Hail the new addiction MO!

God doesn’t give you what you ask for. What you want doesn’t simply materialise from the great blue sky.

Life doesn’t work that way, alas.  

Instead, He gives you the means and the tools and the experience that you can make use of to attain what you want.

As I have mentioned before, I asked God for patience as I am fully aware that I am  lacking in the quality of patience. I am easy-going in mundane, daily matters. Mundane routine don’t flap me, don’t faze me, or disturb my mood. I couldn’t care less about which restaurant serves what good dishes, I am not a hypercritical foodie. I eat anything and everything. (I am only particular about coffee. But not even the brands of coffee do I care. Just any good tasting coffee will do no matter what the brand is). I am not a fashionista. I am not brand-conscious. I wear whatever that is nice-looking and cheap. You don’t have to please me with expensive presents. When in doubt, just give me the latest book that has won an Orange Prize or a Pulitzer Prize or a Booker Prize. 

I don’t get offended easily. I don’t have an opinion about food, clothes, houses, cars, the best way to clean or cook. I am not a fanatic fan of football/celebrities/dramas/movies. I can never understand how fights ever get started at the stadium. Just doesn’t make any sense to me. I am, however, an ardent fan of books but it’s been a long time since I last got worked up about which book  is better than the other. 

But when I feel some people have crossed certain boundaries, certain concepts of truth/justice/fairness (my version of it, at least) or certain universal principles that I think everyone should have, I cannot calm myself down. In such situations, I am adamant that things should go my way. My way of thinking is better. And if you refuse to see it and put the blame on me, manipulate me in anyway (or try to)… if you don’t immediately see that I was right (that I don’t insist you to go my way because it is MY way, but because it is the right way and the most just, the most righteous for everyone), then I get immediately upset. 

You see, a beauty queen will be upset if people criticise her image.  A surgeon is defensive if people criticise how he approaches a certain surgery. A  designer is upset if people criticise her design. A singer would feel humiliated if people criticise her singing. A chef/a cook feels defensive if people suggest that there is a better way to cook rendang, for example. (Been to any gotong-royong memasak, recently? You will get what I mean about how sensitive and defensive a cook can be, it is so funny!) 

I consider myself as a self-developed thinker and ethicist (hence, this is my area of sensitivity). I don’t defend only myself, but I also defend others, especially my patients, against stigma, against their bosses, against their tormentors (read: husbands). I have called up employers, I have called up husbands, I have called up instructors (pretending to ask for collaborative history but actually really just want to SUBTLY let them know that ‘hey I know what you are doing to my patient. She confides in me. I am on to you, now. You better be careful in how you proceed with my patient from now on. She is no longer alone in this. You better watch out’ Hahah. Contrary to the belief of my family members, I can really be charmingly harmful and subtly dangerous when I put my mind to it, as opposed to stormily harmful and obviously dangerous. The storm and danger can come later, if required. There is an art to subtle threat that I have learned in the past. Sometimes, just doing the phone call is helpful…sometimes you need to follow-up on the phone call with a more assertive action. Once, I even offered to accompany my patient to lodge a police report against a particular member of her family… so that she won’t chicken out at the last minute and  things will actually progress SOMEWHERE! But she didn’t take up on my offer and I was left frustrated. Maybe I should be less over-involved to protect myself against this sort of frustration. Some people will never take the assertive action  that they should, it makes you want to pull your hair in distress on their behalf. Maybe I should really learn to accept that some people just deserve the problem that they have. Even Allah won’t change the condition of His slave without the slave himself putting in some effort. So who am I to try to do anything more? I couldn’t, even if I want to.)

There are risks I took without consulting my specialist because I know if I consult them, I might get a different management plan altogether that would not allow me to do what I want to do for my patients. It doesn’t happen always. Most of the time, management is pretty straightforward and we see eye to eye. But when it does happen, it makes me feel stressed. 

(I think most MOs feel the same way, anyway. Many MOs take risks of doing something behind the specialist back because that’s what they want for the patient. I am not the only one. Many MOs in other departments also, if they are senior enough and if they feel bothered enough, would have learned how to manipulate the system to get what they feel their patients deserve. I bet, many specialist when they were an MO would have done something like that as well. So they really shouldn’t be upset if their MOs now do the same thing. It’s part of our learning process and that particular action of taking-risk would enrich your clinical experience and eventually serves you well as a specialist. We are no longer HOs who just follow mindlessly. Sometime we make mistakes and commit errors in clinical judgment but those experience must be gone through.  Sometimes we need the freedom to determine what we want for our patients, right? So, there are minor things you do for  your patients that you won’t consult with your boss if you know he/she won’t agree with you. Or you will manipulate the system in your own way, present things in a different way. I know which specialist will sign OKU form easily so that my patients can get a much needed welfare money, before some politicians can swindle the money away. I know which specialist will allow me to admit patients into the ward. If my patient needs expert counselling that I cannot deliver due to time constraints and lack-of-expertise,  I know which specialist will willingly takeover a difficult case if I consult the case with her. I know which specialist will deliver a good scolding to a patient who needs that scolding. If I don’t want to give something that a rude demanding patient insists for, I know which specialist will have the same line of thinking as I do and I will consult with that specialist so that I can tell the patient “Sorry, even my own specialist say no. See?” Haha. All of my bosses are good in their own way and I have learned to choose and pick with whom I can discuss regarding which type of cases. That’s how MOs manipulate the system… and this is like an open secret. I am not saying anything new here.)

So, because I think of myself as a logician, a thinker and an ethicist, I get defensive if people criticise my logic and my ethical reasoning and how I want things to be done. (Well…everyone is allowed to be upset about SOMETHING, right? Like the beauty queens, the designers, the surgeons, the singers and the chefs of this world. Depending on how you define yourself, you get defensive about those things.)

I also pride myself of being an amateur linguist. I would probably be quite sensitive about anyone criticising my essay or my short stories. Once when I was in Form 5, I had argued with my English teacher when she criticised my English essay. (But I never, for example, argued with my Math teacher because heck, I knew I was bad in maths, so why would I get defensive about it, right?) My excuse for arguing with her was because she said the essay that I wrote for the monthly test was plagiarised from a novel. I asked her, “which novel?”. She couldn’t name it, of course. Just because my essay was good with a different plot twist, doesn’t mean it was plagiarised from a novel, for God’s sake. (she hated that plot twist because there was a controversial element to it that she opposed to, being conservatively religious as she is, compared to me at that time. In my defense, I was just being creative. If she didn’t like that plot twist, she could just tell me so; rather than accusing me of plagiarising!) My sister was a novelist! My father wrote poems and quotes at the first page of all his text books when he was younger! My younger sister is a TESL teacher. My inclination towards language and literary creativity runs in the family!  All my siblings are great readers! We talk about books all the time and we compete with each other in coming up with great phrases all the time. So can you imagine how upset I became when I was accused of plagiarising a non-existent novel?? (By the way, the essay was written in a test. How the heck was I supposed to plagiarise during an exam? Did she suppose I have an amazing photographic memory or something? Did she suppose I memorize a whole lot of paragraphs of that non-existent novel and had committed into my amazing photographic memory of every ‘and’ ‘or’, ‘if’ and ‘but’, every conjunction, every phrase, every colon and semicolon? Did she even know what plagiarism even mean? In any creative writing, having similar plot does not suffice to accuse a writer of plagiarism. If you read mysteries often enough, every novel feel similar and familiar after awhile. All ‘drama pukul 7’ on TV3 are more-or-less the same romantic stories… do we get to accuse the scriptwriters of plagiarising each other?? That’s why genre exist! Similarities in plots are related to genres, my dear readers! It doesn’t matter if the plot is similar, it is the style of writing that matters!  And in my case, I hadn’t read any such a novel that she accused me of plagiarising from! I wrote that essay in an exam, where I could not open any book for reference without anyone noticing! It wasn’t like the essay was written as a one-week-assignment where I would have the opportunity to ‘copy and paste’ some paragraphs out of some books. If that were the case, then her accusation would make some sense! As it was, her accusation only made me assume that she was not pleased that I had written something controversial that she could not accept as  a religious, tudung-labuh-wearing muslimah. Just because she had never read any amazing, grammatically-correct, controversial essay from students in her short duration as a newly-graduate TESL teacher before, doesn’t mean she would get to accuse me of plagiarism. I was instantly inflamed!) Such an unjust accusation, not supported by any evidence, directed towards my ability which I took most pride in…. My God, my 17-year-old self wanted to blow up at her! I called up my parents and told them what this teacher said to me. My father was very angry when he heard about it. I had no idea that he could be that upset over it, or else I wouldn’t have told  him.

For the record, my parents were never the sort who would fight my battle for me. Before this incident, they would always assume that I deserve whatever rare scolding I might get from teachers. If I got bad marks in any of my test, it must be because I did not study enough rather than because the teachers were bad at teaching. They have never confronted any of my teachers for anything…. until this! I was surprised when my mother and my elder sister came to MRSM Langkawi bringing a bag full of my previous essays and short stories that I had written in the past to show to the teacher that writing have always been my hobby and I have always written with the objective of being creative. That my essays have always been this amazing (hahah, my parents’ words, not mine!) That just because I introduced a plot twist that her conservative self may not like was not enough justification to accuse me of plagiarising. 

I tried to stop them from coming. But my father vehemently insisted that I should be defended. (My father has always been a fighter and would push us to do the same in anything!) I felt so stressed that they wanted to come. It was so ironic. All these times, they never wanted to side with me when I felt I was unfairly scolded by my teacher. But when I didn’t want them to come, (because heck, I was already 17 and I could fight for myself) they insisted in coming! I didn’t know whether to feel touched or irritated.

The teacher finally apologized to me after my mother and my sister went to see her. (I was not there when they confronted her because I had a Math test.) And I also apologized to my teacher because I knew how forceful my mother could be when she was feeling angry. I was thankful that it wasn’t my father who came. Or else, the situation would totally be out of control. And I learned from that experience that I should never tell my parents things that I could handle myself. Haha. (This sealed my fate as a very skeptical person towards authority, in general. I became even more skeptical after 2 years of housemanship. I swear I will never put myself in the position of needing any validation from an unjust authority ever again. I avoid authority because I never want to kiss their ass. I think of all authorities as having a tendency to abuse their power until proven otherwise. I don’t know how I am going to cure this overvalued idea of mine… just knowing that I might not be thinking fairly doesn’t cure my tendency to feel exactly like that! I have met many nice people in the position of power, and I think of them as the exception rather than the norm. I guess, even I can be illogical at times.)  

I also pride myself of being a good reader, so I was VERY DEFENSIVE when I first met the brilliant Miss A who interrogated me on my choice of reading which, I now admit, was not as sophisticated as her own choice of delicacies consisting of many notable classic literatures that I had never even heard of before our paths crossed. Compared to Miss A, I was a novice in reading. My defensive stance became meek when I realised I could actually learn from her.

Well, everyone has some stuff they get very sensitive about and thinking, reading and writing are mine. I am sensitive when I am criticized in those. 


But whatever it is, no matter what I said to defend my temperament, it does not justify my lack of patience. Like Miss A had said, we should aspire to be the one with the bigger heart. Ignore minor annoyance, walk away from the source of your major irritation, and if you can’t ignore those things any longer, then educate people with kindness. Don’t snap! 

Or perhaps, I have attained the age of maturity to have learned not to respond to anything and everything. Just walk away. If they never see what you see, don’t force the issue. (I feel more wise and matured just writing about this! Haha. But even now, I cannot imagine how I could have dealt the situation with my English teacher any better. I mean… even maturity and wisdom have a limit somewhere.)

So, having an excellent insight about my severe lack of patience, I plead to God to bestow on me some measure of patience. Make me nice, lol.

And He answered my prayer by making me into an Addiction Medical Officer.

Hahaha. Yeah. He gives me the tools and the experience I need to acquire patience. He doesn’t just arrange for me to wake up one day and be Mother Teresa.

Addiction patients can be manipulative. Check.

They sometimes use religious concept out of context to justify their actions. Check

They don’t have baseline standard criteria that I demand in people around me. Check.

They tick all the boxes that would totally TRY my patience. And if patience is a sort of muscle that have remained atrophied all my life before, I am gonna get a lot of exercise these days, trust me! Haha.

So, wish me luck. Hopefully, I can become a nice person through this experience. Something good may come out of me having to deal with the population in which anti-social traits are prevalent. 

After all, who am I to judge people? We never know how we will end our lives. Just because some people are not up to snuff now, doesn’t mean they will never change. Maybe the ongoing never-ending struggle that they have to face to overcome their addiction (although at times they fail in their struggle again and again) gives them one massive pahala jihad people like us don’t get. 

You earn pahala through struggle, right? It is not the outcome/natijah that brings you the reward from Allah. It is your effort that counts. And with drug addicts, the effort is constant for the rest of their lives. And every time they fall from grace, fail in their struggle and then repent, they get pahala taubat each time.  Who knows, maybe some drug addicts are more beloved in the eyes of God, than us normal people who only go through life blindly and repetitively with no major struggle whatsoever.

A food for thought, huh?

So far, life as an addiction MO is nice. I get to stay in my own Addiction room at the back, that’s the best part. Even though anyone can use that room at anytime (it’s not like I am given an exclusive right to it by my HOD, unfortunately) but not many MOs go to that room anyway, because the room is quite isolated at the back of the clinic. So I have come to think of that room as mine. (I am quite possessive of that room, to be honest. Even though my name was not written on the door of that room, I really think of it as mine and would feel quite forlorn if some other MO sits in that room instead of me. Haha) The isolation space that the room provides is the best part…. a space for me to do my work and to think out loud while listening to my kind of music. It’s like a separate universe from the rest of the crowded chaos at the front.

Ah… peace and serenity! I could really get used to being an Addiction MO. Having my own room is sweet! Sweet, indeed! I love it. My patients love it. We can talk privately without background noises disturbing our conversation. No patients knocking on my door, asking “Lambat lagi ke, doctor?”, annoying me with their disturbance while I am talking to another patient.  I can focus on my patient in tranquility. They feel heard and satisfied. And I feel satisfied. That is the sort of environment conducive for proper consultation and disclosure. 

That room at the back is also very conducive to turn me into a Miss-Nice-Girl. LOL.

So, that’s how it comes about that this ‘being nice’ business is not so hard these days. In fact, it is rewarding in its own way. 

So, until next time, folks! I shall try to update once a month. Might be hard though with the exam looming near. 

Until then, I remain, your humble blogger. 


So This Is How It Feels

I was informed by my specialist that a patient who I saw one month ago had committed suicide at home. He killed himself by hanging.

I was shocked.

“Afiza yang last jumpa dia. Bulan lepas. Tapi sebelum tu ada banyak doktor lain lagi yang jumpa dia. Nasib baik Afiza ada tulis yang ‘patient denied suicidal ideation’.”

I felt terrible almost immediately. I have never lost a patient to suicide before. No patient on my regular follow up has ever committed suicide before.

Medical Officers don’t always see the same patient each time the patient comes for follow-ups. Patients are seen by any medical officers according to which medical officers are available, unless the patient specifically requests to see a specific medical officer. I have a few patients who will only see me but most of the time I see general patients who are not on follow-up with any specific doctor.

When my specialist told me the name of the patient, I just could not recall who he was and how he looked like. It made me feel even worse. He died and I could not even remember who he was.

I asked my staff to trace his OPD card.

Sure enough, that was the first and the last time I had ever seen the patient. I gave his next  appointment in one month time.

God, maybe I should have given him an earlier appointment date. (Regret number 1)

I looked at what I had written in the card, hoping it might help me to remember. But all I saw in my mind was a blank picture. (Regret Number 2)

I looked at what I had written in the card and I felt sick that all I had written were only five lines of documentation: (Regret Number 3)

-Symptoms improving

-Mood is much better

-Appetite still low

-Sleep requiring Stillnox

-Denied suicidal ideation

There are not many times that I feel like kicking myself. But this is one of those times. Ya Allah… Afiza, couldn’t you have written in greater details? My only saving grace is the fact that I had actually documented that the patient had no suicidal ideation, which only meant that I had asked about it.

But did I ask earnestly enough? Did I see his face when he denied having suicidal ideation? Or was I busy writing, rushing to call out another patient on a busy clinic day? Maybe if I was not in a rush, he might feel encouraged to say something that would  clue me in on his suicidal ideas. Maybe if I had watched his face carefully as he was denying the suicidal thoughts, I might have seen something.

A flicker of sadness in his eyes… maybe.

A sad, wry, self-deprecating smile… perhaps.

A finality to his demeanour…

Just something! Something that would prompt me to explore more, dig deeper.

The problem is, I couldn’t remember a damn thing! And that might be a good thing. If I feel THIS devastated for losing a patient I could not even remember, maybe I would feel a thousand times worse if I could actually remember the whole interaction. By not remembering, God spares me the regret I would feel if indeed I had done a sub-par job. 

On a busy clinic day, I might have spent 15 minutes talking to a patient. But I might only scribble a few lines of simplified documentation because I am in a rush to see the next patient. Or I might only see the patient for a few minutes and thus the documentation was brief. So the length of my documentation does not always reflect how much time I have spent exploring his issues.

The problem is I cannot recall anything, including how much time I have spent with him and whether or not I spent any minutes exploring his issues properly.

I went home on that day with a feeling of something deuced uncomfortable in my chest. Not exactly like sadness. But more like a heaviness…. that I associated with a feeling of regret.

If I feel this bad for losing a patient I have seen only once, I cannot imagine how shattering it would feel to lose a patient who is on your regular follow up. You couldn’t help feeling that you are responsible somehow. That you have missed something. Was it something you said? Was it something he said that you did not pick up? Was it just fate and happenstance? Or are you just a crappy doctor?

I packed my things and stayed with my parents that night. I need my mom’s comfort food. I need to see her face. I need to hear the sound of her voice telling me things that I already know. That I couldn’t have predicted these things. That  things happen. That there might never be anything different I could do that would change the outcome. That many psychiatrist have had patients who had committed suicide.

That I am not to blame.

Now, I know….this is how it feels. 

So I followed Julie Andrews famous advice in The Sound of Music: When the dog bites, when the bee stings and I am feeling sad. I simply remember my favourite things….and then I don’t feel so bad. (Don’t you just love how Julie Andrews and the kids look so adorable and happy in that song?)

So I did my favourite things.

I started writing in my blog,

And then, I lie on my bed at my parents’ house, reading my novel and start losing myself in the story. Getting drunk in someone else’s journey.

Thank God, for favourite things! It soothes the blow of this crappy feeling!

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.


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?


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:


“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!