Of all teachings given by the emotion intelligence guru Daniel Goleman, none is more important than that of the almond-shaped amygdala in an area of the human brain called the limbic system. Disgust, fear and anger, it is said time and again, come from the amygdala which acts like a central alarm system calling for a full-fledged "fight or flight" response.
My recent lectures in Beijing brought back the nineteen-year-old memory of my first (this is my second) visit of Beijing. As so often happened to tourists in mainland China, I found my amygdala sending messages of apprehension, making me edgy and easily startled, say, on a bus or at the train station. I am not sure if you've heard those stories of tourists being mugged and robbed of their kidneys, but I was stupefied to imagine myself coming back with single kidney.
The extent to which our neural circuitry overwhelms us with fear is no news to us. Fear and anger, on the other hand, can be reshaped or relearned. After attending the dialysis conference in Beijing, I traveled around on my last day there. When I went aboard a bus yesterday, I found out there wasn't conductor. That means I had to tender the exact fare – which I didn't have. It seemed clear to me that I should get changes with the passengers on the bus. I tried it sheepishly with my ten-yuan renminbi banknote. You can imagine how nervous I must have been as my Mandarin skill won't allow me to utter more than a few simple sentences. In hindsight, I realized that I had undoubtedly made myself look stupid enough, and I was thrilled when the passenger volunteered to pay for me!
When I headed for the airport in the evening, I took a taxi. I ended up paying 70 yuan while the taxi meter stated 60 yuan. Only a foolhardy gambler would bet that I didn't protest when I had been shortchanged. But no, I didn't. Just why I didn't fly into a fury and quarrel with the taxi driver, to be sure, had nothing to do with my poor Mandarin. Good mood, which lasted after the pleasant experience on the bus in the morning, had probably got my amygdala rewired, short-circuiting the path to irritability and hostility.
A postscript to my story of taxi ride: It is not the case that I was shortchanged, I reckoned afterwards, because the extra ten yuan went to the toll fee.
Monday, October 19, 2009
Emotion
This month, a special issue of Science magazine published over 10 papers, written by a total of 47 authors from 10 countries, covering the discovery of an extraordinary 4.4 million-year-old hominid fossil skeleton known as Ardipithecus ramidus.
Of course, I don't have a whiff of paleoanthropology knowledge to discuss how our ancestors ended up walking on two legs. Still, I must admit, evolution is always a fascinating subject. I've been reading recently about the evolutionary root of our emotional life. I am impressed by the way Daniel Goleman chronicles how our primitive brain evolved to have new layers of brain cells endowed with intellect and emotion. It is not that we have improved a lot in terms of emotional intelligence when compared with our ancestors – trust me, we haven't – but many of us are doing not enough.
An account by a subject in one of the very first scientific studies of anger done in 1899 captures the heart of it:
Once when I was about 13, in an angry fit, I walked out of the house vowing I would never return. It was a beautiful summer day, and I walked far along lovely lanes, till gradually the stillness and beauty calmed and soothed me, and after some hours I returned repentant and almost melted. Since then when I am angry, I do this if I can, and find it the best cure.
Of course, I don't have a whiff of paleoanthropology knowledge to discuss how our ancestors ended up walking on two legs. Still, I must admit, evolution is always a fascinating subject. I've been reading recently about the evolutionary root of our emotional life. I am impressed by the way Daniel Goleman chronicles how our primitive brain evolved to have new layers of brain cells endowed with intellect and emotion. It is not that we have improved a lot in terms of emotional intelligence when compared with our ancestors – trust me, we haven't – but many of us are doing not enough.
An account by a subject in one of the very first scientific studies of anger done in 1899 captures the heart of it:
Once when I was about 13, in an angry fit, I walked out of the house vowing I would never return. It was a beautiful summer day, and I walked far along lovely lanes, till gradually the stillness and beauty calmed and soothed me, and after some hours I returned repentant and almost melted. Since then when I am angry, I do this if I can, and find it the best cure.
The same had certainly happened to me. Once, during my teen years, my mother broke my table tennis racket. That made my hair stand like porcupine quills. Alas, I behaved exactly like what that child did – and, remember, back in 1899. My eyes watered. My heart took flight. I exploded. I grabbed my bag and stepped out of the door: I wasn't coming back. The cooling-down walk left me feeling less angry, not more. The memory of this maiden runaway from home has stayed with me for close to thirty years.
Seeing how the history repeats itself – so much so that the narrative looks exactly the same with my own – speaks to a sense of déjà vu. And let's face it, we are no better than our ancestors a century ago.
Saturday, October 10, 2009
Grief
Of all the diseases doctors need to be afraid of, spontaneous fracture of an aging Littmann Cardiology II stethoscope is near the bottom of the list. Unless, that is, the stethoscope belongs to you who are seeing patients.
It was a busy Friday afternoon, with packed schedules including unit meeting and clinic, and many patients were coming in from the emergency room. This time, I thought I could feel my stomach tighten when I heard a painful yell of my stethoscope tubing, which was broken into two pieces. When I put my finger on the tubing, it felt as if I were examining a shoulder dislocation with a palpable gap.
Bleakness massed around me quickly, much faster than it had when a senior soccer player found out he had to hang up his boots. I paused and tried to count to ten but only got to two. I breathed in. And I breathed out. Then I breathed a huge sigh of relief. "A retired stethoscope shouldn't ruin my day," I told myself. A broken stethoscope is the psychological equivalent of milk teeth which are beginning to fall out. They simply signify, so to speak, a developmental milestone. My stethoscope is to step down after serving me (and my patients) for more than a decade.
With that in mind, I learned to make peace with the grief reaction while moving on to see my next patient.
It was a busy Friday afternoon, with packed schedules including unit meeting and clinic, and many patients were coming in from the emergency room. This time, I thought I could feel my stomach tighten when I heard a painful yell of my stethoscope tubing, which was broken into two pieces. When I put my finger on the tubing, it felt as if I were examining a shoulder dislocation with a palpable gap.
Bleakness massed around me quickly, much faster than it had when a senior soccer player found out he had to hang up his boots. I paused and tried to count to ten but only got to two. I breathed in. And I breathed out. Then I breathed a huge sigh of relief. "A retired stethoscope shouldn't ruin my day," I told myself. A broken stethoscope is the psychological equivalent of milk teeth which are beginning to fall out. They simply signify, so to speak, a developmental milestone. My stethoscope is to step down after serving me (and my patients) for more than a decade.
With that in mind, I learned to make peace with the grief reaction while moving on to see my next patient.
Sunday, September 27, 2009
Linus
"It's reassuring to believe that circumstances are against you and that you would write a lot if only your schedule had a few more big chunks of time to devote to writing," says Paul J. Silvia, one of the psychologists who received the Berlyne Award. In How to Write a Lot: A Practical Guide to Productive Academic Writing, Silvia helps me see that this barrier, like most false beliefs, persists because it's comforting. I opened this book at random during my recent visit to City Hall Public Library, and could not stop myself turning page after page.
Why do I find this book nifty? A good question. Not that I aspire to be prolific in publication, but that I am writing less productively.
That admitted, I must further confess the shame I feel when caught napping (and with the dream of a big block of time such as spring break). Admit it – we've all indulged in the dream of waiting for the spring break, waiting for inspiration, and on and on and on. Put simply, there is a good chance that my manuscripts, study proposals, book chapters, manuscript reviews, and even reference letters for my interns, will never be finished because of the time wasted in the cozy dreams. The way we bask in such oddly soothing dreams is difficult to quit, much in the way that Peanuts character Linus clings to his security blanket.
Why do I find this book nifty? A good question. Not that I aspire to be prolific in publication, but that I am writing less productively.
That admitted, I must further confess the shame I feel when caught napping (and with the dream of a big block of time such as spring break). Admit it – we've all indulged in the dream of waiting for the spring break, waiting for inspiration, and on and on and on. Put simply, there is a good chance that my manuscripts, study proposals, book chapters, manuscript reviews, and even reference letters for my interns, will never be finished because of the time wasted in the cozy dreams. The way we bask in such oddly soothing dreams is difficult to quit, much in the way that Peanuts character Linus clings to his security blanket.
Friday, September 18, 2009
Teaching
Ever had a bad luck that dooms your day? And as if that's not enough, your friends or classmates are highflying, and that can demoralize you indeed. After recent discussion among our colleagues and students, I'm convinced that taking a look at these bad luck theories can help.
The bad luck theory is one all-important law of human destiny. If we obey the bad luck theory, we shall almost be sure to get into endless trouble. The bad luck theory goes like this: "If I am assigned to a superb teacher like KL, I'll have the advantages that I didn't have." Or: "If I don't get the chance to listen to the heart sound of that patient with atrial septal defect, I won't be able to pick it up at the final examination..." I can hear the sigh already.
When we perceive ourselves at a disadvantage in our school or workplace (that is, most of the time) we tend to get anxious and picture the worst thing that could keep us struck. We sat there and imagined the worst lives that would be without the luck, playing out the consequences or self-fulfilling prophecy.
I'm sure the bad luck theory is too devastating and should be got rid of. There's going to be a completely different story if we remember the modern Pygmalion story of the musical My Fair Lady – I know this makes me sound optimistic, but I am – and accept ourselves who we are and what we have. To draw upon my student experience, I still remember the autodidact days when we didn't have a whiff of teaching on blood diseases. I ended up reading a textbook of Essential Haematology from cover to cover (but not other subjects within the area of medicine) by the time I graduated from medical school. Of course, I have better knowledge on this topic than other subjects for which I received tons of lectures.
The bad luck theory is one all-important law of human destiny. If we obey the bad luck theory, we shall almost be sure to get into endless trouble. The bad luck theory goes like this: "If I am assigned to a superb teacher like KL, I'll have the advantages that I didn't have." Or: "If I don't get the chance to listen to the heart sound of that patient with atrial septal defect, I won't be able to pick it up at the final examination..." I can hear the sigh already.
When we perceive ourselves at a disadvantage in our school or workplace (that is, most of the time) we tend to get anxious and picture the worst thing that could keep us struck. We sat there and imagined the worst lives that would be without the luck, playing out the consequences or self-fulfilling prophecy.
I'm sure the bad luck theory is too devastating and should be got rid of. There's going to be a completely different story if we remember the modern Pygmalion story of the musical My Fair Lady – I know this makes me sound optimistic, but I am – and accept ourselves who we are and what we have. To draw upon my student experience, I still remember the autodidact days when we didn't have a whiff of teaching on blood diseases. I ended up reading a textbook of Essential Haematology from cover to cover (but not other subjects within the area of medicine) by the time I graduated from medical school. Of course, I have better knowledge on this topic than other subjects for which I received tons of lectures.
Tuesday, September 15, 2009
Insane or In Synch
A man was about to stand up from his chair near the end of clinic consultation, when he asked me about his kidney problem. It's around lunch time on a rainy Monday, and after seeing 16 patients, I was wondering if I missed to make abundantly clear that his diabetes mellitus hasn't caused any complications.
"No, not at all. Not even a trace of protein in your urine. Let me repeat: your kidney function is perfectly fine," I explained in a professional manner after looking back at his blood test and urine results. I had a hunch (and it later proved to be pretty accurate) that this patient didn't believe in what his doctor – hell, a doctor with special interest in kidney disease – had said.
Yet, I saw no reason for the worry as to the odds of having kidney problems. He didn't even recall a single family member who had developed kidney disease. So our discussion went on and on and on. I told him it isn't possible. He told me it is. I told him it isn't. He told me it is. I was beginning to conclude that this guy must be insane until he told me about his weak kidneys taking a toll on his sex life. Bank on it. My patient was talking from the perspective of traditional Chinese medicine, wherein our kidneys take care of the sexual function.
There's a lot of this going around. The two of us were simply not in synch when we spoke to each other. There is a story about a five-year-old girl who was chatting with Daniel Gottlieb when they went for a trip in his van. Just as they pulled up to a traffic light, the girl asked this famous psychologist from the back of the van, "Uncle Danny, what does having sex mean?" Needless to say, this is not a question you and I want to answer. Finally Gottlieb took a deep breath, and whispered, "Having sex is what grown-ups do when they want to have a baby."
The older sister of that five-year-old girl wasn't impressed, though. "Uncle Danny, what are you talking about? My sister just asked you, 'What does heaven's sakes mean?'"
"No, not at all. Not even a trace of protein in your urine. Let me repeat: your kidney function is perfectly fine," I explained in a professional manner after looking back at his blood test and urine results. I had a hunch (and it later proved to be pretty accurate) that this patient didn't believe in what his doctor – hell, a doctor with special interest in kidney disease – had said.
Yet, I saw no reason for the worry as to the odds of having kidney problems. He didn't even recall a single family member who had developed kidney disease. So our discussion went on and on and on. I told him it isn't possible. He told me it is. I told him it isn't. He told me it is. I was beginning to conclude that this guy must be insane until he told me about his weak kidneys taking a toll on his sex life. Bank on it. My patient was talking from the perspective of traditional Chinese medicine, wherein our kidneys take care of the sexual function.
There's a lot of this going around. The two of us were simply not in synch when we spoke to each other. There is a story about a five-year-old girl who was chatting with Daniel Gottlieb when they went for a trip in his van. Just as they pulled up to a traffic light, the girl asked this famous psychologist from the back of the van, "Uncle Danny, what does having sex mean?" Needless to say, this is not a question you and I want to answer. Finally Gottlieb took a deep breath, and whispered, "Having sex is what grown-ups do when they want to have a baby."
The older sister of that five-year-old girl wasn't impressed, though. "Uncle Danny, what are you talking about? My sister just asked you, 'What does heaven's sakes mean?'"
Thursday, September 3, 2009
It has been two years since I joined Facebook. I still remembered my reluctance to accept my friend's invitation to join this social-networking site at the very beginning. Why? One reason – one of the big ones – is the anxiety of my space being invaded.
It's a thorny question. We're looking for ways to link with our distant friends. And yet, we might not want certain people (oh, say, our parents) to access our profile page. No matter how many times we hear the stories of Facebook users being caught as a result of their online pictures (for possession of alcohol, defacing a national monument, or any monkey business you can imagine), most of us keep on publishing our personal lives and tastes without a second thought.
Which brings me to a recent New England Journal of Medicine Perspective article about practicing medicine in the age of Facebook. That, in itself, is a remarkable essay of Facebook etiquette, reminding us the possibility of posting items on networking sites that might reflect poorly on us and the medical profession. In practice, doctors and medical students have been taught to be discreet in disclosing information. Matters aren't so straightforward when we surf the social-networking sites. We might simply assume that we're wearing Harry Potter's Invisibility Cloak in front of a computer screen. The next thing we know - God forbid - we're naked.
It's a thorny question. We're looking for ways to link with our distant friends. And yet, we might not want certain people (oh, say, our parents) to access our profile page. No matter how many times we hear the stories of Facebook users being caught as a result of their online pictures (for possession of alcohol, defacing a national monument, or any monkey business you can imagine), most of us keep on publishing our personal lives and tastes without a second thought.
Which brings me to a recent New England Journal of Medicine Perspective article about practicing medicine in the age of Facebook. That, in itself, is a remarkable essay of Facebook etiquette, reminding us the possibility of posting items on networking sites that might reflect poorly on us and the medical profession. In practice, doctors and medical students have been taught to be discreet in disclosing information. Matters aren't so straightforward when we surf the social-networking sites. We might simply assume that we're wearing Harry Potter's Invisibility Cloak in front of a computer screen. The next thing we know - God forbid - we're naked.
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