As a therapist these days, faced with all the grim realities of our times, it's hard to escape the admonitions about becoming more involved in community activism, social advocacy, or social justice work of some kind. It all sounds noble, praiseworthy, and important, but most of us are too busy trying to take care of our clients and keep our own heads above water to venture out to serve some larger cause. It's one thing to volunteer a few hours per week or take on some low-paying clients, but who has time to change the world when we already have our hands full trying to make a living and get through the obstacle course of a normal work week?
Nevertheless, much of the work I now do takes me thousands of miles away from my practice and my family for months at a time. I don't feel that I chose to embark on a different kind of professional pathway, nor do I have a clear idea of where I'm going next in my life. We regularly talk with our clients about the importance of making choices in life, but in my own experience, it often seems that some paths choose us.
I now spend several months each year working in remote regions of Nepal, helping lower-caste girls, who are at the greatest risk of being forced into early marriage or trafficked into sex slavery, by making it possible for them to attend school and become the first girls in their villages to go on to receive a higher education. After 12 years of effort, we have hundreds of girls in our program from a dozen different villages scattered around the country. But I never planned or even dreamed of such a mission: it was something that fell into my lap.
Imagine, if you will, that you're in a remote village somewhere in the world--as I was more than a decade ago--conducting research on maternal mortality with a graduate student. While going about your business, you learn that young girls are somehow "disappearing" from school without causing anyone to express any particular curiosity about their whereabouts. So you question the school principal about what's going on. He shrugs and tells you that some families are so poor that they have no choice but to keep their girls out of school and working at home, where the lucky ones are forced to marry by age 12. The not-so-lucky ones end up sold, kidnapped, or tricked into sex slavery and smuggled across the border into India, where they can end up being raped 15 to 20 times per day, and die of AIDS within a few years. This may be one of the most horrific tales you've ever heard, but so far, it's just a story among all the cruel, heartless injustices occurring every day around the world. But what if this principal standing next to you casually points to a young girl talking to her friends and tells you that she'll be "disappeared" next? What would you do then?
What if you asked the principal how much it would take to keep this little girl in school and away from harm, and he told you that it would cost all of $50? What if you impulsively reached into your pocket and gave the principal the money to save this girl's life, and then learned that unless you were prepared to revisit this village and check on this girl, she and the money would likely disappear? What would you do then?
I must confess that it wasn't courage or altruism that led me down this path. Since I don't believe in luck or fate, I think that my present course is the logical consequence of a life spent acting impulsively and trying to do the most good that I can in the limited time I'm allotted. That's why, so many years later, I find myself somewhere in the Himalayan foothills, three planes, a bus ride, and long walk--mostly up a steep mountainside--to this ridge, where I'm resting with a group of volunteers and 55 of the scholarship children we support.
The Girl with the Turquoise Scarf
I'm sitting on a rock, trying to catch my breath in the thin, cool, mountain air. For the past half-hour, we've been snaking our way up a narrow trail leading to a stupa, a Buddhist shrine, perched high over a Himalayan village. I turn and look downward, noticing with relief that I'm not the only one who stopped to rest: dozens of girls are strung out behind and ahead of me, the youngest 10 years old and the eldest in her late teens. They've all been transported here from their villages across Nepal, each supported by a scholarship to keep her in school.
I wonder what I'm really doing here. My first thought is that I'm hiding from my responsibilities back home, or maybe hiding from myself. But no, that's not exactly it. I've been ready for a change in my professional life for some time. Throughout my career, I've periodically felt stale doing therapy, tired of hearing my same old anecdotes and stories, and I've managed to revitalize myself by reinventing how I work. After altering the way I do therapy more times than I can count, I realized that even that wasn't working anymore. I've felt trapped by my routines, stuck in the template that's become my life. Lately I've felt more and more like a hypocrite as I've urged my clients and students to take new risks to nourish and stimulate their lives. It's getting harder to live with myself when I realize that whatever time I have left is passing by at a fairly fast clip.
There's one other thought that bothers me as I sit idly on this rock catching my breath: as important as my work is back home seeing clients, teaching therapists, writing about therapy, more and more, it feels like I'm replaceable--that there are so many others who could do what I do. But I look at these children surrounding me on this mountain, all waiting for directions about where we're going next, and I wonder where they'd be without our help.
As I've done every year during the past decade, I've brought a team of therapists, graduate students, and other professionals with me to work with the girls we're supporting to have a better life. We've spent the prior week conducting home visits, consulting with parents and teachers, awarding new scholarships, and providing supplies and resources for the children. We've been mentoring and helping them support one another in the face of the challenges of extreme poverty, catastrophic illness in their families, and often a parent who's abandoned them. This is the first time that many have left their villages; some have traveled for three days to join us. The girls from the jungle region in the south have been mostly terrified by the strange environment of the mountains. They're climbing the steep incline in flip-flops or plastic shoes. Despite our efforts to help girls from the various groups interact with one another, they're mostly staying close to friends.
As I breathe deeply and gather my energy for the climb to the summit, I review the morning's activities. We'd arranged the girls in small groups, each from a different village. They'd been asked to share something in their lives about which they were proud, as well as some difficult struggle they were facing. Since most of the girls are from the "untouchable" caste, it isn't surprising that many shared economic hardships, such as living in small huts and sleeping on the floor. But I was shocked by how many of the girls have lost parents--some to disease, others to abandonment. A few have fathers who are alcoholics or incapacitated. One girl's father was eaten by a tiger! As they were telling their stories, they were trying to hold back tears. I was amazed by their courage and resilience.
Supposedly, we're here to help these children, but they've done so much for me. Many of them, and their families, have nothing and expect nothing, yet they appear to accept their fate with cheerfulness and joy; maybe the next life will be better. As for me, it's when I'm here that I feel most alive, and at least for the few months after I return, I feel a new clarity and focus about what's most important to me, none of which includes ambition and materialism. If only the effects would last!
I'm at a fork in the road, quite literally, as the trail we're following splits in two directions, just as my life seems to be. Reaching my sixth decade, I wonder how to refashion my life in the ways I've often advocated that others do. With the perception of limited time that comes with aging, I'm asking myself more and more frequently what I want to do with the opportunities I have left.
My reverie is interrupted when a hand touches my shoulder. The girls are reminding me it's time to move on. As we continue up the trail, I notice one girl who's still sitting on a rock, shivering. She's quite striking, though taciturn; in the time I've known her, we've barely spoken. I recognize her as one of the girls from a jungle village. I ask her name. "Timro nam ke ho?" She smiles shyly and looks away.
While most of the other children file ahead of us, I sit next to her and offer her my jacket to cover her shoulders. She just shakes her head in that ambiguous half-yes, half-no Nepali gesture. She's obviously embarrassed by the attention. I notice some of the other girls further along the path watching us carefully. I wonder whether what I'm doing is culturally appropriate. It's a thought that frequently crosses my mind in situations when I'm trying to be helpful in a strange land.
"Please," I insist to the girl, "you must wear this jacket." I cover her and she meets my eyes for the first time. It's then that I notice how carefully, almost compulsively, she keeps rearranging her turquoise scarf to cover the right side of her face, almost as if she's hiding something.
I'm used to reticence, of course, not just in Nepal, where I've worked for so many years and still don't know what's going on most of the time, but in therapy, where I'm accustomed to clients who withhold information until we've developed sufficient trust. I sense that something is terribly wrong here, but I don't yet know what it might be. At times like this, I find myself wishing I were back in the comfort of my office where I know the rules, understand the language, and feel more in control. But then one reason I'm here in the first place is because I thrive on novel experiences that challenge me in new ways, and enjoy surrendering control at times.
Once we've both gathered our strength, we continue walking up to the top of the hill and I lose track of the girl for a while. The other girls are all running around, screaming and yelling, fascinated by all the pine needles hanging from the trees. The Himalayan peaks are stretched majestically across the horizon, but it's the tree branches that command the most attention. The other girls pull the branches down and place the ends on their heads as makeshift hats.
On the way back down the trail, I notice the girl wearing my jacket is continuing to hold her turquoise scarf across her face. Finally, my curiosity gets the better of me and I ask if she'd mind removing the scarf so I can see her face. I sense immediately that she's mortified by my request as the other girls start to gather round us. I feel as though I have no choice but to proceed. "Please," I insist, "could I see your face?"
Slowly, reluctantly, the girl allows the scarf to unravel. I'm horrified to see that her cheek is completely swollen and pus-filled, and has all kinds of nasty colors. My first reaction is that someone struck her, but she explains that it's a skin infection that's been getting worse. I realize that, without some sort of intervention, this girl may not only become permanently disfigured, but could even die.
I call over her teacher and the other adult chaperones. "Look at her face," I say. "We have to do something!" They look concerned, but then just shrug. What can be done? In a country where 90 percent of the population has no access to regular healthcare, most injuries and diseases have to run their course or heal on their own.
I insist that the girl must receive medical care; that she be taken to a doctor, a dermatologist, who can lance the wound and provide antibiotics to kill the infection. I'm told that this is much too expensive, especially consulting with a specialist. There are also transportation costs and the money needed for the drugs. Another shrug.
"What would all of that cost?" I ask. "I'll pay for it. We must get her some help."
I'm told this would cost as much as 1,000 rupees, which sounds like a lot until I do the calculations and figure that it's about $13. For less than the price of a single meal back home, I can save this girl's face, if not her life! I make arrangements right then and there for her to get medical attention as soon as possible.
"You're a god," the girl whispers to me with awe.
I don't know what to say to that other than to shake my head.
"You're my god," she repeats to me. I can tell that this is no idle compliment.
I hurry away. I don't want her to see me crying.
Once alone, I just completely lose control, sobbing in a hoarse voice I barely recognize. I'm scaring myself with the raw power of my emotions. I've done a lot of good things in my life. I've helped a lot of people in my professional life. I look for opportunities every chance I get to help little old ladies cross the street, lost tourists find their destinations, or anyone else I meet locate what they're seeking. But of everything I've ever done, nothing seems to come close to what I can do for this young girl because I noticed that she kept covering her face.
After leaving the village of the girl in the turquoise scarf, a small group of us journey overland and then by small plane, followed by a three-day walk, to another village in the Everest region. We spend the day traversing the side of a cliff to visit a monastery perched high on a peak, and then go farther to a school and small settlement sitting precariously on the mountainside. Earlier in the year, two of our scholarship girls were killed in an avalanche near this spot, their huts and families swept down into the river below.
We're conducting home visits, showing each of our girls that we support their education by having tea with their families. We talk to the parents about how important it is that they allow their girls to attend school, and that we'll support them to become whatever they wish to be. We visit one home in which a mother tells us that she can only afford to send one of her twin children to school. The two kids, both 6 years old, shyly peak around her legs. The mother asks me if her daughter might be able to attend school along with her brother. When we agree to support her, the mother and both children start crying for joy. I lose it again and struggle to keep myself together.
After experiences like these, how do I go back to my work routine back home, seeing client after client in 50-minute time slots in my carefully organized work day and teaching restless, distracted students in large lecture classrooms? Even though I've spent half the previous year traveling around the world working on service projects in a half-dozen countries, I've spent much of my life telling myself I could never afford to do something like this. When I was a much younger man, I met a woman who told me she was taking a year off to travel around the world. When I remarked how lucky she was to do that she became furious. "Are you freaking kidding me?" she said. "Do you know what I used to do for a living? I was a secretary barely making minimum wage. But I quit my job, sold all my stuff, and invested all my savings in this adventure. Anyone can do this if they're willing to pay the price."
That conversation has haunted me ever since. Although I've never had much interest in travel for its own sake, I've always fantasized about what it would be like to "buy out" some of my time so I could work in regions of the world where they need help the most. Many of us got into therapy in the first place because we wanted to change the world. My initial plan was to work with those who are most neglected, whom nobody else would help. Yet my interest in earning a comfortable living and enjoying the luxuries of life led me to work in a university, seeing comfortably middle-class clients. Granted that most of my students are from disadvantaged groups, and many of my clients are pro bono, I still feel as if I could easily be replaced. If I wasn't doing this work, someone else could step into my role with little difficulty.
It's been just a few months since I returned from Nepal. I've lost so much weight that none of my clothes fit and I've been walking around in a daze for a while. I'm haunted by what I've witnessed, and sometimes burst into tears for reasons I don't understand. I think about the girl in the turquoise scarf and wonder how she's doing. I think about all the other girls we support, and feel so helpless that we can't help more of them. But there's nothing I've ever done that feels more satisfying--and more challenging.
The most important part for me is that I know I'm making a difference. Each year, I see these girls grow into poised young women who have dreams and opportunities for education and professional careers. They want to be teachers and doctors and engineers. They're the first girls in their villages to receive a higher education. As a therapist, I may not always know and appreciate the impact of my work with clients, but when working in the field, it seems as though we're indeed changing a small part of the world.
I wonder why it's necessary to travel halfway around the world to make such a difference. Why can't I remain content with helping my students and clients back home, where there's also much need? My heart pounds when I admit to myself that it doesn't make me feel special enough; any decent therapist can do that. I want to reach out to those whom nobody would ever think of helping. I want to be in a position where I know that if we don't do this work, nobody else will. I could easily work within my own community, where many important things remain to be done, but I hunger for the exotic, even as I complain about the petty hardships of life in this unfamiliar world. I feel better about myself when I encounter people who have so much less than even the poorest people I encounter in my life back home.
When I honestly examine my personal motives for doing work in such a remote region, I must admit I enjoy feeling like a martyr, escaping from the mundane aspects of my life, hiding from issues I'd rather avoid, having an excuse to travel, and having access to an exotic world that few outsiders have ever witnessed. But most of all, at the core of what I'm seeking, is the intimacy and caring I experience with my team members, the parenting role with the hundreds of children, the close relationships that develop over time. It's almost fun to commiserate with our team members about the difficulties we face, bitch and moan about the annoyances we encounter (squat toilets, limited food choices, armed Maoist rebels, traffic jams, fuel and electricity shortages, garbage strikes, unfamiliar cultural rituals). I love what I learn about the world--and what I learn about myself.
So I keep trying to reinvent myself, not so much to have some measurable impact in the world, but to satisfy some deep need within. I crave creative expression and opportunities to do things differently in situations I've never encountered before. I see some of my clients making all sorts of exciting changes in their lives, and I want some of that too! Then there are clients who sometimes don't return, and I wonder what really happened. The clients I see with the most intractable, chronic problems, who need help the most, often take such a long time to achieve observable results. I love that I can work on a project in which it takes so little money and effort to actually save a girl's life!
In the end, I keep wrestling with the ultimate question of what really makes a difference in the lives of those we help. There are all kinds of answers to this, depending on your orientation, professional context, and personal style. But what keeps driving me is the experience of deep connection with the people I'm trying to help, whether clients in my practice, students in my classroom, or young girls in Nepal. They're my teachers.
I'm deeply grateful that I've chosen a profession that allows me to learn so much--requires me to grow so much--every day. Yet, however remarkable the benefits of being a psychotherapist, I find the experience of helping and connecting magnified tenfold when I move outside the framework of the normal therapy transaction--and when I'm not even being paid for my efforts. At those moments, it can be hard to tell who truly is the helper, and the gesture of giving becomes indistinguishable from an act of love.
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