Thursday, May 14, 2015

When is Your Behavior My Problem?

When is Your Behavior My Problem?

We have an odd idea that if everyone would just “mind his own business” then we would all get along just fine.  It ignores the fact that my actions and your actions intersect in numerous ways.  Think about two people passing each other on a busy street.   How close you decide to walk by me can be a concern.  How loud you are can impact me.  Your body odor or even just the sight of you can change my day.  A man in a bathrobe swinging a sword and carrying an  AK-47 could smell great and walk silently all the way over on the other side of the street, but I would be impacted.  The swordsman might be perfectly content and not the least interested in my behavior.  So what gives me the right to be troubled by his?  He is legally clothed and open carry laws for swords and rifles give him the right to carry such weapons in most parts of the U.S.  However, if I didn’t call 911, I could be pretty sure that someone else would.  Take away the sword and the rifle, but imagine the fellow shouting at an invisible antagonist.   That’s a more common sight (well maybe not in a bathrobe) on many city streets.  We learn to look the other way and hope for minimal engagement with the guy, but we probably don’t call the cops.  Put a clean pressed suit on him and add a bluetooth phone headset to his ensemble and we probably will barely glance his way.

On business trips to Japan, it was common for school children to walk up to me and say “Hello, how are you.”  They were taking an opportunity to practice their English.  Once I was wearing western boots and a Stetson.  Grown men called out to me, “Hey Texas.” or “Cowboy, John Wayne.”  and so forth.  I wasn’t alarmed, I knew I stood out.  But when a lovely young woman walks the street in a simple skirt and blouse, she may be constantly assaulted by whistles, catcalls, and unwanted invitations of various sorts.  She stands out only in being female and perhaps more attractive than most of the folks around her.  I think she has every right to be disappointed, even alarmed, by the behavior of those who accost her.

“Minding our own business” presumes observance of a modicum of social niceties.  Violate the expectations for such behavior and you quickly find that you have attracted the attention and possibly the ire of those who observe you.  You needn’t even be physically close.  Post a mocking cartoon of Mohammed and you may forfeit your life due to anger in a distant country.

Navigating the expectations of those around us can be difficult when our thinking is clear and our education is extensive.  Years ago as I sat at at a sushi bar in Tokyo, a man next to me engaged me in conversation.  His english was good and I was interested in his story.  I signified that interest with a periodic “hmmf” sound.  After a couple of those interjections, he stopped speaking suddenly and glared at me.  “No hmmf” ,he said.  He demonstrated much more soothing “mmmmm” sound.   My German American roots served me poorly as a basis for politely listening to a Japanese man tell a story.   In fact, they served me poorly in many interactions in Tokyo.  Where I sat around a table, how I crossed my legs, pouring my own beer into my glass, and wearing the slippers (much less my shoes!) in the wrong part of an Inn amounted to rude behavior.  I had done some homework on proper etiquette, but it needed far more study than I devoted to it.  And even when I knew the right thing to do, it was all too easy to slip into old habits.

Mental illness, alcohol, and drugs can all fog a mind and make it very difficult to properly observe social norms.   The transgressions run the gamut from mildly annoying to truly alarming.   Each of us exhibits varying degrees of tolerance for unusual behavior.  Small amounts of background information may allow us to maintain equanimity that would elude us otherwise.  For example, knowing that Jimmy is developmentally disabled may enable me to ignore loud outbursts of childish glee or sudden fits of anger.   Understand that the man accosting me is suffering from dementia will likely cause me to overlook repetitive questions.   Knowing that someone is drunk may allow me to ignore slurred curses.

Minding our own business is not adequate.  Overlooking or tolerating the actions of others is also required.  Seeking to educate ourselves about afflictions that may cause others to behave oddly is helpful.  It also helps if we do our best to avoid making assumptions about why others act as they do.  In addition, even knowing that another’s behavior is intentionally rude or disruptive, we can make a choice to grant a degree of grace.

I don’t mean for a second that we can simply tolerate all behaviors in others.  It is wise to develop a clear set of boundaries that we insist upon in our interactions with others.  It is necessary to know what our options are when those boundaries are breached.  It may mean walking away, we may need to call for help, or we may have to employ some sort of self defense along a spectrum from speaking sternly to making use of whatever weaponry we have at hand.   If someone is coming uncomfortably close to boundaries we have set, it is better to respond sooner than later in hopes that a milder response will be adequate if it is timely.   Neither do we have to determine whether a law has been broken or whether the offense is the result of ignorance or malice on the part of our respondent.  Knowing such things may be useful, but they are not required for us to take action.  

Courage may be required to inform others that they have violated boundaries that we insist upon.  We may fear the reaction to our admonition.  But a failure of nerve is unlikely to relieve us of an unpleasant interaction.  We may seek to work up courage by drawing upon our anger and indignation, but I believe that is unlikely to mitigate a given situation.  It is better to make a measured, factual statement of what the problem is.  It is appropriate to raise our voice or be emphatic in a measure appropriate to the nature of the interaction as it unfolds.  An overly controlled response can actually be seen as insulting or provocative when the other has already expressed a lot of emotion.   But even a vigorous response can be a de escalation in a highly charged environment.

When is your behavior my problem?  It is when I decide it is.  However, in addressing the problem my obligation is to do what I can to be a peacemaker, to give grace, and to be ready to turn the other cheek if necessary.   

Tuesday, May 05, 2015

How Sick is Sick?

How Sick is Sick

Sick is pretty obvious some of the time.  The coughing, sneezing, miserable looking person is sick and probably very aware of it.  Other times sick is stealthy.  A friend of mine became very thirsty, day and night.  His favorite drink was Coca Cola, but he just couldn’t drink enough to quench his thirst.  A friend suggested he get his blood sugar checked.  She was a dietitian and knew the symptoms of type I diabetes.  Sure enough, my thirsty friend needed to start insulin shots right away.  

Sick can be tricky as well. Is my throat scratchy, and am I feeling tired because I’ve been socializing too much, or because I have the first symptoms of a viral infection.  Is that ache in my chest a heart attack, or is it just a bit of soreness from weightlifting earlier that week.  Worse yet, is that sharp pain in my back a pulled muscle or is it related to the misaligned vertebrae that a CAT scan reveals.  I have a tendency to hypochondria.  On the other hand, one night a few years back when my chest ached so much that I had trouble catching my breath, the doctor chastised me for waiting around until the next morning to get it checked.  I was rushed in for a CAT scan with dye injected into my heart.  That test was clear, but blood tests showed a high level of some sort of inflammation, and I had been having intense aches in my shoulders, back, and hips for weeks.  More tests and a trip to a rheumatologist gave me a diagnosis of ankylosing spondylitis: my immune system attacking my joints, also known as bamboo spine due to its unfortunate tendency to cause the vertebrae to fuse together and become brittle.    He was ready to put me on some very expensive and intense drugs to suppress my immune response (I was already taking a whopping dose of prednisone to damp down the inflammation and resultant pain).   “Wouldn’t something show on an x-ray?”, I asked.  The doctor seemed amused that I would suggest a test, but agreed to order it.  No damage at all related to ankylosing spondylitis, but badly misaligned vertebrae, as mentioned above.  Good news, that might be why my back hurts sometimes, but it’s unlikely to result in a severed spinal cord.

Kids get sick, but most of the time they think of it as a random, temporary inconvenience.  The  older I get, the more I tend to think of ailments as part of a growing collection of maladies.  Get a couple of oldsters in the right mood and they will sit and swap tales of a medical nature for hours on end.  Sick and old, seems obvious right?  But the same two oldsters may be running miles a day, swimming circles around youngsters, or biking mountain passes that might overheat the old family sedan.  

Is a kid with the flu sicker than a geezer with two joint replacements and a pacemaker?   The kid may be lying inert in bed for days and the geezer may be hiking the Pyrenees.

As hard as it is to set criteria for physical sickness, mental illness can be all the more difficult.  And the two can be confused or even entwined.  When I was severely depressed in my fifties, I lacked the energy to make it up a couple of flights of stairs without really working at it.  Physically I was a bit overweight, but otherwise as healthy as the proverbial horse.  Conversely, an engineer I worked with would sometimes feel so energized that he stayed all night long at work cranking out his usual work plus loads of patent applications.  He seemed far more healthy than me until his bipolar disorder took a swing south and landed him in a psych ward with severe depression.  Meanwhile, I was plugging along dragging my ass up and down the stairs at work, wondering what the heck was wrong with me.  Another friend realized that he was a new incarnation of the Christ.  God spoke directly to him on a very regular basis, and he was quite certain that God had revealed deep secrets to him.  He might have gone on functioning well enough except that at least one of the revelations involved a young woman who was deeply in love with my friend, according to his conversations with God.  All attempts to convince him otherwise, including a restraining order acquired by the woman, did nothing to change his mind or stop his attempts to contact the young lady.  It was pretty clear to everyone else that he was very sick, but he could not be convinced.

My bipolar coworker, my smitten friend, and I all had trouble realizing that we were sick, much less having insight into what the nature of the illness was.  These situations make me wonder about the oft quoted statistic that about one in five Americans are suffering from mental illness.  What if I were to say that one in five Americans were suffering from physical illness?  How could I have any credibility give the number of possible illnesses and the range of disability that any given illness might confer?  Of course, one might counter that we could carefully record all the diagnoses given by the various medical doctors for a given population.  But a few problems crop up.  When I was diagnosed with ankylosing spondylitis, but the diagnosis didn’t stick, how would we count that.  Not to mention that the same constellations of symptoms had also been diagnosed as pericarditis and polymyalgia rheumatica.   Would that count as three illnesses, or none since all the symptoms disappeared after a few months?  In less than a year I cycled through the emotions of thinking I had a life long progressive disease,  a serious illness that would only resolve after many months of treatment, a possible life threatening ailment, and ultimately nothing at all.  I suffered anxiety and depression as I considered the various futures posed by each diagnosis.  But I had already suffered anxiety and depression for decades at that point. Was I any worse off than when I had anguished over the various rounds of layoffs that loomed prior to me successful retirement.  And now that I was retired and stable on a regimen of medications, exercise, and relaxation methods, was I no longer sick or just in a sort of remission with side effects?

Sometimes we know we are sick, but others don’t believe us.  Other times we think we are well, but others don’t believe us.  Or we may be feeling sick and receive full support in our thoughts on the matter from friends, family, and the medical establishment.  And we could all be wrong.