26. “Reverse Culture Shock”


It’s been about two weeks since I’ve been back, and I have not put my fingers on the keyboard.  There are a number of reasons why this is so, but the primary reason is that I want… to be more present, and the past half year is hauntingly ever-resent.  The very morning I awoke for the first time in my bed in Montreal I received a message from the clinical coordinator in Amsterdam asking me if I was willing to go to the Sudan.  It turned out that the government is kicking out the NGOs for a host or reasons, and there is a need to train local doctors how to continue treating persons with schizophrenia and bipolar disorder.  Good work, and very necessary.  I wanted to go, and I ached to say yes.  But my body was depleted, and I sheepishly wrote back that given my commitments to various hospitals (locum contracts that I had set up), I could not go.    It was true, but I also knew that I was not ready to return the next day.  I didn’t know what I needed, but there was a need that I had that could not be met in Darfur, and I would not have been able to do a proper job.  I sadly declined.

Needs.  Forgetting a very healthy thing, and sometimes is an efficient means of processing.  I once came across a fellow who had served in the army in a war-stricken land, and I asked him the usual questions to see if he had post-traumatic trauma: re-experience with physiological and psychological distress, hyper-vigilance, and numbing, to name a few.  He had what I would consider a healthy, normal pattern of behaviour, and a healthy, normal constellation of sadness, fear, and loathing of the negativity of the experience.  He told me about his buddies who had been diagnosed with PTSD, and his eyes welled with tears.  I asked him what his thoughts were about how he had avoided that, and his answer surprised me:  “I came back, I went on a two-week bender, and when I came out, I just put my head down and worked hard.”  Let’s be clear, I am not advocating this.  That moment has never left me, though.  Forgetting, as Théodule Ribot wrote in his Maladies Des Mémoires, is one of the boundaries of the self.   If you can’t remember, you’re hooped.  And in a surprising way, if you can’t forget, you can be hooped, too.

Omar Khayyam once said something like “I drink not for mere love of wine, nor to scoff at faith, but only to forget myself for a moment, for that alone do I drink.”

I didn’t quote this to the veteran.  Alcohol is a very bad medium- or long-term solution.  The line that kept coming to my mind, and what we did discuss, was the phrase about smelling the roses, the implication being that if you stop and smell the roses, you smell everything else as well.  Another phrase comes to mind, again I don’t recall who said it, and I am fighting the urge to be academic and look it up.  It lauds “the hard moral work of remembering.”  Yes.

OK, academic diversions aside.  Now.  How am I now?  The staccato sentences mirror my thought process.  I am tired, and have to sleep in the afternoon still… this is fading, but for a week, it was consuming.  My capacity for social interaction is growing, but too many people in a room is exhausting.  The memories of close friends in Chad, especially Issakha and the counsellors, are vividly fixed in my mind.  In psychiatric parlance, I have trouble code-switching.

I am home, wherever that is.  Eating well, sleeping in a safe land and a comfortable bed, and caring all around.  My friends and colleagues are in Chad, listening to heavy artillery, fearful that the fragile stability could break at any moment.   I miss them, and feel for their situation, and the powerlessness to change much of it.

Now.  What is it like now?  Like a faraday cage, where the sounds and smells all seep in, but I am walking around in a haze.  Sparks of stimulus on the periphery.  Like an overexposed picture, my quasi-detached consciousness in the centre.  The sound of cars is disturbing me more than makes sense.  I cannot switch from thoughts of Chad to thoughts of my life… “where are you?” a few of my friends have asked.  “Just catching up on sleep,” I return, and hope that the playfulness in the tone is enough to keep from more prying or concerned questions.   I don’t want to talk about it and have the topic changed.  Sometimes I walk away.  I’ve never done that before.  One of the few things that a psychiatrist never says (or should never say) is “too much information.”  But I find I need to walk away.  My buffer is thin.  My resources have been taxed.  I’ve been working again.  Jumped back into the hospital life, and it has been very busy.  The nurses tell me I look gaunt, and it’s true.  When I look in the mirror, I wonder how I had 15 pounds to lose, but it went somewhere.  I feel like I’m communicating with some barrier in between, like there is an isthmus between me and the mainland of the world I used to be in.  It is a weirdly detached feeling.  Sometimes it goes away, and I enjoy that.  Other times I wonder how long it was like this before, and I never knew.

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