call that cheating!)

Everybody, at one time or another, does this to some other person. I am guilty of it, myself. But being in psychiatry taught me that I should be careful of what label I use. Unless I want to diagnose you as a patient, I am not going to tell you what label I put your category of thinking is. (But I cannot promise not to label you in my mind. This is something already second nature to us in psychiatry. But I promise to always bear in mind that whatever label I give you in my mind will be changeable upon future evidence.)

***

Black, white, shades of grey…they are only continuum of (non)colours.

Like Person A and person B, we can be white, black and grey in different issues and in different circumstances and in different times. So, if you don’t agree with someone, do not label her thinking; just refute her argument with your own argument.

I was told to be tolerance of ambiguity if I want to be a psychiatrist.

I was told to embrace ambiguity. But the most ambiguous thing to me is the concept of ambiguity itself. It could be that your ambiguity might be my clarity and my clarity might be your ambiguity.

At the end of the day, who is the judge of all these?

So, after having thought about it long and good, I decided to say:

1)I am not going to label anybody’s thinking unless he/she is a patient that I need to diagnose. It is quite easy to unfairly label someone’s thinking inaccurately, just because we do not have the same principles that he/she does. So I will minimize my tendency to give labels, to reduce my probability of unfairly and wrongly labelling someone. (this is me displaying my non-dichotomous thinking, see?)

2) There are many grey areas. But there are also many black-and-white areas. However, your black might be my grey. My grey might be your white. If we are to have an argument, let’s respect each other by arguing on each other’s points rather than ending an argument by giving labels to your opponent’s thinking. It is boring to win so unfairly easily just by giving a general statement such as ‘you are dichotomous!’. Actually…it’s cheating!

3) Since we have established that we all have our own dichotomous and non-dichotomous moments at different times with different issues, let’s just agree to ‘live and let live’. We all should be able to say what we think and defend why we think the way we do, without fearing other people would label us with this and that (unless you are a patient and I need to look at that aspect of things because it is my job).

4)At the end of the day, do what you think is right. Because there will always be someone else somewhere who still think that what you think is right is actually a grey area. As long as you can be at peace with yourself, the rest fall into insignificance.  I won’t say stop caring what the society thinks. We live in the society and there should be some level of deference to social etiquettes. But ONLY up to a point. Beyond a certain point, you yourself know when is the right time to make a stand no matter what, and if that time comes, do not fail to make a stand just because you are afraid of what the society might think and label you. Just remember that Society had wrongly labelled our prophets too in those days…so, what’s the big deal if they wrongly label you who is not even a prophet pun kan? It is only a big deal if you fail to be true and fail to be at peace with yourself just to appease the society. Don’t make that mistake.

 

Finally, my dears!

CARPE DIEM!

LIVE AND LET LIVE!

Polygamy: A Discussion, My Perspective

Being a PSY MO is a privilege. Strangers you have never met before sit in front of you, tell you their personal life stories and bare their emotion to you in a manner that humbles you to the core.

I, for one, can never be that emotionally naked with anyone. I am that much of a coward (I freely admit).

I have met many type of women, but for the main purpose of this discussion I will discuss women with regards to their marital (micro)status:

1)Betrayed first wives

-How could my husband do this behind my back? He cheated on me

-Selepas berpuluh tahun berkorban…lepas dah senang, boleh dia pergi cari yang lain. Susah bersama-sama. Bila dah senang, orang lain yang dapat habuan.

 

2)Second wives who are unjustly treated

– Tapi dia janji nak ceraikan isteri pertama dia. Sekarang dah tiga tahun, dan saya masih isteri kedua.

-Saya tahu saya isteri kedua. Tapi saya rasa macam perempuan simpanan saja. Hubungan kami terpaksa dirahsiakan sebab isteri pertama masih belum tahu. Don’t I have my own rights as a second wife to be recognised as such? Bukannya saya minta dia tinggalkan isteri pertama pun. Saya tak kisah jadi isteri kedua. Tapi sampai bila mahu rahsia? Dia langsung tidak adil dari segi nafkah dan giliran bermalam.

(Bila kita fikir pasal isteri kedua, perkataan yang kerapkali terlintas adalah ‘perampas’ or home-wrecker. But they have their own stories. Some of them did not know that the guy who had courted them was already married. By the time they found out, they were too blinded by love to ever go back.)

 

3)Wounded second wives who just found out that her husband had just married a third wife

-Saya isteri kedua dan saya bekerja. Isteri pertama tak kerja. Gaji suami saya lagi kecil dari gaji saya. Malah, gaji saya pun dia guna untuk perbelanjaan isteri pertama. Macam mana dia boleh kahwin yang ketiga pula? Saya berkorban dah banyak, tapi dia tidak adil pada saya.

 

(Of course it is ironic if a second wife gets angry when her husband has a third wife. After all, the second and the third wife have something in common in the sense that they both marry a married man. The second wife was the one who set the precedent of ‘madu’, so what rights does she have to act upset when her husband later marries another, some might ask. But in circumstances like the above, where the first wife is not working and the husband is actually dependent on the second wife’s income, it is totally understandable why a second wife gets upset when her husband marries a third.)

 

3)Single women who fall in love with married men

-So naive and trusting they are, that you feel like keeping them in their cocoon of innocence til kingdom come, and protect them from all corrupted powers by holding them in your warm sisterly embrace. But the same quality of wide-eyed naivete can also be cruelly termed as ‘stupidity’ and sometimes it is hard to keep yourself from wanting to drown them in cold iced water just so they could wake up from their slumber.

-This is an all too common stories, it is heartbreaking.

 

Sorry…did I say ‘stories’? I should have used the word ‘realities’.

Oh dear reader, I might use the word ‘stories’, but they are hardly fiction.

 

I am sure out there, third wives and fourth wives have their own perspectives of the trials and tribulations of married life. They are not just beautiful gold diggers and ‘pisau cukurs’ of the world, all the time. Life is tough for all of us, I am sure. Even for them, though I am yet to meet one in my clinic.

Being a PSY MO taught me to appreciate perspectives and angles. Being an avid reader drives me to get a story in its whole. I admit there are times when my impatience become quite obvious, when their stories do not seem possible, until another perspective from another person makes it plausible. The reader in me instinctively sought the ‘a-ha moment’ when I listen to my patients. The ‘a-ha moment’ makes everything click and the whole story complete. There are times when instead of listening patiently, I would say ‘But just now you said this…so how does that then become this? But why didn’t it end up like this since you had done that? Shouldn’t it be like this?”

I was relentless (especially when the follow-up clinic is not busy and I have the time).

So yeah, I do appreciate perspectives and angles. How they enrich a simple plot and a story line.

But being a PSY MO also taught me that it is LAZY indolence to simply end an argument with “semua orang ada pendapat dan perspektif masing-masing. We shouldn’t judge.”

I believe that in some things, there are universal truths and some basic principles that even your opinions and perspectives SHOULD NOT violate. Because then, you would end up being UNJUST.

So perspective and opinion aside, we all should STRIVE to arrive at that universal truth and reconcile and realigned our perspective to it. Universal truths such as divine guidance and justice and honour and kindness are above opinions, every single time.

 

Divine Guidance

I am not a feminist. As a Muslim, I don’t need to be.

Once when a polygamy issue was discussed among us, I’d freely announced my confident heartfelt conviction that “Men can marry more than one, up to four, provided he is a good Muslim man who is kind and just.” I didn’t think my view is all that controversial because it’s not like there is any other way to look at it, being a Muslim.

So some of my colleagues and friends tease me now and then for my un-feminist, unconventional view as a woman.

I shouldn’t feel I need to say anything. I thought it was supposed to be obvious. As Muslim women, we should already know that polygamy is already in the syariat. Who am I to have a different opinion than what God has outlined? You may argue the matter if you don’t share the Muslim faith…but for Muslims, there is no other choice. You don’t get to have an opinion on this. Sorry.

 

One day, when we talked about one particular polygamy case among ourselves, some of the guys had thrown in the opinion that “Suami dia tak salah kahwin dua. Dalam Islam, memang suami tak perlu pun beritahu isteri pertama kalau dia kahwin lain. Tu cuma undang-undang Malaysia. Agama tak cakap pun yang suami perlu minta izin isteri pertama.”

 

Oh, God! Some guys totally lost the plot. They are selective in their facts and practise self-serving bias that is so blatantly unfair that it needs to be addressed. They were surprised when I said that the husband was very much at fault. “Haih…Dr. Afiza kan pro-poligami. Awat sekarang lain pula. Ke sebab dah ada boyfriend, dah ada feeling, tu pasal cakap macam lain pula.”

 

I just had to laugh. Jumping to conclusion is always a hilarious thing among psychiatry colleagues. I do it at times, myself. I give my ‘jumping to conclusion’ impressive fancy terms such as deductive reasoning (Sherlock Holmes, anyone?) and educated guessing. We like to feel that it was just our power of observation and our mastery at psychodynamic that brought on the insight that we had about other people. And in this case, they thought I had changed my stand on being pro-polygamy because “I have someone special and cannot bear sharing him one day”. That was an interesting inference but a false one, funny though it is.

 

They still didn’t get it. And I was too tired to explain to them thoroughly because the discussion was a small talk that was not supposed to be serious to them. Guys (and some girls) talk about polygamy merely to tease the women and make jokes at their expense without any real intellectual purpose. It was just small talk, after all. Why should we get so intense, right?  They hardly wanted to make it into a DEEP intellectual discussion or a SERIOUS dialogue that it deserves.

Talking about one of the tenets of munakahat deserves a sincere attempt at comprehensive understanding, but that’s just my personal opinion and not many people share my overly intense temperament. I was tempted to venture further, and argue more, make them understand…but I let it go. (I am not always serious, I think. I admit, small talk bores me and I avoid it most of the time. But I do enjoy light topics, in my own way. However, when a subject is interesting and important in which I happen to have an opinion, I don’t enjoy discussing it only lightly. I believe that an important matter should be discussed at length and deeply, as it deserves…. or NOT AT ALL)

 

You see, I didn’t want to be the one inserting an awkward moment by being too grim and severe and a know-it-all show off when it was supposed to be all light and laughter. I do know that I have the tendency towards intense manner of expression that other people find puzzling. (I am hyperthymic in personality, I have that much insight about myself.)

So I let it go, then. But that left me with so much burning longing to write. All that intensity needs to be channelled, don’t you think? Hahah.

****

 

I reaffirm my stand that polygamy is a beautiful thing when it is rightly practiced. Practice it right or don’t go there at all.

 

An Act of Betrayal

Once upon a time:

-Isteri kedua dikahwini TANPA ada perjumpaan sulit ‘dating’ sana sini. Tiada ‘explicit text messages’ that would hurt the first wife. Suami tidak mengabaikan rumah tangga untuk berjumpa ‘girlfriend’ di luar pengetahuan isteri pertama. Isteri kedua dikahwini for practical reasons – janda yang suaminya gugur di medan perang, andartu yang tiada pergantungan, mengukuhkan perhubungan politik dua hala dan sebagainya. Even when love came into the equation, there was no so-called dating and meeting in secrets, talking freely with non-mahrams unchaperoned. There was no deliberate deception and creative story-telling. There was no time STOLEN from his halal wife and children, so that the husband could then secretly see the girlfriend (and prospective second wife) behind his wife’s back. In the first place, that is haram, you know. Isteri mana yang tak akan rasa ‘betrayed’ bila dapat tahu semua out-station selama ini adalah penipuan? Yang semua lambat balik overtime selama ini adalah pembohongan! Yang tak cukup duit selama ini adalah bayaran kemaksiatan.

Lying in itself is a betrayal. And lying so that you can spend time and money with a non-halal woman is DOUBLE/TRIPLE the betrayal.

Suami yang menyatakan bahawa dia mahu mengambil girlfriendnya sebagai isteri kedua untuk mengikut sunnah adalah satu kebodohan yang tidak dapat dimaafkan. Lelaki itu seperti orang yang mahu mengamalkan sunnah untuk makan dengan tangan kanan tetapi menjamah khinzir.

You have tainted the beautiful practise of polygamy by mixing it with the maksiat of ‘mendekati zina’ before you finally decided to marry your girlfriend as a second wife. How dare you describe such a practice as sunnah? Attributing something haram to our prophet, as though our prophets all had girlfriends while they were married to their first wife. How bigoted your thinking has become!

And you dare think yourself holy when you take a second wife (who you met through non-halal means), just because in your self-serving bias, you consider it sunnah and your male rights. That is SO DELUSIONAL.

Yet, guys didn’t see this. Even so-called ‘alim’ ones have girlfriends outside their home and justify their taking of second wife as sunnah.

I was not of ‘sekolah agama’ student. Yet, I knew my limits and rights as a Muslim woman. I knew that polygamy is beautiful (and thus some people think I am a weak non-feminist, willing to be betrayed), but I also encourage women to NOT stay in a bad unjust marriage (and then the same people think I might be a feminist after all, but a weird one who condone polygamy).

I didn’t attend sekolah agama. But even I knew of the very famous ayat “masuklah ke dalam Islam secara keseluruhan (kaffah)”. Jangan ambil separuh-separuh and make polygamy look ugly and distasteful to not just Muslim women, but non-Muslims as well. You want to practise polygamy, practise it right from A to Z.

Or NOT AT ALL.

 

Once upon a time:

-Memang dulu tidak perlu meminta izin isteri pertama untuk kahwin dua. Isteri pertama tidak perlu diberitahu. Sebab mereka memang akan tahu! It was not treated as a dirty secret, back then.

Pada zaman dulu, tidak perlu untuk ada specifier ‘meminta izin’. Menyatakan bahawa “suami perlu memberitahu isteri pertama tentang poligami” sama seperti menyatakan bahawa “kita hendaklah mandi menggunakan air”. It is understood. Because if you practice polygamy the way Islam means for you to practice it, there is NO WAY you can be fair and just without telling the first wife about it.

-Tidak perlu berahsia untuk berpoligami. Suami yang berpoligami pada zaman kegemilangan Islam adalah seorang yang warak. Mereka tidak berbohong. Mereka adil.

Mereka adil dalam nafkah dan giliran. Jadi pada malam yang mereka tiada di rumah isteri pertama, mereka akan menyatakan secara jelas kepada isteri pertama bahawa mereka berada di rumah isteri kedua mereka yang sah dan halal bagi mereka. My point is: there was no lying! Tidak berbohong. In that situation, the first wife won’t go for years not knowing, and the second wife won’t go for years (not even a day) without being being publicly acknowledged or introduced as a second wife.

So back then, the question of ‘izin isteri pertama’ did not rise. It was a non-issue because the Muslim men in the old days were honourable. They didn’t lie, they were not cowards who cheated behind their wives’ back, they knew they have to be just and they practised justice with no apology. They treated the matter as fact with no evasion or prevarication “Hari ni giliran isteri kedua and I am going. I will see you in two more nights.” They took Islam in its entirety, in all its truthfulness and justice.

No one is maligned and everyone gets their due rights.

 

Fastforward to 2014…

The guy marries his girlfriend (whom he has had years of non-halal relationship) in secret. He has a second wife but cannot go to her as often (because no first wives would ever believe the frequency of his so-called out-stations and overtimes).

The first wife is betrayed with lies. The second wife is betrayed by being treated like she is a dirty sordid, little mistress who must remain a secret, until God knows when!

What a bastard of a man! What a coward!

 

Jadi zaman sekarang, meminta izin atau memberitahu isteri pertama tentang kewujudan isteri kedua adalah satu keperluan supaya semua pihak yang terlibat maklum akan situasi yang sebenar dan tiada sesiapa yang haknya ditindas. Because men are so unreliable at understanding the fine points of good practice of polygamy, a specifier of ‘perlu memberitahu isteri pertama’ is created where it should have been understood. The existence of this rule in Malaysia goes to show how low the honour of men have sunk! It goes to show how little they can be trusted to deal with all their women justly.

Jadi lelaki yang menyatakan bahawa “Islam tidak menyuruh untuk memberitahu isteri pertama atau meminta izinnya untuk berkahwin lain” adalah lelaki yang singkat pemikirannya. Mereka fikir taraf dan ‘standard’ mereka sama seperti taraf dan standard para nabi dan sahabat yang tidak pernah cuba berahsia untuk ber’couple’ dengan teman wanita di luar rumah secara haram. Mereka lupa bahawa para nabi dan sahabat tidak pernah berbohong apabila bermalam di rumah isteri-isteri lain. Semua isteri-isteri para nabi dan sahabat tahu akan kewujudan isteri-isteri lain FROM THE VERY BEGINNING dan soal keizinan/pemberitahuan tidak pernah timbul pada masa itu.

 

Message To All Women.

Dear women, RAISE YOUR STANDARD.

 

Dear first wives,

Raise your standard in how you choose to be treated.  Can you still love a man so weak and easily tempted by lust for another woman that he would resort to dishonourable conduct behind your back?  Do you still respect a man who is such a coward that he would treat another woman (your fellow sister in religion) like she is a dirty secret? How can you love a man whose sense of responsibility is so lackadaisical that he would succumb to lust (disguised as love) by marrying another woman when he could not even afford it! Trust me, second and first wives that I have met in my clinic are hardly married to a wealthy man. In fact, they had to work, sometimes beg their relatives for money.

It made me wonder, why they stay in that marriage? I asked; they gave me their reasons. I respect those reasons, but I disagree inwardly.

 

Dear secret second wives (or third or fourth),

Raise your standard in how you choose your husband You are forgiven if you didn’t know that the man who has been courting you is already married. But if you did, how can you love a man who is so corrupted that he would lie to his wife and betray her like it was not a big deal, just to be with you? Don’t you feel that such a man is disgusting? (And what business do you have of going out with him, in the first place? Why do you nurture feelings that you should have nipped in the bud from the very outset?) How could you NOT WORRY for your future when you first considered accepting such a man as your husband? Would he treat you fairly and acknowledge you as his second wife…did you ask yourself that question? Would he introduce you to his family and friends once both of you are married…did you ask him that? He had already proven himself as a coward by lying to his wife. He had already proven himself weak and easily tempted by trying to court you into being his girlfriend before he finally married you at the Thailand border. Don’t you deserve a stronger man…did you ask that to yourself before you cross the border?

-Don’t you deserve a man who marries you for your sake and not because he had a problem with his first wife that is yet to be settled? Don’t you deserve a man who don’t go around carrying baggage of unfinished business when he starts a life with you?

Don’t do this to yourself. If he is yet to acknowledge you as his second wife to his family and friends, leave him. You deserve better. I am sure each and every one of us have their own reason for staying in an unhappy marriage, but the reason must be worth it. Worth the pain, the tears, the unacknowledged status.

It must worth the destroyed self-esteem. It must worth the pain of being treated like a dirty little secret.

 

Dear single woman who finds herself courted by a married man,

-Raise your standard in how you choose your husband. Don’t go out with non-mahram males (single or married) at quiet places, unchaperoned. If he is a married man, insist to meet the first wife and get formally introduced as prospective co-wife. Let him prove himself as a strong man with clear and pure intention. If he doesn’t have the spine to tell his first wife that he wants to take a second wife, what other responsibilities would he run away from when the going gets tough, God only knows. Do it honourably and do it right.

-If you are the sort of woman who do not see polygamy as something you can endure, then be forthright from the beginning. If he promises to divorce his first wife because he “doesn’t love her anymore and you are the true love he has been waiting for his entire life yadda yadda yadda” (please employ some common sense when you evaluate his romantic words; 90% of them might be a lot of cow dung), then get him to divorce his first wife BEFORE you actually tie the knot with him. Don’t believe him if he says that he will divorce his first wife after you are married. This is a negotiation, girl! In all negotiation, there is power play going on and you need all your bargaining chips. Once you married him, you have weaken your position because you would have lost that bargaining chip already. He will never divorce his first wife. I wouldn’t too, if I were him. Why would I want to do that when I can have my cake and eat it too?

-It is better to remain happy and single than trapped in a bad marriage to a weak and immoral man who can only give you crumbs of bread when you deserve the whole loaf.

 

Dear married brothers,

-Raise your own standard in who you are as a Muslim man. And that means acting honourably, justly, with no betrayal and lies.

-Do you believe that you are a good, strong and honourable Muslim man who wants to do what’s right and what’s just to every woman in his life?

-Are you willing to be fair to all your future wives? If you are, that’s half the battle done. Do you have the financial ability to care for all your wives and the children? If you do, you can consider marrying another and doing it right and proper from A-Z. Make polygamy beautiful again by embracing not just the sexual aspect of the marriage, but all the responsibilities that it entails. The responsibility is huge!

-There will always be naïve women who trusts so easily. Doesn’t mean it is okay to take advantage of them. Some people think that the women deserve to be hurt for being so stupid. But that’s not the point. Stupid people may get conned. But it doesn’t justify the action of the con-artists. There will always be naïve people out there; bad people take advantage of them, good people will protect them. So, be one of the good ones, not for anyone’s benefit, but because that is your self -standard and no less.

****

I guess, most people cannot discuss polygamy without getting emotional. The males wouldn’t dare to discuss it without disguising it as a joke, a light and laughing matter.

Whenever there is an attempt at discussion, it is muddled by self-serving bias in BOTH males and females. It would be funny if it was not so exasperating.

When I said I support polygamy, I was regarded with incredulity.

When I commented on the wrongs committed in polygamy, they confused me with a self-serving feminist and thought that I had changed my opinion on polygamy because I am now supposedly ‘in a relationship’.That was beyond hilarious.

I never change my stand on polygamy. I support it wholeheartedly when it is done right. That has always been my stand since I’d first learned it properly years ago and I never waver. But life is not black and white. I knew that.

The law is clear. But the circumstances sometimes are not. So most people manipulate the law to suit their circumstances. It can be really confusing. The trick is in discussing important issues such as this deeply and intellectually, not lightly nor emotionally.

Otherwise, don’t discuss it at all. Abandon the fruitless time-wasting debate that gets nowhere.

Instead, write it. And spread awareness.

 

 

Abraham Maslow Hierarchy of Needs In Relation To Housemanship: A (not exactly evidence-based) Theory

Lately, people have been talking about how ridiculous it is to have matrons and nurses monitoring housemen in wards. I agree with their sense of the absurd. But to be fair, let’s take a wait-and-see attitude before commenting further.

This article is going to be my amateurish take of Maslow Hierarchy of Needs in relation to our housemen. I am no psychologist…have not had the opportunity to read much psychology as I am currently prioritizing psychopharmacology and psychopathology in my revision.

I might be wrong but this is simply my way of looking at why things have become the way they are.

***

Abraham Maslow Hierarchy Of Needs
Abraham Maslow Hierarchy Of Needs

 

This is a diagram showing Maslow Hierarchy of needs. It basically tells us that there are many levels of needs in each individual that motivate them to work. After one level is met, they will struggle to continue to achieve the next level of needs, climbing up the pyramid of needs to achieve the pinnacle of all needs. The pinnacle of all needs is termed as ‘self-actualization’.

 

Basic Physiological Need Is The Strongest Motivating Factor

Once upon a time, most people went to work because they needed the money to meet their basic physiological needs. Not going to work meant not being able to pay for your basic physiological needs,namely the air (thank God that is free),food, water, shelter.

Even within the same level, there are different priorities that need to be met. Someone who is struggling to breathe is not going to think about food.

Imagine the life of a homeless person who does not have much worldly belongings beyond the clothes on his back, to begin with. Someone who cannot even ensure his or her next meal would not yet think that having shelter is that important (relatively speaking). Even procreation and reproduction (seen as important for continuation of species) is placed at the back burner. Really, finding love and a partner to share a homeless life with, is not important at this level. Being hungry is more urgent than having a home or a partner.

Once you are able to ensure your basic physiological needs are consistently met (i.e, water and food; we can assume his airway, breathing and blood circulation are in working order), then you start to dream about having a small, tiny shelter.

At this level of needs, you don’t care if you have any satisfaction at work. You don’t care about ideals and philosophy yet at this level. You don’t care about principles and would not know if you have one. Concepts like justice, fairness, gender equality, higher morality, fighting for the rights of others….they are just Utopian to you. You generally know those concepts are good ones, but you realize that mastering and internalizing those concepts cannot provide you with food once a day. So those concepts are just floating like pure white clouds up high in the sky…for wealthy rich people, higher in social status to talk about and concern themselves with. You couldn’t care less about those mumbo jumbo at this particular stage. Your boss can be a tyrant, your colleague can be a nuisance but you are always motivated to go to work because you are motivated by the most important of all needs; the basic physiological needs.

You don’t care about feeling secure in your employment just yet. You don’t care if you are unfairly treated just yet. You don’t care if your male colleagues get paid more than yourself just yet. You are just grateful to be having this job!

Have you ever heard our grandmothers and grandfathers suffered from depression? They might, for all we know. But they STILL performed their back-breaking intense labour with undying ardour (think rubber tapping, here. Not office work). My paternal grandparents were rubber tappers. They didn’t have the time to dwell on their feelings of dissatisfaction because continuing in labour means putting food on the table. In fact, I don’t think it ever occurred to them to be dissatisfied.

Once, they tried to stop my father from continuing into his secondary school because they simply did not have the money. Education is not important when you are struggling to survive. But my father – thank God, I wouldn’t know where I would be, otherwise – persistently insisted to go to school. He was his school’s best student in SPM but he couldn’t continue his tertiary education because he had to go straight to work. He did go to university but he was only able to do that much, much later. I was already in my kindergarten by the time my father completed his diploma in Accountancy from ITM. I was 10 years old when my father finally graduated with a degree in Accountancy from UUM. I witnessed the sort of struggles my father had to go through being a mature part-time student and a weekend father. I witnessed my mother’s endurance in being a weekdays-single-parent. Looking back, it must be a difficult and hectic life for them at that time, I suppose…but it was a happy one. To the mind of a 10-years old child, they sure didn’t look depressed.

This reminds me of a lecture given by Dr. MAZA once. Happiness and contentment cannot be determined by how difficult one’s life is. Happiness is a miracle bestowed to whoever Allah blesses. Someone who is homeless may sleep much better than those who reside in a mansion (how many people have come to PSY clinic complaining of poor sleep even if they have everything else they need. What would they give to be able to sleep a deep slumber like the weary, exhausted homeless people in the street! Being unable to sleep is one of the most frequent complaints in our clinic.) Sleep is a blessing bestowed on anyone Allah permits, and the affliction of having poor sleep does not distinguish where you are in your social status. It affects anyone rich and poor, if you are unlucky enough to get it.

Someone who only has ikan kering and sambal belacan may eat better than rich people with poor appetite. (by the way, I happen to like eating ikan kering, sambal belacan and telur dadar to accompany my rice.I tried it during a program anak angkat once and it was actually quite yummy) You can serve them the best of meals prepared by the best of chef but if someone has poor appetite, they just cannot stomach anything. (think of those with depression)

So, Allah is most fair in HIS blessings to HIS slaves. A difficult life in the eyes of others may be just as happy (if not more) where it matters most.

 

 

Now fast forward a few decades….

Our housemen grew up in households whose mothers and fathers are much better at providing basic physiological needs. Their mothers and fathers work really hard to make sure that their own childhood deprivation will not be repeated onto their beloved children. Food, water, a nice home, and for some people, an annual vacation locally or abroad, are their childhood experience. Some housemen are offspring of other doctors who have always led an affluent life. Food, water, security in friendship and family ties…those are something they have always known all their lives and to a certain extent, taken for granted will always be theirs. They grew up reading a lot and have formed ideals in their head about how their lives are supposed to be. They don’t talk about getting their next meals….they talk about politics and humanitarian issues (I hope). They don’t talk about where to find shelter at night, they talk about philosophies and principles that used to be utopian to their grandparents and parents.

 

Look again at the Maslow hierarchy of needs. At which level of needs do our housemen begin their working lives? We can already assume that they don’t start their working lives at the level of physiological needs. Most of them sure don’t start their working lives at the level of safety and belonging. At the very least, they start their working lives at the level of ‘esteem’.

Pretty high up there in the pyramid!

Believe me, some of my contemporaries and juniors (depending on how high they are in their family social status) start their working lives even at the highest level of ‘self-actualization’. They grew up being the best at everything and some were only ever been best students all their lives. They value morality, creativity, spontaneity (within the appropriate context). They value justice and their opinion being heard. They want to feel needed and they want to feel empowered.

Having those values at the workplace would motivate them to go to work. Simply getting a salary at the end of the month is not going to cut it anymore.  Some of the commentators were saying “Tolonglah jangan bekerja sebagai doktor kerana duit. Kerja sebagai doktor kerana you betul2 minat”. Come on…that comment is redundant, in my opinion. How many doctors of the previous generation really work as a doctor because they liked it? I have met many older generation who didn’t even specialize in the field they really like, yet they go on to become HOD some more.

Perhaps, it is because the previous generation start their working lives at a different level in the pyramid? Or perhaps they too start their working lives at the higher level of pyramid…where their principles and esteem state that “Once started, I cannot quit”. I don’t know.

But I am just saying that there are many complex reasons why housemen are termed ‘problematic’ these days. But as a PSY MO, I am not going to use the word ‘problematic. I am going to use the term ‘demotivated’.

***

Now, you are telling your housemen of how bad they are at work. No doubt, some of them have poor attendance at work and mediocre performance during formal and informal assessment. Their attitude leave much to be desired. Some of our criticism are valid but some are exaggerated. We criticized them heavily for everything they did wrong. But we did not praise them for the things they did right. (Remember that they are starting their working lives at the ‘esteem’ level in the hierarchy of needs). If they presented their cases well, we did not comment on their improved performance…because we feel that it is what they are supposed to do, anyway. But when they forget the slightest thing, we scold them something fierce. I cannot help but think that our attitude towards them is not balanced.

Now, that is not the attitude of a good teacher. I know that you are going to say “This is not a school. This is work. Don’t expect praises and recognition.”

But remember where they are at the hierarchy of needs. Their motivation plummeted every time they are heavily scolded for the slightest thing while not getting any recognition for their improvement.

Yes, this is not a school. This is simply life! But in life, we have to be fair.

I believe in being  fair. If I am going to scold you for every single thing you did wrong no matter how little, I am also going to praise you for every single thing you did right no matter how puny. But since I am quite stingy in my praises and recognition (I have a somewhat brusque manner and sometimes do not remember to praise people who have made my life easier at the workplace), I tried to be less particular about making my criticism known as long as the mistakes is not too glaring. If I feel that I can overlook those mistakes, I will overlook it or perhaps, gently admonish it. My lack of severe criticism is balanced by my lack of praises for them (not because I do not appreciate their work, but sometimes I forgot to acknowledge how helpful they are). I try to be more appreciative when I remember to do so. But overall, I am just not very demonstrative. But I think, I am pretty balanced. I don’t praise much but nor do I feel like scolding my subordinates all the time.

Being fair in that manner creates good will in the working environment. Go ahead and scold them for every little thing. But ALSO  go ahead and praise them for every little improvement. Otherwise, you should moderate BOTH your criticism and your praises. At least, your housemen know that they will be scolded today but will also be recognized tomorrow for their good work. And this will meet their needs for ‘esteem’ in their work place.

 

Fast forward to the future where life is more luxurious than today….

One day, your school-children will grow up too. Your children too grow up in relative luxury  if they are doctors’ children, trust me.

I grew up when eating out at KFC was a treat. Heck, eating out ANYWHERE was a treat.

But your children grow up having almost everything they could wish for if they are children of doctors. They too will start their working lives at the very high level of Maslow pyramid. Hopefully, your children will not be as ‘lazy’, as ‘bad’, as ‘irresponsible’ and as ‘manja-litis’ as these housemen.

Some housemen are offspring of doctors. One of them might be yours one day. Some housemen who are offspring of doctors study in overseas…they come back to Malaysia and complained about the system now, and you tell them that they are ‘manja’. Your own offspring 10 years from now might have even HIGHER ideals about how things should be at work. Hopefully, they will not be labelled manja by their own bosses.

Perhaps only then you will recognize that your children just want to meet different level of their needs compared to you. It is not their fault. It is just the way things are. You brought them up with the confidence that all their needs that are physiological, all their needs for safety and a sense of belonging are met. They took that for granted already. Now they want more. Once you have met one level of need, you will only care about meeting the next level. That is sunnahtullah…how things are. Human beings are created to be greedy for the betterment of what they already have.

And in the case of housemen nowadays, the next level to be met is esteem and then, self actualization.

***

Now our job as parents is to instil the right ‘esteem’ and the right ‘principles’.

No matter how rich you are as a parent, give them chores at home. At least they should wash their own plates, make their own bed, wash their own clothes and sometimes take care of their younger siblings. Chores must be completed. They are trained to be accountable for what they are explicitly asked to do. Not completing the chores should warrant a punishment and their privileges should be taken away.  And  when you occasionally treat them to something nice, there should be a very compelling reason for you to do so.

Some people do not agree about spanking children when they misbehave. Well…perhaps most psychiatrist would disagree with me when I said I would not discount the possibility of spanking them (within limit and reason) when it is warranted. But that’s just my personal opinion. Sometimes I believe that because my parents were so strict, I made it through housemanship. Even the scariest boss I had ever met had never scolded me any worse than my father had when I misbehaved. The only difference is that, with my father, I had the luxury and the satisfaction of answering back and stating my case, and thus my internal conflict is resolved right there and then. During my housemanship, I did not always answer back to every thing my boss said, but then, I wrote about it in my blog. So eventually, it evens out. Hahah.

As a parent, we need to tell them : “We go to work because our self-esteem demand that we fulfil our responsibility. And that means completing your work properly. Forget your tyrant boss, forget your annoying MOs. They are problematic in themselves. But you yourself should not be problematic in your own way too. Go to work! Finish what you started! Not for them, but for yourself. You have your own standard in behaving….not going to work is not an acceptable standard in yourself”

If you instill in them the principles and ideals of responsibility, they will go to work because they want to fulfill that responsibility. Because being responsible is ALREADY part of their ideals and their sense of esteem in the hierarchy of needs.

But to to have that sense of responsibility as part of their ideals and sense of self…. that takes a lifetime of training. Giving chores at home is one of those training. Asking them to account for what they do is a training. Telling them repeatedly as they grow up that you have to complete what you started is a training starting from childhood.

I grew up having an elder sister who is independent of my parents’s money since she was 18 years old (she was a famous novelist a decade ago…wrote three famous novels and earned a lot of royalty. She stopped writing after completing her PhD in statistics, mostly due to her hectic adult life. My sister and I share a deep passion for writing. The difference is in her case, she has been published and I am forever envious hahha).

I could not imagine not completing my housemanship without having a proper Plan B for what I want to do with my life. I could not imagine the shame of still having to depend on my parents once I started my university life. Not because my parents would not support me, but because my ideals  – that is, my sister – did not need my parents’ money by the time she was at the uni. And I too, felt like I should be like that. (Yup, we had some serious case of sibling rivalry going on,  but we love each other loads….well, sometimes. hahha)

See? It was not physiological needs that motivate me, at the end of the day. It was not money, really. It was simply my ideal at that time that I should be independent of my parents. To be honest, four years ago, I started working at the level of ‘esteem’ in the Maslow pyramid.

***

Below are several proposals of how to ensure that your housemen go to work:

  • Parents must take back their assurance of “I will support your physiological needs if you quit housemanship.” Perhaps only then the housemen will be easily motivated to go to work. Forcing our housemen children to meet their own physiological needs is a higher motivating factor because it is the most basic. They would be less likely to be MIA if they know they could lose their job and thus, their means of survival.

-But realistically, how many parents can do that? Can we tell our kids “I don’t care if you go hungry. Get out of the house. I am not going to shelter you. You are an adult now. Go earn your living.” Seriously? Sampai hati kah?

– Unfortunately, this may not be realistic for loving parents out there.

 

  •  Creating an environment of work that meets their ideals

-Unfortunately, my dear housemen, this is not realistic either. It takes a lot of work and years of persistent advocacy to create what you feel is an ideal working environment. This is an ongoing job and your being MIA is not helping the cause. That is why you have to continue your housemanship. So that when you become a specialist, you can create that environment. To quote Mahatma Ghandi: “First they ignore you, then the laugh at you, then they fight you, then you win”. Envision that in your mind, and go to work every day.

– It is sunnahtullah that the older generation will be leaving sooner or later. It is sunahtullah that our time will come to set the agenda. But remember that it is also sunnahtullah that your junior might not agree with you later. No hard feelings…no offense…that’s just how things are. Just make sure you remember how you were when you were young….so that you will try to meet your juniors half way.

 

 

  • Housemen to tough it out, be an MO, and later, be a specialist and then advocate your ideals more forcefully.

-This is the most realistic option. It is in NO WAY refuting your feelings of how bad our system is. I am not saying your complaints are all invalid (some of them are valid, some are really a case of ‘manjalitis’ and some are just plain rubbish).

-I am saying, do not quit yet… but work for your ideals from now.

-Remember that you do not work for whichever boss you despise. You go to work because you want to be a functional member of the society who contribute to the well-being of others. It is part of fulfilling your esteem and your self-standard in who you are as a person. If that means you have to take craps from some people for two years, just do it. It will be better, later. Trust me.

– Once you have obtained the position of a specialist, you will be in a much better position to sway your circle of influence. The reward will be sweet.

– Do not make rash decision to quit when you are under stress. Stress trigger your fight-or-flight reaction. In situations like that, you do not use your prefrontal cortex in making decision. Not much higher level thinking is involved in making rash decisions under duress. Instead, your amygdala takes over, asking you to simply react (in the mistaken belief that you are in danger and trying to prompt you to run), and thus stupid decisions are made at times like this; decisions that you would not normally make when you are relaxed and thinking clearly.

-Of course housemanship itself is stressful. But if you tough it out, you will learn to force yourself to use your prefrontal cortex to think clearly even when you are in stress. You will master the art of thinking clearly on your feet, at the spur of the moment while being attacked with questions or insinuations of incompetence by your specialist and your MOs (and perhaps the matron and the nurses too, since they are said to be monitoring you soon. Gosh, I feel so sorry for you guys). Practice makes perfect, after all. Imagine 2 years of being able to force down your amygdala to rise to the usage of higher prefrontal cortex during stress when other ‘normal non-doctors human beings’ would already turn tail and run! That is something to be proud of, you know.

 

 

  •  Government to implement the reward-punishment system

-On the part of the administration, we should go through the procedure of ‘tindakan tatatertib’ if all other options are exhausted. We understand how reward-punishment method works. If all fails, this should be implemented to the letter.

-Being serious in punishing MIA housemen can bring back the sense of urgency for housemen to do well in their housemanship. In a way, we are threatening them with loss of employment. If they still don’t care enough to come to work afterwards, then perhaps they do not need their jobs after all, and their employment should be terminated. Once you deliver the warning, you have to follow it through. Perhaps, this is the ONLY way to revive their sense of commitments.

 

***

Below are some of the quotes by Abraham Maslow that I find quite illuminating in its wittiness. At the very least, they are very entertaining. I certainly enjoyed reading them and I hope you do too.

 

 

  • “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”

(I actually meet a few people who are like that. Never think outside the box. Some of our old generation elders are like that. Resistant to new ideas. So stubbornly obstinate, I give up changing their minds and consign them as a lost cause)

  • “What a man can be, he must be. This need we call self-actualization. A musician must make music, an artist must paint, a poet must write, if he is to be ultimately at peace with himself”

(I went “oh yeah” at the phrase ‘a poet must write’. I totally get it.)

  • “What is necessary to change a person is to change his awareness of himself”

(being self aware is very important. Imam Al-Ghazzali in his Alchemy of Happiness states that “One who knows oneself, knows one’s Lord.”)

  • “You will either step forward into growth, or step backward into safety”.

(This one quote should resonate in all of us. Nothing is static. There are only two options: forward or backward. You choose).

 

 

Remember to stay motivated, folks.

Until next time, insya Allah.

 

With love,

Afiza Azmee