Dear Curious Fox,
Big announcement ahead!
I am moving on to my next exciting adventure, which sadly means I will no longer be producing Curious Fox events. When Effy and I started building this community at our first event on April 7th, 2016 (I humbly admit I am a sappy nostalgic), we had no idea what an inspiring narrative would follow over the next two years.
On the outside, Curious Fox is a warm, welcoming place that encourages curiosity and connection, having grown from a monthly panel discussion into an event brand. Now Curious Fox hosts our traditional panels as well as sophisticated soirées and star-filled conferences.
But more impressive than that is what Curious Fox symbolizes: acceptance - both of other peoples' ideologies and identities and of your journey to discover your own. It's a space in which Foxes give themselves permission to consider things that are new or foreign to them. The only space of its kind that isn't targeting any demographic or lifestyle except "the curious."
Curious Fox is so much more than an event series – it's a movement.
Every time you attend a Curious Fox event, you are bravely subscribing to our mission to explore relationship design and sex-positive culture with a community rather than in isolation, lending even more power to our collective curiosity. Together we can challenge shame, stigma, and fear by normalizing options outside the status quo. Together we can empower each other to make conscious choices when designing our lives. You – yes, YOU! – are making a statement by supporting Curious Fox and for that I am grateful.
There are many things I will miss about Curious Fox. I will miss greeting you at the door each month and attempting to learn all of your names, unapologetically writing terrible wordplay in these emails, putting care and love into each Fox Notes summary of the panels, frantically running around before each event and having it be 200% worth it, sending literally (literally!) thousands of emails, and more. It's been more than a pleasure serving this magical community. It's been a gift.
To stay in touch I welcome you to add me on Facebook or email me. Don't be a stranger!
Thank you again for everything. Stay curious.
Sending Curious Fox love,
Sara
Big announcement ahead!
I am moving on to my next exciting adventure, which sadly means I will no longer be producing Curious Fox events. When Effy and I started building this community at our first event on April 7th, 2016 (I humbly admit I am a sappy nostalgic), we had no idea what an inspiring narrative would follow over the next two years.
On the outside, Curious Fox is a warm, welcoming place that encourages curiosity and connection, having grown from a monthly panel discussion into an event brand. Now Curious Fox hosts our traditional panels as well as sophisticated soirées and star-filled conferences.
But more impressive than that is what Curious Fox symbolizes: acceptance - both of other peoples' ideologies and identities and of your journey to discover your own. It's a space in which Foxes give themselves permission to consider things that are new or foreign to them. The only space of its kind that isn't targeting any demographic or lifestyle except "the curious."
Curious Fox is so much more than an event series – it's a movement.
Every time you attend a Curious Fox event, you are bravely subscribing to our mission to explore relationship design and sex-positive culture with a community rather than in isolation, lending even more power to our collective curiosity. Together we can challenge shame, stigma, and fear by normalizing options outside the status quo. Together we can empower each other to make conscious choices when designing our lives. You – yes, YOU! – are making a statement by supporting Curious Fox and for that I am grateful.
There are many things I will miss about Curious Fox. I will miss greeting you at the door each month and attempting to learn all of your names, unapologetically writing terrible wordplay in these emails, putting care and love into each Fox Notes summary of the panels, frantically running around before each event and having it be 200% worth it, sending literally (literally!) thousands of emails, and more. It's been more than a pleasure serving this magical community. It's been a gift.
To stay in touch I welcome you to add me on Facebook or email me. Don't be a stranger!
Thank you again for everything. Stay curious.
Sending Curious Fox love,
Sara
AIDS IS HERE TO STAY... AND THAT'S OKAY
On a sunny day in June 2014, Governor Cuomo announced his goal of ending AIDS by the year 2020. That day, four people were newly diagnosed with AIDS across New York City. Had the governor made that announcement a decade ago, the number would have been twelve. And twenty years ago – several dozen. So we seem to be making progress, but does that mean the end result – less than 750 new HIV cases annually across the state – can actually be delivered? Can the AIDS epidemic realistically come to an end within the next five years?
Let’s look at the numbers. Across the state of New York, there has been a decline in new HIV infections by over 40 percent in the last decade and the data indicates that this trend will continue. What has contributed to this decrease? As we enter the fourth decade of battling HIV in the United States, the strategies for prevention, detection, and treatment have advanced significantly since the days an HIV diagnosis was akin to a death sentence. We now have therapies like PrEP (Pre-Exposure Prophylaxis) that use HIV medications to prevent transmission to an uninfected person. HIV tests now work more quickly, accurately, and affordably. Primary prevention efforts are becoming more expansive and strengthened; today I saw another “PrEP + condoms” poster on the J train, complete with Spanish translations. With the cumulative advancements in antiretroviral therapy, living a normal life with HIV can be as simple as choosing a medication regimen.
So why is ending the epidemic in the next five years potentially unrealistic? The aforementioned improvements all come from the biomedical perspective. They ignore several key elements in public health: the social and structural barriers to prevention and treatment. Particularly at-risk populations include people of color, young adults, and men who have sex with men. In fact, the Center for Disease Control reported a doubling of HIV infections in young, gay or bisexual men of color in 2014.
Governor Cuomo lists in his blueprint several key goals that will end the AIDS epidemic, including boosts in healthcare retention, starting anti-HIV therapy early, and medication adherence. This need for improvement is consistently confirmed by the surveillance data. In 2012, only a bit over half of people who were linked to HIV care after receiving a diagnosis ultimately achieved a suppressed viral load. But what social circumstances are feeding into that trend? Certain groups will remain marginalized from the general population, creating a gap in access to and utilization of modern therapies and technologies. Governor Cuomo’s recommendations require two things as the lowest common denominator: consistency and resources. Two things marginalized groups – whether for their age, race, orientation, or lifestyle – cannot be guaranteed.
So we may or may not see the end of AIDS by 2020. Here’s the bottom line:
It doesn’t matter.
To clarify, the HIV problem cannot be eradicates since the problem itself is naturally and rapidly transforming. Now we aren't only focused on preventing new infections. The HIV population is aging. As the incidence has steadily decreased over time, the number of people living with HIV has still increased every year due to the growing availability of better therapies resulting in longer lifespans. Moreover, beyond the numbers we must be cautious about how our prevention efforts affect cultural elements surrounding the issue. Viewing HIV/AIDS as a beast to be defeated is propagating the stigma that affects survivors’ lives on a daily basis. Ending the AIDS epidemic does not wipe out the disease, but merely lowers the incidence to a controllable level. There will still be people with AIDS and significantly more with a suppressed viral load living their lives in New York City. Riding the subway. Attending our holiday parties. Hugging our children. Bearing their own children. It is counterproductive to further stigmatize a disease that is not disappearing anytime soon.
AIDS is here to stay, so let’s accept it. Embrace it, so that we can embrace those living with the disease. As the rate of new infections continue to decrease, let us not allow the survivors to also be pushed out of the public eye. We must keep the discourse about HIV/AIDS as alive as its evolving population.
Let’s look at the numbers. Across the state of New York, there has been a decline in new HIV infections by over 40 percent in the last decade and the data indicates that this trend will continue. What has contributed to this decrease? As we enter the fourth decade of battling HIV in the United States, the strategies for prevention, detection, and treatment have advanced significantly since the days an HIV diagnosis was akin to a death sentence. We now have therapies like PrEP (Pre-Exposure Prophylaxis) that use HIV medications to prevent transmission to an uninfected person. HIV tests now work more quickly, accurately, and affordably. Primary prevention efforts are becoming more expansive and strengthened; today I saw another “PrEP + condoms” poster on the J train, complete with Spanish translations. With the cumulative advancements in antiretroviral therapy, living a normal life with HIV can be as simple as choosing a medication regimen.
So why is ending the epidemic in the next five years potentially unrealistic? The aforementioned improvements all come from the biomedical perspective. They ignore several key elements in public health: the social and structural barriers to prevention and treatment. Particularly at-risk populations include people of color, young adults, and men who have sex with men. In fact, the Center for Disease Control reported a doubling of HIV infections in young, gay or bisexual men of color in 2014.
Governor Cuomo lists in his blueprint several key goals that will end the AIDS epidemic, including boosts in healthcare retention, starting anti-HIV therapy early, and medication adherence. This need for improvement is consistently confirmed by the surveillance data. In 2012, only a bit over half of people who were linked to HIV care after receiving a diagnosis ultimately achieved a suppressed viral load. But what social circumstances are feeding into that trend? Certain groups will remain marginalized from the general population, creating a gap in access to and utilization of modern therapies and technologies. Governor Cuomo’s recommendations require two things as the lowest common denominator: consistency and resources. Two things marginalized groups – whether for their age, race, orientation, or lifestyle – cannot be guaranteed.
So we may or may not see the end of AIDS by 2020. Here’s the bottom line:
It doesn’t matter.
To clarify, the HIV problem cannot be eradicates since the problem itself is naturally and rapidly transforming. Now we aren't only focused on preventing new infections. The HIV population is aging. As the incidence has steadily decreased over time, the number of people living with HIV has still increased every year due to the growing availability of better therapies resulting in longer lifespans. Moreover, beyond the numbers we must be cautious about how our prevention efforts affect cultural elements surrounding the issue. Viewing HIV/AIDS as a beast to be defeated is propagating the stigma that affects survivors’ lives on a daily basis. Ending the AIDS epidemic does not wipe out the disease, but merely lowers the incidence to a controllable level. There will still be people with AIDS and significantly more with a suppressed viral load living their lives in New York City. Riding the subway. Attending our holiday parties. Hugging our children. Bearing their own children. It is counterproductive to further stigmatize a disease that is not disappearing anytime soon.
AIDS is here to stay, so let’s accept it. Embrace it, so that we can embrace those living with the disease. As the rate of new infections continue to decrease, let us not allow the survivors to also be pushed out of the public eye. We must keep the discourse about HIV/AIDS as alive as its evolving population.
3 WAYS TO TOTALLY WIN AT ONLINE DATING
#1. Know your priorities.
Spoiler alert: the following tip is the key to enjoying any dating experience, not just online. We all have things that are extremely important to us – so important that they could make or break a connection with someone. Some people call these dealbreakers; here we will refer to them as priorities.
Note that these are not the same as preferences. Let’s say you like dogs but your date likes cats. Even if you feel very strongly about your preference, is there not a chance your date will learn to like dogs and you will learn to like cats? Maybe that’s not even relevant to the kind of connection you will end up cultivating.
By priorities, we are talking about the kind of beliefs, values, and lifestyle choices that are non-negotiable no matter what kind of interaction you have with someone. While actively dating, be in touch with your priorities and make sure they are addressed during the first date or two. Better to do it sooner rather than later: you don’t want to be a liberal who finds out on the fifth date that your partner wants to make America great again.
2. Embody consent culture.
To practice consent culture means to prioritize verbal consent and to make sure that everyone is on board with what’s happening. Not with a shrug or “okay, I guess” – more like “HELL YES!” Consent culture takes away that ambiguity so that everyone feels safer.
Besides the safety aspect, consent culture also helps promote sex positivity by challenging us to voice our desires and face rejection with confidence. Rejection is hard to both give and receive, but intellectually we know it’s not personal. It gets much easier with practice. Practice owning your enthusiastic yeses, knowing your nos, communicating when you change your mind, and embracing rejection!
Consent isn’t just relevant to physical touch. When someone isn’t interested in an activity, escalation, or even part of your relationship design, thank them for taking care of themselves so you don’t have to. This is a central part of consent culture that makes dating more fun, safe, and rewarding.
3. Have fun!
Dating should be fun. Dating should never not be fun.
It sounds simple, but many people experience “dating fatigue” without recognizing it and end up resenting the process. This happens often in online dating because of the constant opportunity to find new dates. Don’t let it happen to you!
Signs of dating fatigue:
You want to bail on your dates or ignore their messages.
Reading prospects’ profiles exhausts you.
You’d rather curl up in bed than have one more first date.
To prevent dating fatigue, think of ways that dates can enhance your life, not take away. Think of activities you love that you rarely have time for. Have you wanted to explore a certain park? Try a restaurant? Go to a friend’s improv show? Do that! Go on dates that make you think “Yeah!” Even if you end up not clicking. Get excited about it! And take breaks whenever you need.
Bonus tip: On a budget? Search for free events and fun public spaces near you. You might be surprised how many there are!
Spoiler alert: the following tip is the key to enjoying any dating experience, not just online. We all have things that are extremely important to us – so important that they could make or break a connection with someone. Some people call these dealbreakers; here we will refer to them as priorities.
Note that these are not the same as preferences. Let’s say you like dogs but your date likes cats. Even if you feel very strongly about your preference, is there not a chance your date will learn to like dogs and you will learn to like cats? Maybe that’s not even relevant to the kind of connection you will end up cultivating.
By priorities, we are talking about the kind of beliefs, values, and lifestyle choices that are non-negotiable no matter what kind of interaction you have with someone. While actively dating, be in touch with your priorities and make sure they are addressed during the first date or two. Better to do it sooner rather than later: you don’t want to be a liberal who finds out on the fifth date that your partner wants to make America great again.
2. Embody consent culture.
To practice consent culture means to prioritize verbal consent and to make sure that everyone is on board with what’s happening. Not with a shrug or “okay, I guess” – more like “HELL YES!” Consent culture takes away that ambiguity so that everyone feels safer.
Besides the safety aspect, consent culture also helps promote sex positivity by challenging us to voice our desires and face rejection with confidence. Rejection is hard to both give and receive, but intellectually we know it’s not personal. It gets much easier with practice. Practice owning your enthusiastic yeses, knowing your nos, communicating when you change your mind, and embracing rejection!
Consent isn’t just relevant to physical touch. When someone isn’t interested in an activity, escalation, or even part of your relationship design, thank them for taking care of themselves so you don’t have to. This is a central part of consent culture that makes dating more fun, safe, and rewarding.
3. Have fun!
Dating should be fun. Dating should never not be fun.
It sounds simple, but many people experience “dating fatigue” without recognizing it and end up resenting the process. This happens often in online dating because of the constant opportunity to find new dates. Don’t let it happen to you!
Signs of dating fatigue:
You want to bail on your dates or ignore their messages.
Reading prospects’ profiles exhausts you.
You’d rather curl up in bed than have one more first date.
To prevent dating fatigue, think of ways that dates can enhance your life, not take away. Think of activities you love that you rarely have time for. Have you wanted to explore a certain park? Try a restaurant? Go to a friend’s improv show? Do that! Go on dates that make you think “Yeah!” Even if you end up not clicking. Get excited about it! And take breaks whenever you need.
Bonus tip: On a budget? Search for free events and fun public spaces near you. You might be surprised how many there are!
SUMMARY OF PANEL DISCUSSION ON JEALOUSY
Before getting into concrete approaches to jealousy, it’s important to examine where it’s coming from. What’s interesting is that jealousy might be more intrinsic than we think: twin studies show that there is a genetic component. The same study shows that while emotional jealousy is equal between genders, sexual jealousy is more oriented toward men. In general, there are two types of jealousy to consider: dispositional, i.e. a part of your character, or incidental, i.e. influenced by circumstance. On our panel there was a wide range of representation. One panelist felt it was very ingrained and automatic, and another noted that competing with their siblings from a young age built triggers for jealousy. On the other hand, one panelist said having siblings taught them that “love multiplies, not divides,” but still experiences incidental jealousy. Which one resonates with you? Are there specific areas where jealousy comes to a boil, like work or family? Is it part of your disposition or a sliver of your emotional profile?
Another panelist explained that it was helpful to deconstruct jealousy, noting that it is a composite emotion. It’s a label we place on a combination of feelings, which could include anger, insecurity, fear of abandonment, feeling left out, and more. By asking yourself questions about the source, you can figure out what the underlying emotions are and identify your needs.
A helpful step is to determine whether your jealousy is rational or irrational. In the case of the latter, you can equip yourself to address it on your own or quickly communicate with your partner asking for reassurance. You can do this by asking yourself the following questions found in the Jealousy Handbook: 1. Do you fear losing a valuable resource you have access to (time, attention, affection, etc) to someone else? 2. Does the other person want that resource? 3. Are you in direct competition for that resource with the other person, and is there not enough to go around? 4. Will you ultimately be compared to the other person and come out the losing side? If the answers to these questions are no, then your jealousy is not coming from a place based in rationality.
Think about how the fire alarm goes off in your house – it’s loud and discombobulating to the point where you freeze, totally immobilized by the stimulus. Jealousy mirrors that same phenomenon in your head. Just like when you investigate the blaring alarm, you won’t be able to think straight until you turn it off because you’re not in your wise mind. Take that cooling off moment and silence the alarm, let yourself experience the jealousy, and describe what it feels like in your body. Using labels or a “body scan” to identify the feeling is very powerful because you take away the fear. After examining jealousy outside the panic of the siren, you might find that it was irrational jealousy, or a false alarm (like a malfunctioning toaster). Maybe you’ll find it was rational jealousy, and you are ready to address it from a cool headed place.
You might discover an array of potential solutions to get those needs met, whether it’s catering to their love language, modifying agreements, or introducing them to the person triggering the jealousy. If you partner is getting triggered constantly, ongoing communication will help identify the underlying cause.
The panelists agreed that one of the most invaluable ways to approach jealousy was to have support from their community, which helped them realize they aren’t the only ones who struggle. Everyone gets jealous! It’s nothing to fear. When in doubt, through your exploration of alternative relationships keep in mind the three C’s: community, connection, and communication. And of course, stay curious.
Another panelist explained that it was helpful to deconstruct jealousy, noting that it is a composite emotion. It’s a label we place on a combination of feelings, which could include anger, insecurity, fear of abandonment, feeling left out, and more. By asking yourself questions about the source, you can figure out what the underlying emotions are and identify your needs.
A helpful step is to determine whether your jealousy is rational or irrational. In the case of the latter, you can equip yourself to address it on your own or quickly communicate with your partner asking for reassurance. You can do this by asking yourself the following questions found in the Jealousy Handbook: 1. Do you fear losing a valuable resource you have access to (time, attention, affection, etc) to someone else? 2. Does the other person want that resource? 3. Are you in direct competition for that resource with the other person, and is there not enough to go around? 4. Will you ultimately be compared to the other person and come out the losing side? If the answers to these questions are no, then your jealousy is not coming from a place based in rationality.
Think about how the fire alarm goes off in your house – it’s loud and discombobulating to the point where you freeze, totally immobilized by the stimulus. Jealousy mirrors that same phenomenon in your head. Just like when you investigate the blaring alarm, you won’t be able to think straight until you turn it off because you’re not in your wise mind. Take that cooling off moment and silence the alarm, let yourself experience the jealousy, and describe what it feels like in your body. Using labels or a “body scan” to identify the feeling is very powerful because you take away the fear. After examining jealousy outside the panic of the siren, you might find that it was irrational jealousy, or a false alarm (like a malfunctioning toaster). Maybe you’ll find it was rational jealousy, and you are ready to address it from a cool headed place.
You might discover an array of potential solutions to get those needs met, whether it’s catering to their love language, modifying agreements, or introducing them to the person triggering the jealousy. If you partner is getting triggered constantly, ongoing communication will help identify the underlying cause.
The panelists agreed that one of the most invaluable ways to approach jealousy was to have support from their community, which helped them realize they aren’t the only ones who struggle. Everyone gets jealous! It’s nothing to fear. When in doubt, through your exploration of alternative relationships keep in mind the three C’s: community, connection, and communication. And of course, stay curious.
CONSENT CULTURE: AN INTRODUCTION
To practice consent culture means to prioritize verbal consent and be certain that everyone is on board with what’s happening. Not with a shrug or “okay, I guess” – but a strong, emphatic “HELL YES!” You won’t find explicit verbal consent being practiced in most places that facilitate new connections. Mainstream nightlife relies on suggestive eye contact and touches on a crowded dance floor to initiate an encounter. Consent culture, on the other hand, takes away that ambiguity so that everyone can feel safer.
Besides the safety aspect, consent culture also helps promote sex positivity by challenging us to voice our desires and to face rejection with confidence. Polite rejection is handled in an entirely different way in consent culture than by the rest of society and it makes all the difference. When someone turns down a proposition, you’ll often hear as a response, “Thank you for taking care of yourself.”
Let’s zoom in on rejection – what happens when you inevitably hear a “no”? When we think of our experiences with rejection, we can agree that it’s just as difficult to give a no as it is to receive one. When rejecting someone, it can feel like you are giving the kiss of death, and when being rejected, it can feel humiliating and painful. What about rejection is so hard? I propose two answers.
First, we are biologically programmed to fear rejection. Far back into human history, there was a time when rejection literally meant death. If we were rejected from our tribe, we couldn’t eat, take shelter, or fend for ourselves. When we experience rejection in modern times, those fears are no longer rational, but our lizard brain easily forgets that.
The second answer refers to our social conditioning. The first time we experienced rejection was when we worked up the courage to talk to our crush in 8th grade English class – an extremely turbulent and sensitive time in emotional development. That first memory of rejection is traumatizing not just because adolescent hormones heighten all emotional experiences, but also because there are no references in TV or movies on how to experience rejection in a healthy way. Some even go so far to portray rejection as a life-destroying experience. After that period, we don’t practice the muscle of rejecting and being rejected. Instead, we are left to re-experience the trauma of middle school over and over again. The rhetoric of the media trickles down into the depths of our culture to reinforce the fear and discomfort surrounding rejection.
Rejection is no longer the end of the world. We are communicative adults in the 21st century, no longer relying on our lizard brain or adolescent mind. When you get a no from someone, thank them for taking care of themselves. When you want to give a no, realize that you are not hurting the other person and trust them to take care of themselves. If we intellectually overcome our fear of rejection, we can fully adopt consent culture in which we are able to give and receive nos with confidence, kindness, and grace. We can be part of the growing movement that empowers people to navigate new connections and sexual exploration in a way that is healthy and benefits everyone.
Consent is about so much more than words and motions. It’s a culture we intentionally subscribe to that dictates how we behave and treat each other with the objective being that we are all on the same page. The rules get you on your way but the goal is to internalize consent as a mindset. Consent is a huge, complex, and nuanced topic and we must keep talking about it to fuel the public conversation.
DOWN WITH THE DSM: FLAWS OF THE DIAGNOSTIC TOOL
The diagnostic measurement of mental health is a highly controversial issue, and rightfully so. While the commonly used DSM is widely endorsed in mental illness diagnosis, its lack of sensitivity to the varying cultural and sociolinguistic nuances of different communities renders it a less effective tool than previously thought.
In the past few decades, the publicly accepted understanding of mental illness has drastically transformed from how the effects of external events, conflicts, and social dynamics influence mental health (biopsychosocial model) to how clinically relevant symptoms warrant a diagnosis (medical model). In an ideal world, mental illness would be diagnosed through lab tests and physical examinations that provide insight into a patient’s unique brain pathways, but we are limited by the slow progress of brain research. Thus, psychiatrists must rely on descriptive diagnosis until biologically relevant methods become available. Their solution? The DSM. However, its capability to label mental disorders does not necessarily imply accuracy. While its construction could be considered a necessary step toward embracing the medical model of modern psychiatry, in practical use the DSM fails to address fundamental challenges in detecting mental illness in diverse environments.
Sweetland et al. suggests the adaptation of an instrument be “culture free” during any cross-cultural study, which entails establishing equivalence between the standard tool and culture-specific criteria. In contrast, the more recent study conducted by Rasmussen et al. advocates that a diagnostic approach should aim to be “culturally informed” over culturally neutral. The former study does effectively acknowledge how cultural variation can affect mental illness detection, e.g. the subtle difference between the phrases “depression” and the South Africa translation “the spirit is down”; the consequences of low literacy; and even opinions about spirits and sorcery. However, this means of translating a culture to fit into a molded Western-oriented understanding is not as productive as the method employed in the latter study: creating an entirely new screening instrument tailored to that culture (i.e. The Zanmi Lasante Depression Symptom Inventory). This valid and reliable tool was developed and articulated independent of a pre-existing framework, and therefore effectively embraces how descriptive diagnoses must be accompanied by a highly nuanced sensitivity to cultural context.
At the heart of the issue, there is one dominating truth: while the prevalence of mental illness may be universal, the experience and diagnosis of it is not. Because of this, the DSM can never be a fully effective instrument as it was intended to be. Instead, individually crafted diagnostic tools should measure how single communities perceive, manifest, and treat mental illnesses using ethnographic methods that weave culture-specific values into the instrument’s core. Until clinicians can rely on methods that measure more universal aspects of mental illness (i.e. brain signaling pathways), it is imperative to accept the variability of cultural, sociological and linguistic phenomena across different populations and their inevitable effects on mental illness diagnosis.
In the past few decades, the publicly accepted understanding of mental illness has drastically transformed from how the effects of external events, conflicts, and social dynamics influence mental health (biopsychosocial model) to how clinically relevant symptoms warrant a diagnosis (medical model). In an ideal world, mental illness would be diagnosed through lab tests and physical examinations that provide insight into a patient’s unique brain pathways, but we are limited by the slow progress of brain research. Thus, psychiatrists must rely on descriptive diagnosis until biologically relevant methods become available. Their solution? The DSM. However, its capability to label mental disorders does not necessarily imply accuracy. While its construction could be considered a necessary step toward embracing the medical model of modern psychiatry, in practical use the DSM fails to address fundamental challenges in detecting mental illness in diverse environments.
Sweetland et al. suggests the adaptation of an instrument be “culture free” during any cross-cultural study, which entails establishing equivalence between the standard tool and culture-specific criteria. In contrast, the more recent study conducted by Rasmussen et al. advocates that a diagnostic approach should aim to be “culturally informed” over culturally neutral. The former study does effectively acknowledge how cultural variation can affect mental illness detection, e.g. the subtle difference between the phrases “depression” and the South Africa translation “the spirit is down”; the consequences of low literacy; and even opinions about spirits and sorcery. However, this means of translating a culture to fit into a molded Western-oriented understanding is not as productive as the method employed in the latter study: creating an entirely new screening instrument tailored to that culture (i.e. The Zanmi Lasante Depression Symptom Inventory). This valid and reliable tool was developed and articulated independent of a pre-existing framework, and therefore effectively embraces how descriptive diagnoses must be accompanied by a highly nuanced sensitivity to cultural context.
At the heart of the issue, there is one dominating truth: while the prevalence of mental illness may be universal, the experience and diagnosis of it is not. Because of this, the DSM can never be a fully effective instrument as it was intended to be. Instead, individually crafted diagnostic tools should measure how single communities perceive, manifest, and treat mental illnesses using ethnographic methods that weave culture-specific values into the instrument’s core. Until clinicians can rely on methods that measure more universal aspects of mental illness (i.e. brain signaling pathways), it is imperative to accept the variability of cultural, sociological and linguistic phenomena across different populations and their inevitable effects on mental illness diagnosis.
MEDICAL SCHOOL APPLICATION ESSAY
“May your road be rough.”
Dr. Ogedegbe explained on my first day at NYU that these words, penned by the late educator Tai Solarin, are published every New Year’s Day in newspapers across Nigeria. The phrase reads like a curse but is actually intended to empower the masses with the promise of risks and courage, success and failure, hope and fear. In the end – growth. Upon hearing Solarin’s words, I readily embraced them. It was my first day as a public health graduate student. While I faced an exciting road ahead, I carried with me the history of a journey begun years before that had led me to my path to medicine.
In the spring of my junior year at MIT, I was diagnosed with learning disabilities and ADHD. The diagnosis contextualized the troubles I had encountered in college despite my raw passion and curiosity. In hindsight, I didn’t require refined study habits to enthusiastically accept my father’s Sunday morning math challenges growing up. So I withdrew from MIT to make changes. The following year was equal parts sweat, tears, and unbreakable determination, leading to my (second) acceptance to MIT for my final semester. I spent those months encircled by piles of neuroscience journal articles on Friday nights. I surprised myself with the beauty of probability theory after proving the Monty Hall problem. I meticulously counted footsteps on a sidewalk while constructing an ethnographic description of my neighborhood. My journey imparted more than a renewed love of learning: as I forged my own unconventional path, I opened myself to the narratives of those around me. I began challenging myself to relate to others’ perspectives through their eyes and embrace how they were different from my own.
I discovered many things during my withdrawal period. In addition to probability theory, others’ perspectives, and my own determination, I discovered my desire to pursue medicine. My aspirations were solidified during my experience volunteering as a first responder on inner city ambulances in Tel Aviv. I participated in the silent, mechanical beehive that was each CPR call. I observed how my supervising medics relied not only on their extensive medical knowledge, but also on nuanced context and cues unique to each situation. The language barriers forced me to rely on body language and eye contact to comfort patients when they were most vulnerable. More than precipitating these humbling moments, each of those patients planted seeds that fed my growing desire to practice medicine through the lens of public health.
I stared at the medic in disbelief. He spoke in fast Hebrew, “Is there a problem?” I glanced at the blue stripe on his uniform and the red one on mine. “No,” I said. We were transporting a Sudanese refugee after an assault in a rough neighborhood; he only sustained mild injuries but I still felt that the medic’s call to put him on the bench rather than the bed was unwarranted. He later told me his reasoning – it would waste a set of sheets. This situation exposed the complexity of the barriers imposed on this patient’s medical treatment. I realized that life on the ambulance could not be isolated from the outside world; a person’s demographics, background, status, identity, and beliefs all have potential to impact health outcomes. Suddenly, my conceptualization of medicine extended beyond examining physical symptoms. It dawned on me that public health and medicine go hand in hand, and understanding the social determinants that influenced health would allow me to better serve my patients.
I witnessed this perspective being put into practice while studying abroad in Mexico. Tracking mud all over the cement floor, my classmates and I crowded in a modest hut in a rural mountain village near Cuetzalan, Puebla. We patiently watched as the traditional healer cracked an egg into holy water. He carefully analyzed the patterns in the egg whites’ movement as they floated to the bottom of the glass. Our guides translated from Nahuatl to Spanish to English the healer’s description of the cleansing process – or as my public health colleagues and I understood, clinical diagnosis. He further explained how he prioritized patients taking active roles in their health by establishing trust, eliciting hope, and embracing faith. In a one-of-a-kind medical model, the traditional healers combined forces with hospital doctors to optimize wellness for each individual in the surrounding villages. Like the Mexican healers, I want to bridge these worlds. Using my public health background to inform my medical degree will help close the gap between medicine and culture in order to create healthier communities.
Through my journey towards becoming a physician, I have identified my mission. My mission is to be the point of first contact with underserved populations through primary care. My mission is to empower my patients to take agency over their health, even after they leave the doctor’s office. My mission is to work with each patient as a partner. The path will not be easy, but I embrace the challenges that lie ahead because they will encourage problem solving, discourse, and learning. In the end – progress. Let the road be rough.
Dr. Ogedegbe explained on my first day at NYU that these words, penned by the late educator Tai Solarin, are published every New Year’s Day in newspapers across Nigeria. The phrase reads like a curse but is actually intended to empower the masses with the promise of risks and courage, success and failure, hope and fear. In the end – growth. Upon hearing Solarin’s words, I readily embraced them. It was my first day as a public health graduate student. While I faced an exciting road ahead, I carried with me the history of a journey begun years before that had led me to my path to medicine.
In the spring of my junior year at MIT, I was diagnosed with learning disabilities and ADHD. The diagnosis contextualized the troubles I had encountered in college despite my raw passion and curiosity. In hindsight, I didn’t require refined study habits to enthusiastically accept my father’s Sunday morning math challenges growing up. So I withdrew from MIT to make changes. The following year was equal parts sweat, tears, and unbreakable determination, leading to my (second) acceptance to MIT for my final semester. I spent those months encircled by piles of neuroscience journal articles on Friday nights. I surprised myself with the beauty of probability theory after proving the Monty Hall problem. I meticulously counted footsteps on a sidewalk while constructing an ethnographic description of my neighborhood. My journey imparted more than a renewed love of learning: as I forged my own unconventional path, I opened myself to the narratives of those around me. I began challenging myself to relate to others’ perspectives through their eyes and embrace how they were different from my own.
I discovered many things during my withdrawal period. In addition to probability theory, others’ perspectives, and my own determination, I discovered my desire to pursue medicine. My aspirations were solidified during my experience volunteering as a first responder on inner city ambulances in Tel Aviv. I participated in the silent, mechanical beehive that was each CPR call. I observed how my supervising medics relied not only on their extensive medical knowledge, but also on nuanced context and cues unique to each situation. The language barriers forced me to rely on body language and eye contact to comfort patients when they were most vulnerable. More than precipitating these humbling moments, each of those patients planted seeds that fed my growing desire to practice medicine through the lens of public health.
I stared at the medic in disbelief. He spoke in fast Hebrew, “Is there a problem?” I glanced at the blue stripe on his uniform and the red one on mine. “No,” I said. We were transporting a Sudanese refugee after an assault in a rough neighborhood; he only sustained mild injuries but I still felt that the medic’s call to put him on the bench rather than the bed was unwarranted. He later told me his reasoning – it would waste a set of sheets. This situation exposed the complexity of the barriers imposed on this patient’s medical treatment. I realized that life on the ambulance could not be isolated from the outside world; a person’s demographics, background, status, identity, and beliefs all have potential to impact health outcomes. Suddenly, my conceptualization of medicine extended beyond examining physical symptoms. It dawned on me that public health and medicine go hand in hand, and understanding the social determinants that influenced health would allow me to better serve my patients.
I witnessed this perspective being put into practice while studying abroad in Mexico. Tracking mud all over the cement floor, my classmates and I crowded in a modest hut in a rural mountain village near Cuetzalan, Puebla. We patiently watched as the traditional healer cracked an egg into holy water. He carefully analyzed the patterns in the egg whites’ movement as they floated to the bottom of the glass. Our guides translated from Nahuatl to Spanish to English the healer’s description of the cleansing process – or as my public health colleagues and I understood, clinical diagnosis. He further explained how he prioritized patients taking active roles in their health by establishing trust, eliciting hope, and embracing faith. In a one-of-a-kind medical model, the traditional healers combined forces with hospital doctors to optimize wellness for each individual in the surrounding villages. Like the Mexican healers, I want to bridge these worlds. Using my public health background to inform my medical degree will help close the gap between medicine and culture in order to create healthier communities.
Through my journey towards becoming a physician, I have identified my mission. My mission is to be the point of first contact with underserved populations through primary care. My mission is to empower my patients to take agency over their health, even after they leave the doctor’s office. My mission is to work with each patient as a partner. The path will not be easy, but I embrace the challenges that lie ahead because they will encourage problem solving, discourse, and learning. In the end – progress. Let the road be rough.