Humiliation(ism)

“Dehumanising the victim makes things simpler, its like breathing with a respirator, it eases the conscience of even the most conscious and calculating violators, words can reduce a person to an object – something more easy to hate, an inanimate entity, completely disposable, no problem to obliterate…” – M. Franti

On the surface, Brad was a confident, seemingly bulletproof junior doctor. Outside of medicine, he played guitar and basketball on weekends. A cheeky smile and a way with words enabled Brad to make most people warm to him on demand. Few people believed he would take his own life. Fewer still would admit that humiliation was the cause.

Bullying of junior doctors was recently highlighted on the ABC’s four corners program in May 2015. The episode entitled ‘At their Mercy’ identified a toxic culture of ‘belittling, bullying and bastardization’ within the teaching hospital system. It went on to report an alarming statistic of one in five medical students who had thoughts of suicide in the previous 12 months. There was reference to a cycle of abuse ‘where teaching by humiliation is routine.’

‘Are you listening to me Brad? Did you even understand the question? Aren’t you supposed to be a third year medical student? A first year student could give me a better answer.’ Silence. ‘Well? Are you just going to stand there? Don’t look at them. They won’t help you. And don’t anyone else answer for him, he needs to learn.’

The definition of humiliate is to make someone feel foolish. But this doesn’t convey the emotional impact of humiliation in the slightest. Not everyone will admit to feeling bullied but few people can deny experiencing the feeling of humiliation at some point in their lives. I’d argue it’s hard to forget.

‘So welcome to your first intern term, what’s your name again?’ Brad. ‘Look, I’m probably not going to remember your name but as the Registrar I have to do most of the work around here so when I tell you to do something, just make sure it gets done and we’ll get along fine.’ “I’m Brad, this is Con, we’re both supposed to be on your team I think?” Sigh. Pause. ‘Why do they have to give me two tweedle dumbs this term… you do realise how much more work it is to teach both of you?’ 

In September 2015, the Royal Australian College of Surgeons (RACS) commissioned an investigation into toxic abuse and bullying. The report by the Expert Advisory Group indicated 49% of the 3500 RACS fellows, trainees and International Medical Graduates (IMG’s) have been subject to discrimination, bullying and sexual harassment. Importantly, the RACS has issued and apology and vowed to take action.

‘When I ask you a question, you answer me. Do you understand? Unless you’re a fucking mute? Are you a mute Brad?’ No doctor… I mean Mister. ‘Do you really think you’re cut out for this sort of work Brad? Plenty of less stressful jobs, you could always be a bus driver… I just don’t think you’ve got what it takes for medicine but lets see if you can prove me wrong shall we?’

Humiliation can often be hidden under a thinly veiled layer of humour. Plainly derogatory yet often overlooked. This is the insidious nature of humiliation. It also allows an opening for others to participate. Not necessarily with words but merely mutterings of approval serve to fuel the fire of humiliation.

I’d offer that humiliation is a combination of dehumanization, denigration and intimidation. People accused of bullying are often shocked at the label based on an alleged misinterpretation of intent. But humiliation suffers less from misinterpretation and far more from its participants being silent and complicit. Myself included.

‘Now Brad is it? You’re a resident doctor and required to be on-call over the weekend. Remember that I’m available over the phone if you desperately need me for something… but don’t hesitate to cope will you?’ But I’ve never done this job before and I’m a bit worried about being on call all weekend to be honest. ‘You’re not going to cry on me now are you Brad? Lets just be clear - I’m not your psychiatrist’

In 1998 Monica Lewinsky became one of the first people to experience humiliation on a world wide scale at the hands of the internet. Not only did she receive notoriety for her affair with former president Bill Clinton, her phone conversations and private life became public viewing. In the seventeen years since this incident we are seemingly more adept at identifying and labelling bullying. Yet the same cannot be said for humiliation. Lewinsky managed to very clearly articulate the problems with humiliation and its role as the currency of bullying. Several times Lewinsky felt so humiliated that taking her life somehow appeared to be the only option.

In order to understand this narrative more clearly, I should confess I went to medical school with Brad. I was also an intern in the same year as Brad and I completed residency years with Brad. Not once could I be accused of bullying Brad. However I participated in humiliating him on numerous occasions. I laughed, I sniggered and ultimately I condoned his humiliation. One could argue Brad was such a stable, resilient individual and appeared to take it all in his stride. Others were far less emotionally well equipped. But assumptions are misleading and often grossly inaccurate.

If what happened to Brad sounds trivial, you are most likely a part of the medical fraternity. The ubiquitous use of humiliation is widespread across all levels of medicine affecting everyone. The significance of humiliation is context dependent and completely subjective. Yet a failure to quantify humiliation does not prevent its catastrophic ramifications. Whatever you do as a reader, please don’t pity Brad or myself, or any other victim of humiliation. But please change (or consider) your own reaction the next time you witness or unwillingly participate in the humiliation of another.

“if you want total security, go to prison. There you’re fed, clothed, given medical care and so on. The only thing lacking… is freedom.” - D. Eisenhower

Prison is a place for criminals. Not for people like you and I. Or is it? Despite working in various prisons (albeit intermittently) over the last seven years I’m no expert on the (ironically labelled) correctional system. What never ceases to amaze me is the seemingly endless supply of people who claim to understand both the system and those contained within it. So I thought I’d attempt to dispel some common myths. Belief systems provide only the perception of security. Both time, or strength of grip are unable to transform a flawed belief system and despite considerable effort - It remains just that.

Working as a GP in a prison is much like general practice in any setting. With a few differences. Higher rates of mental illness, substance use and low socioeconomic status make for some complex medical issues. Contrary to popular belief, inmates do not get better health care than the rest of the community. Nor is it some sort of holiday resort. Prison is a place where no one wants to find themselves but is in fact filled with people. Yes, people like you and me. Most of whom will return to the community - at some point. So their health needs remain complicated on both sides of the rather large barbed wire fence. They are not miraculously ‘cured’ once inside. 

The second part of the holiday resort myth is that people actually want to return to prison. A prison is not designed to be a place of torture. It is punishment via the removal of liberty. Denial of freedom is not a flippant predicament. So do we really believe that people readily volunteer to deny themselves freedom? Having access to medical care and food and clothing in prison comes at a cost most of us would not endure for a moment, let alone months to years. Just think how much we take for granted our ability to visit friends, provide support for family, choose what we eat, choose what we wear and choose when we want time away from others. Similarly, people re-enter the correctional system multiple times for many reasons but largely due to societal barriers. Not because people enjoy the removal of their liberty. 

Let’s imagine for a moment you found yourself on the inside. Locked up for a misdemeanour that resulted in a bad outcome in the presence of alcohol. For arguments sake - you remain convinced it was accidental but admit you have some issues with alcohol. You serve three months for a first offence and then apply for parole. During your ‘inpatient’ stay, you are likely to see the general practitioner once or perhaps twice if you put in repeated requests. You will not be able to access dental services in this time. In addition, you will not be able to access any alcohol or substance counselling, nor will you be able to enrol in a program for substance use rehabilitation or anger management. Unfortunately, this is only accessible by people who are in the system longer than 12 months. Damn. There goes your rehabilitation. But you’re a resilient person and you’ll be out in three months. 

Meanwhile life on the inside becomes a statistical probability matrix.  Prohibited substances (such as opiates, amphetamines etc) are seemingly readily available. But needle sharing is equally as common. You discover 50% of the population has hepatitis C (a blood borne virus). Too bad if you have an opiate addiction in Queensland - the smart state decided methadone is unnecessary. Yet methadone studies reveal a 40% reduction in recidivism rates. Methadone provides continued and controlled access to an opiate instead of trying to buy it on the street. As for NSW, they decided too many people are on the methadone program in prison so it will be capped at a certain number. NSW has employed the car park is ‘full’ model. This means you wait for someone to leave before you can gain access. All of this because there are apparently too few GP’s willing to prescribe methadone in the community. Opiate substitution programs take time and are costly to administer correctly in prison (and in the community). It would seem the costs of untreated opiate addiction and harm reduction measures are someone else’s problem.  Increased funding for prisons is clearly not a popular policy, nor is it a vote winner.  

Three months later you find yourself applying for parole. But your application is denied. A recent high profile case involving an ABC journalist and a perpetrator on parole resulted in this situation for you along with many others. Overcrowding is rampant throughout the system largely due to the revamped parole policy. So you serve the rest of your time inside and then find yourself back in the community, eyes blinking in the headlights. Your rediscovered ‘freedom’ comes with some catches. You have a permanent criminal record. Every time you attempt to gain employment you are faced with a criminal record check. Even renting a property becomes more challenging. Boarding houses with single rooms resemble the dimensions of a segregation cell in prison. But it’s a room and no one asks questions. With no job and reduced accommodation options your seemingly secure world is now far less predictable. Suddenly you belong to a marginalised community. People look at you differently. Their judgement is palpable. But don’t worry, you’re not alone. Indigenous Australians are approximately 2.5% of the entire population but somehow 26% of the prison system. Now you have a new reference point for marginalisation.

>>Read article by Paul Simpson and Michael Doyle from the Justice Health Research Program at the Kirby Institute, University of NSW, on possible solutions to reducing indigenous incarceration rates.

So what have you learnt from your relatively short stint inside the prison walls? Was prison a successful deterrent for any future misdemeanour? Do you feel rehabilitated? Are you now welcomed back into your community? Sadly the answer is a resounding ‘no’. Prison theory is just that. The so-called correctional system is failing to correct. Society too is failing in its role. Marginalisation of the vulnerable is everyone’s responsibility to address - not just those in government or the judicial system.  People do not choose prison as the better alternative. This is the myth we tell ourselves to justify the status quo. Freedom of thought is still yours to control (for the moment) - so hold onto it fiercely.  Popular thinking may feel like security. But sometimes, it only serves to loosen your grip.

Mandatorial

If someone comes to me, any community in the Northern Territory, with a viable economic future, and says, 'We want to be part of a bold new approach,' I'll put them down as a major project, and I'll do everything I can to help them out.
Adam Giles 




Dear Adam,

It is with much interest that I have been following your new mandatory alcohol treatment policy. It certainly has me thinking. Actually I'd like to discuss the possibility of expanding the legislation to encompass other problem areas.

At the top of my list is an intervention for drivers who are a danger to cyclists. More specifically - drivers who repeatedly put the lives of cyclists at risk on our roads. I can think of nothing better in the way of reform to have mandatory intervention for these individuals. 

Lets take a look at the proposal in more detail. As with your policy, I'm not suggesting we imprison all drivers - just those who have a problem. Its purely an intervention to assist them in understanding how to deal with their issues. In addition, an opportunity to look at some mental health issues that may be underlying behavioural patterns towards cyclists when driving a car. Despite some individual reluctance to participate in treatment, they will eventually understand how invaluable it may be. Forced is such an emotive word. I prefer enrolled. Choice after all, is very overrated.  

We must take a holistic approach. Without necessarily wanting to stereotype, certain individuals are more prone to acts of stupidity against cyclists when driving. Therefore I suggest we begin with Shane Warne. An immediate intervention is required in order to send a message to those who continue to behave in a manner that makes our streets unsafe for cyclists. Shane encompasses all the most reprehensible aspects of the intolerant driver. Not satisfied with the intimidation of a near miss (or nick), Shane is geared toward a full scale attack (actually knocking a cyclist off their bike entirely). Shame on you Shane. 

But it cannot stop with one individual. Treatment centres will be required in all states of Australia. Access to counselling, medical teams and mental health assessment in order to maximise the impact of such intervention. A tribunal will be set up to determine each individuals treatment needs. There will have to be security staff at all centres around the clock and police may be called upon to return an individual in the instance of attempted escape. This is not a prison however. It is merely a treatment opportunity for repeat offenders who know not what they do. 

As the treatment centres become more common they will in turn act as deterrents for other would be drivers targeting cyclists. The social implications are profound. This is brave policy initiative. Not for the faint hearted. Thats why I need your help Adam. Who better to approach than a person able to pass legislation completely devoid of any evidence? A policy that is economically costly and has no proven benefit. But who believes in research anyway?

I too am sick of listening to 'do-gooder' drivers opposed to good old-fashioned common sense. Its time for them 'to get out of the way' and embrace the future. Join me Adam. The cyclists of this country need your support. Do you want to be part of a bold new approach? Can you help out?

I look forward to further discussion with you in person.

Kind Regards,

Arron

Trust me...

“If you only trust the TV and the radio; these days you can’t see who’s in cahoots; ‘cos the KKKwears three-piece suits”- Rebirth, Public Enemy

Trust is an integral part of health care delivery. In fact, doctors are consistently rated amongst the most trusted professionals in public opinion polls. So consider the prospect of your local doctor being part of a group who wore sheets on their heads and preached racial intolerance? Unacceptable? Clearly. But what if a group with similar levels of intolerance called themselves ‘doctors for the family’ and chose to hide in plain sight?

The Klu Klux Klan (KKK) almost seems to belong to a different era. It was in 1991 that hip-hop group ‘Public Enemy’ referred to KKK philosophy infiltrating mainstream elite society in America.₍₁₎ Sadly, this prophecy was already a reality in various communities around the world.

In the early 1990’s in Australia, the KKK lacked a public presence but racial prejudice still had a very public profile. In 1995, an AFL player reported being called a ‘nigger’ in the national competition (the sports highest level).₍₂₎ And in 1996, Collingwood player Damien Monkhorst publicly apologized to Essendon player Michael Long for calling him a ‘black bastard.’

In September 1996₍₃₎, racial intolerance gained a very public endorsement from none other than a politician addressing the parliament. It was an insidious, damaging and reprehensible speech that gained notoriety through the normalization of bigotry. No longer easily identifiable by choice of costume, intolerance had become widespread.

Fast forward to 2012. Racial prejudice still occurs but is frowned upon in social and sporting circles alike. Intolerance prospers however, in many different forms. 

A group of medical doctors (called ‘doctors for the family’) decided to publicize their intolerance of homosexuality in a recent submission to parliament. Unacceptable? Clearly. Yet the group of doctors who signed the petition to parliament have not been subject to investigation by an ethical standards committee. Unsurprisingly, no sporting star was vilified in the ‘doctors for the family’ submission to parliament on the basis of their sexual preference.

One of the roles of the medical board of Australia is to uphold the ethical standards of the profession. When a medical doctor strays beyond the boundary of a guideline and beyond the boundary of acceptable behavior its labeled professional misconduct. As follows:

Placing the public at risk of harm because of practice in a way that constitutes a significant departure from accepted professional standards (s.140(d))

Surely, there is no greater example of professional misconduct than using your status to perpetuate and incite intolerance – placing marginalized individuals at risk of harm.

It is time for the medical fraternity to take a stand. In order to maintain the level of trust afforded by society, our ethical standards cannot be compromised. It is the responsibility of the medical governing body to take action against the doctors involved with this submission and restrict their registration. When such intolerance becomes normalized and acceptable it can take generations to amend. I want to believe I can trust my doctor, don’t you?

(1)    Apocalypse 91 – the enemy strikes black. Public Enemy. Lyrics: Chuck D

(2)    Derek Kickett (May 1995) playing for Sydney Swans against Collingwood

(3)    Pauline Hanson, maiden speech to House of Representatives 

What would you do with $30million?

Dear Mr Tattersalls,

I wrote to Santa Claus but he must have forgot what I want. My Dad says I can have anything I want if he wins tattslotto. The TV says we can get 30 million dollars. But only if we win.  If I had that much, I really could get anything I want, and the thing I want most is my Dad home from prison. 

You see Mr Tattersalls, Dad talks about you all the time, even though he never met you. When Mum and Dad fight he sometimes screams ‘George - tatts me out of here.’ And then Mum laughs. Other times Dad talks about all the things he would get for our family when we win the first dvision. Dad says its different to division in school cos Ms Anderson is teaching us that next year in grade three.

My Dad is not a bad man. Its true that there are bad people in prison cos my friend watched a show on pay TV about prison in America but my Dad never did any of that stuff. My Dad has the diabetes. It’s a condition my Mum says. But Dad calls it a disease and he says ‘condition’ is just a nicer way of saying disease that you have for a long time. Dad had it since he was my age and my older sister has it too. I used to want to have it. But now I don’t.

One day Dad went to work and never came home. Mum said he went for a holiday. But after a few weeks I stopped believing her. She thinks I still believe in the easter bunny too but everyone knows that’s not true, Dad puts out the eggs. He didn’t this year.  Then some kids at school started saying stuff about my Dad. I got mad and Mum had to come to the principals office. They sent me to speak to a counselor.

The counselor smelled like vanilla. She spoke too soft and some words I couldn’t hear. I told her that I knew my Dad wasn’t on holidays. So Mum came to the counselor with me the next time and they told me Dad was in prison cos of the diabetes. ‘But he is not bad’ I said to the counselor ‘so why is he in prison?’ She said that Dad drove his car to work and hit it into another car cos the diabetes made him pass out.  The man in the other car died, but Dad still lived.

I cried lots that night. I hoped that the man that died didn’t have kids. They would be sadder than me even. Mum said it wasn’t Dad’s fault. I believed her again now. She said his sugar went too low and that made him pass out. Like the time at aunt Glenda’s birthday party before I was born and they had to call an ambulance. I remember that story. When Dad tells it he says the ambulance woman gave him mouth-to-mouth and Mum got mad.

So you see Mr Tattersalls, it’s not really Dad’s fault. It’s just the diabetes that made him pass out. Plus, he said he was sorry the other man died. My Dad was a good driver and he never had any crashes. My uncle Jim did though. He was always getting new cars.  And he went on holiday lots too. So I asked Mum if uncle Jim had the diabetes. But she said he drank to much beer and that’s why he had lots of car accidents and holidays (but I think she meant prison and didn’t want to say it). She says uncle Jim can stop drinking beer if he wants but dad can’t stop having his diabetes. It’s not fair she says.

At Christmas lunch, its Dads job to do the cooking. Uncle Jim drinks beer and aunt Glenda brings cake. Dad says her cakes are too dry but she always puts a lucky coin in them. This year we got take away food and aunt Glenda didn’t bake her cake. Everyone missed Dad. Even uncle Jim cos Dad couldn’t drive him home. Mum cried when she gave us our presents. She said we spent all the money on trying to get Dad out of prison and she wanted to get us more. Mum said they might let Dad out early if we won tattslotto. So that's why we need your help Mr Tattersalls. Mum says our luck has to change. Last year Dad got the lucky coin.  


From,

Me (and Mum too)

Lines in the sand

A people that values its privileges above its principles, soon loses both – Dwight Eisenhower

‘Junkie’ is a word I detest. It's also a highly emotive word and has several different interpretations. Interestingly, it's used across the entire socio-economic spectrum and is almost universally considered derogatory. To a large number of people however, for whatever reason, it represents a line in the sand. Cross it and you're one of them. But is it really that black and white?  Who draws the line? And who controls the location of the line? Embarrassingly, I used to think it was pretty simple.

In 2005, a four year old boy from Mildura (VIC) died of a prescription drug overdose. Yes, four. The culprit – prescription opiates. His parents were both opiate dependent and the pill that ended his life was located in the family home.

Say opiates and most people think Heroin. But a much larger and more common problem is the prescription form of this medication - obtained from your local GP. With a street value of approximately one dollar per milligram, prescription opiates are popular items. Prescription opiates are also one of the best examples of the expansive grey area encompassing the line in the sand referred to earlier. 

On one side of the divide is ‘Steve’ a family man with a steady job and two children with chronic back pain requiring a prescription for ‘pain’ pills every two weeks from the local GP. 

The local doctor becomes uncomfortable about Steve’s opiate medication requirements and questions his increased use. Steve jokes heartily that he obviously isn’t addicted to them and clearly doesn’t look like a junkie. After all, he can control it, he holds down a job, tends to the needs of his family and plays guitar every weekend for the church band. The doctor nods, smiles and hands Steve a script.

A whole world away, on the other side of this line is ‘Eve’ - a woman who is unemployed, with no fixed address and presents to the local Emergency Department with vomiting and stomach pain. She soon discovers that she is pregnant.

There is both joy and shame as she informs staff of her injecting prescription opiate addiction. ‘Eve’ is keen to be a mother and is advised to commence methadone to ensure the safety of her baby.  ‘Just go and see your local GP’ the friendly staff member informs her.

The next day Eve enters the first GP surgery she can find and ironically ends up seeing the same GP as Steve.  Eve is very anxious and doesn’t want to sit down. She is acutely aware of the stares she received from the reception staff and shuts her eyes momentarily. Pleading with herself to ignore the perceived judgment, Eve makes a promise to no longer inject opiates.

‘I’m terribly sorry’ says the tired and sympathetic GP, ‘but I don’t prescribe methadone.’ Too ashamed and in a rush to end her discomfort, Eve neglects to inform the GP about her pregnancy. Instead she attempts to relay the gravity of her decision to stop injecting prescription opiates.

Remembering advice from hospital staff, Eve (choking back tears) asks about a tablet form of methadone. ‘Again Eve, I’m very sorry but according to medicare guidelines I’m only allowed to prescribe that medication for chronic pain and not for someone with opiate dependence such as yourself… tablet methadone is used for things like long term back pain for instance.’

Not exactly even stevens  - if you'll kindly excuse the pun. Prescribing opiates it seems, is not so simple, and has been described by some as a 'catch-22' situation. But putting prescription opiates in the too-hard basket is not the answer.

For too long our health system has danced around the multitude of issues associated with prescription opiates and definitions of dependence. At a recent inquest into the death of the four year old boy who overdosed on prescription opiates, coroner Jennifer Tregent called for mandatory GP education to ‘identify drug dependency and strategies to deal with it.’  

As a GP I welcome the mandatory education and training. It is long overdue. Maybe its time for all GP surgeries to reconsider the meaning of the sign in the waiting room that reads ‘we do not provide scripts for addictive medications.’ This clearly doesn’t help solve the problem. GP’s represent a privileged few that are able to have a major impact on prescription opiates... or we can keep pretending its impossible to shift a line in the sand. So next time you say the word 'junkie' - ask yourself what it means to you.

Choose your own adventure... Age 14

‘Take the blue pill the story ends and you wake up in your bed and you believe whatever you choose to believe… take the red pill and you stay in wonderland and I show you how deep the rabbit hole goes’ – The Matrix

I have always loved ‘choose your own adventure’ books.  It’s a simple yet delightful concept of multiple possible endings to a story where the reader is often the hero or central character in the book. Apart from confessing that I still occasionally indulge – the books were a large part of my world at age 14. The concept of being able to choose a different outcome fascinated me and formed part of my decision-making matrix. Despite this (or in part due to this) my ability to make decisions at 14 years of age was quite flawed.

A recent incident highlighted by the media (7/10/2011) involved a 14 year old boy who also made a rather poor decision. For whatever reason, he decided to purchase an amount of an illegal substance in Indonesia (where the substance is considered a narcotic).

There has been much attention given to this story as it involves multiple layers of topical issues. A 14 year old boy on drug charges. An Australian citizen overseas caught in possession of an illegal substance, held in detention.  Not to mention the political jostling it affords our ex-prime minister who is himself suffering from a touch of  ‘relevance deprivation syndrome’ (his recently quoted and quite apt descriptor of a media commentator).

Yet the most alarming point from my perspective is one that may not make the debate at all - what decision making capacity will this 14 year old individual have in four years time? Or ten years time? Whether or not the 14 year old individual in question is punished in Indonesia or Australia is irrelevant. More importantly – how does he develop his decision- making skills and avoid becoming part of our increasing prison population statistics?

Perhaps we can apply a ‘choose your own adventure’ analysis. Lets take the ‘red pill’ and turn to page 96 to see how our 14 year old hero fares in a hypothetical situation. After returning to Australia he is placed in juvenile detention. He serves his time and is released under the guidance of a mentor and case worker. Fast forward four years and our hero is faced with another choice of participating in a risk-reward scenario where the reward is now financial gain. He takes the risk. This time he can no longer be sent to juvenile detention. Accused of armed robbery he is placed on remand in a medium to maximum security male prison. 

Our hero (now 18 years of age) has not been convicted or sentenced. He finds himself in an environment where up to 50% of the population is Hepatitis C positive. Where substance use within the prison population is rife. Where he is subjected to threats, intimidation and physical harm multiple times per day.  Decisions inside the four walls of the prison are seemingly made for him – but are they? He is sentenced and released after time served and is now in possession of a permanent criminal record. This new classification (ex-prisoner) comes with all sorts of bonus prizes including – difficulty gaining employment or housing and a one in 10 chance of death within the first twelve months of release.  Not the happiest of endings for the red pill.

Take the blue pill, turn to page 84 and our hero is released from detention in Indonesia. He wakes up in Australia and is greeted with a horde of people outside his central coast residence taking pictures of his every move. He is verbally reprimanded for his crime and returns to school after an eventful holiday. Fast forward four years and he is faced with another choice of participating in a risk-reward scenario where the reward is financial gain. He takes the risk.  A big night of success at the casino (celebrating a friends birthday) – has resulted in our hero amassing a large sum of money. He gambles everything he has on the number 14 and loses it all.  So much for the lucky blue pill.

Clearly – not all choices have equal ramifications and not all circumstances are the same. The examples given were meant to be extreme and also to highlight that decision making is not a genetically pre-determined ability. It is a learnt skill and continually evolving. Human beings are all afforded the opportunity to obtain new knowledge and add to our decision making capabilities independently of age. Fortunately, my decision making skills since age 14 have managed to improve over time as a result of being taught by a number of different people, but also by being in an environment that was safe enough to allow for mistakes.

So who is responsible for ensuring that 14 year olds making poor decisions don't end up in jail at 18? If you think it’s the role of parents turn to page 54… if you think it should be part of formal education at a school level turn to page 76… If you think its up to the individual turn to page 87 …