Hi all,

A short message and just one essay this last month. If you missed last month's newsletter, it's available in the archive here.

Just published this last weekend.

MOSF 17.9: “Can I Withhold Care from a Bigot?” A Brown Psychiatrist’s Perspective

This 3500 word essay expands on an ethical dilemma posed in the New York Times to NYU professor of ethics and law Kwame Anthony Appiah. His response was right on, but also underestimated the potential for damage to caregivers and caregiving teams from dealing with a hostile and challenging patient. By understanding the psychology of such a person, we might better be able to deal with such situations when they arise, by setting limits and building solidarity and awareness in the team. The essay will be of special interest to caregivers in health care and education, I think.

The parallels between this situation in a hospital and our society writ large are not lost on me, and I outline these parallels in the essay. It might be workable when a bigoted person comes for care - the experience of care might incline them away from bigotry. But what happens when the bigot has great societal power, and a propaganda machine?

This is playing out in real time, as we try to build a team to sustain "caregiving" in all its forms in our nation and world.

Nearly all my patients, and me myself, have had to deal with hostility in their lives. An authoritarian type. A superficial person attached to wealth, power, status, possessions, fame, or looks, or so torn up inside that they turn to addictions to soothe a lack of belonging or the demons they've inherited in a distressed family and cultural history. "Mao, Mom, and Me" might be the memoir of the immigrant child. How do things get so effed up? And why is it so hard for some people to see that kindness and nurturing are the only workable solutions in transforming toxicity? Just why do some people transmit and not transform trauma? How might nurturing go viral, as opposed to trauma? How to help the vulnerable more? Can we build our depth around relating to vulnerability with compassion and resilieance? Can this help us transform the web of trauma into a web of healing?

These are questions I think about, on this Interdependence Day Weekend. Hope you find good food, gentle care, and at least an island of belonging within, as we traverse the squalls of this historical time in America.

Warmly,

Ravi