Tuesday, 27 March 2012

What's it like to be a monk?

One of the things I love about books that are autobiographical is that they allow you to vicariously experience another perspective, lifestyle, or environment. With that in mind, I recently picked up Phra Peter Pannapadipo’s book Phra Farang: An English Monk in Thailand from my local library.

Of course as a woman I could never be a monk, but travelling in Asia I have enjoyed wandering through many temples and often wondered about the lives of the orange-robed Buddhist monks that inhabit that world. For author Phra Peter (surname Robinson, before he became a Buddhist and moved to Thailand), the contrast between the monastic life he entered into at the age of 40 and his former life as a successful British businessman couldn’t have been more startling. (Talk about somebody experiencing a mid-life crisis!)

However, having a “normal” British background gives Phra Peter a most unique outsider/insider viewpoint not only into the meaning of Buddhism and monastic life—for himself and for the other monks and everyday Thais he interacts with—but also of the cultural contrast between the modern, Western world and the age-old beliefs and traditions of rural Thailand. And as a native English speaker, he is able to tell many interesting, wonderful, and often funny stories about the events he experiences and his thoughts about those events without any of the awkwardness that might come were his stories filtered through a translator. As his understanding of himself and his experience grows, so too grows the understanding of his readers.

One of the fundamental Buddhist precepts is that attachment creates suffering. Thus it is not surprising that a Buddhist monk relinquishes his worldly attachments (stuff, people, places, goals) as much as possible in his pursuit[i] of personal internal spiritual growth. Life without stuff, without attachments, is fairly simple.

Although he was resident at several monasteries in Thailand, as well as his “original” monastery, Wat Buddhapadipa in the UK, much of the book details Phra Peter’s life at the small, rural monastery Wat Nahoob several hundred miles north of Bangkok. Here he rose at 3:45 a.m.—first one up at the monastery—to ring the morning temple bells calling the monks for morning chanting. At 6 a.m., the monks would walk the morning alms round through the village, followed by breakfast from the food they collected. (In Thailand, this is not seen as begging; the Thai people give to the monks to make spiritual merit for themselves, a two-way sharing that benefits both parties.)  Lunch, the final meal of the day for the monks, was at 11 a.m., and the bells were rung for evening chanting at 5 p.m. The rest of the day for Phra Peter was spent meditating, studying, teaching, and with routine house-keeping and maintenance unless there was some “event” on at the monastery or village: an ordination, a funeral, a festival.

Phra Peter sums up: “At Wat Nahoob I had everything I needed: a delightful little kuti[ii] in a beautiful forest setting, I admired and respected my abbot and I got on well with the village people. I had all the food I needed and all the time I needed.” But then he goes on to say that such idyllic conditions can lead to complacency, “a potential hindrance, for it could lead to torpor and apathy. A monk should always be satisfied with things and situations just as they are, but not to the point where his mind becomes stagnant.”[iii]

Phra Peter chose to “disrobe”—cease being a monk—ten years after his ordination. He devotes his life now to a charity known as the StudentEducation Trust (SET) which he established for disadvantaged Thai students. SET has provided over 4000 scholarships for Thai students to obtain vocational training or university degrees, and continues to provide cash grants for textbooks, school uniforms and other requirements for Thai children from impoverished backgrounds, enabling them to stay in school and learn.

For Phra Peter, the experience of being a monk was an important step on his life's journey. His contribution to the world, though writing about his experiences and through his charitable work, is commendable. 

This is a fine and insightful book, easy and enjoyable to read, and recommended.

[i] “Pursuit” is probably not the best word choice since that implies a deliberate action to achieve a result, whereas the Buddhist precept of non-attachment would imply that the result of such inward looking is of no consequence.
[ii] Hut, cottage—his was about 9 feet square, on stilts, with a significantly overhanging roof for rain protection. 
[iii] Extracted from the book, Pp 263-264.

Wednesday, 21 March 2012

"Smear Tests Prevent Cervical Cancer." Really?

There’s a delightful series of ads being run on New Zealand television encouraging women to get regular cervical smear tests done. The latest in these ads, titled “The Beach” is on air at the moment. It’s not on youtube yet, but you can watch it here.

These ads are produced for the National Screening Unit, under the auspices of the National Health Board of the Ministry of Health—in short, the New Zealand government. They’re the same folks who run the breast screening program. (See my earlier blog Are Mammograms Good for You?.)

I think the women in this ad are really sweet and really natural, and I enjoy watching the ad, but what bothers me about it is the tag line at the end: “A smear test every three years could stop you from getting cervical cancer.” Really? Are smear tests a method of cancer prevention these days? Gosh! And here I thought they were just a method of cancer detection! And there’s a difference between detection and prevention, isn’t there? Is this misleading advertising?

You don’t hear concerns regarding cervical screening as you sometimes do regarding breast screening, probably because although the procedure is somewhat invasive, there’s no radiation or other potentially harmful aspects to getting a cervical smear, and they can detect cervical cancers before a person is aware of their own illness. But I got to wondering just what sort of record cervical screening actually has. So I did a little investigating.

According to a summary of research studies on cervical smear tests provided by the Women’s Cancer Information Centre in California[i], cervical cancer rates in the US dropped after the introduction of routine cervical smear tests, and 50% of cervical cancer cases now occur in women who have never been screened. I don’t know if that really tells us much of anything unless we know how many women have regular pap tests.  If it’s 50%, then having the test doesn’t make a difference.

In the US, a country with over 300 million people in 2007—and although it is a rough estimate, presumably about half of those are women, so let’s say 150 million women,--just  4021 died of cervical cancer in 2007[ii], a little over 2 thousandths of one percent. The New Zealand National Screening website claims that without screening, 1 woman in 90 will develop cervical cancer, compared to 1 in 570 when smear tests are conducted every three years, although they don’t clarify how they arrived at these figures, which are footnoted as “estimates”. They also state that currently about 60 women each year in New Zealand die of cervical cancer (3 thousandths of one percent) but if untested, 1 woman in 200 will die of cervical cancer[iii]—about half a percent, based on half the population of 4 million. 

Research just reported today[iv] that compared cervical cancer rates between the US, where the average woman may have 20-30 pap smears in her lifetime, and the Netherlands where 7 smears over a lifetime are the norm (national guidelines there recommend tests ever five years between the ages of 30 and 60) showed no difference in cervical cancer mortality rate. The authors conclude US physicians overscreen.

For a cervical smear—or pap test—the doctor scrapes a few cells from a woman’s cervix with a swab. In the laboratory, that sample is brushed onto a slide and examined with a microscope for cells that appear abnormal. Because there is room for mistakes at all three stages of this process, accuracy rates for smear tests have a fairly high risk of error. According to Slowik’s 2011 article How Accurate are PapSmear Results?, 20-45% of results are false negatives (reporting that cells are normal when they are not), and a smaller percentage are false positives (reporting the presence of cancerous or pre-cancerous cells when cells are normal). The New Zealand National Screening website gives a 20% rate for false negatives, a figure also reported by McMeekin, McGonigle, and Vasilev.

Cervical cancer rates seem to be higher in some specific demographic groups including Maori, Pacific Islanders, and Asian women in New Zealand (see Benefits of Regular Screening), and according to the NHS Screening Service in the UK, those who have multiple sexual partners, those who come in contact with high-risk HVP viruses, those who are HIV-positive, those who take immunosuppressive drugs, and those who smoke. Having had multiple pregnancies also increases the risk. Since the development of cervical cancer is generally very slow, it most commonly appears in middle-aged and older women (average 50-55 years). Most screening programs discontinue screening after age 65-70.

 At the end of the day, it seems that the risk of developing cervical cancer is actually pretty low, but there is no harm in having regular pap smears. By regular, every 3-5 years seems to be adequate unless you have been assessed as ‘at risk’, and keeping in mind that the accuracy of the test for detecting cancer or pre-cancerous cells is only about 80%. 

So, do smear tests prevent cervical cancer? I think it is misleading to suggest that, but early diagnosis of pre-cancerous cells can lead to earlier treatment, and that might be something that saves your life. Besides, at the very least, it’s good for the health industry and keeps people employed, including—I’m thinking of the ads here—some very fine actors. 

[i] D. S. McMeekin, K. F. McGonigle, and S. A. Vasilev, 2000-2007. Cervical CancerPrevention: Cost-Effective Screening.
[ii] See Demographics of the United States for population numbers; Centers for Disease Control and Prevention for US cervical cancer vital statistics.
[iii] Benefitsof Regular Screening, National Screening Unit Website

Tuesday, 20 March 2012

Dark Side to Video Game Learning

In my previous post, NightRun Like Skyrim, I shared a quite extraordinary personal experience of enhanced physical ability that I directly attribute to “learning” acquired through play of the new and very popular computer/video game Elder Scrolls V: Skyrim. In that case, I found myself behaving in a new and unpredictable way which I found quite mind-blowing. But if that change could happen so easily, subconsciously, and unobtrusively—I wasn’t even aware it was possible until it happened—what other new “skills” might I (or someone else) be learning from Skyrim and other such games that are less socially positive?

Many studies have been done concluding that violence in video games, tv, and film can affect the thoughts, behaviours and attitudes of people who play or view them. Having the ability to participate as a character in a story, as with an avatar like in Skyrim, intensifies the experience and increases aggressive behaviour if the game is a violent one (Fischer, Kastenmuller, & Greitmeyer, 2009). Of course most studies like this are quite contrived. Participants—often university students—might do one task, and then their responses are measured on a second task, or in a different environment, or the intensity of responses is picked up by electrodes attached to the skull. Whatever. And I’ve always thought, “Yeah, it’s probably true that violence in films or games can increase violent tendencies,” but I haven’t lost any sleep over the idea. I never really thought about participatory media, in particular, as a way of “learning” violent or anti-social behaviour much until now. But there’s something about the visceral, subjective experience of actually gauging my own responses that wins over generalized laboratory studies for me any time.

Skyrim is rated R-13 for “violence and offensive language”. I don’t know about the offensive language—I haven’t noticed any—but the rating seems to be about right for violence level, and I can well imagine computer saavy kids who love games being into this one at 11 or 12, and parents easily turning a blind eye. It’s not so much the violence in the game that concerns me—ok, so your sword gets blood on it when you slash at a snarling wolf, giant frostbite spider, or attacking bandit--but the morals and ethics are another story. Right from the start, you are encouraged by your first [temporary] guide to simply help yourself to assorted armaments, armour, foodstuffs and potions as you find and fight your way out of Helgen Keep (the opening “quest”). It appears in the game that for the most part, you can take what you can get and kill anybody who gets in your way. In the towns of Skyrim it’s different: you’re reminded that if you “take” it is stealing and it is important to not get caught or you will be arrested. You are not taught that it’s wrong to steal, just that it’s wrong to get caught! Indeed, you can, over the course of the game, increase your lockpicking, pickpocketing, and thieving skills to become an expert at these arts.

Now it seems to me that any game that glorifies fighting skills, sneaking skills, thieving skills, and the like, a game in which you participate as a character free to make choices and decisions about what to do and how to do it at every juncture (it truly is an amazing game!), and that you get more “loot” and complete more quests if you are a better fighter, thief, pickpocket, and/or mage—the Buddhist philosophy wouldn’t get you through the first quest—is bound to install some rather ego-inflating it’s-all-about-me meta-programs in your brain if played very much. And along with that, a “belief” that if you can take something, you should. 

I don't plan to stop playing the game, but I am planning to stay aware of the insidiousness of the Skyrim ethics. And I wonder about the kids, especially, and vulnerable adults who are really, seriously into their avatar persona in whatever games they play, and find themselves pulling aspects of their avatar and the avatar's world into their own personal lives.

I dunno. As they say, this is a curly one.

Monday, 19 March 2012

Night Run Like Skyrim

I’m not a serious gamer. The last computer game I bought was Civilization IV, and that was probably five or six years ago, I probably got it out of a bargain bin, and although I admit I’ve spent many happy hours over the years playing Civ, I've had little inclination to buy another game. But for some reason I absolutely cannot explain, I recently forked out nearly $100 for Elder Scrolls V: Skyrim, and have had an absolute ball playing it. I’m surprised to discover some curious carry-overs into real life, one of which was so mind-blowing, I want to share it with you.

If you’re not familiar with Skyrim, it’s kind of like an interactive fantasy novel where your character/avatar explores this amazing kingdom, goes on quests, does battle with a variety of nasty villains and creatures, harvests wild herbs, learns magic, and if you choose to follow what appears to be the “plotline” you discover you are “dragonborn” and a saviour of sorts.  After some 30 hours of play, I think I’ve barely scratched the surface of this amazing and stunningly beautiful land, and I’m hooked.

As an avatar—and this is my first experience playing a game of this sort—you can experience events either first hand through the eyes of your character (1st person) or by watching (3rd person), and I find myself generally preferring the 1st person point of view. A lot of the time in this game—if “game” is really the right word—you take yourself jogging down roads and paths, day or night, in all sorts of weather, as you travel from one place to another, meeting and conversing with other journeymen/women and keeping a watchful eye out for wolves and other potentially malicious beasts. (Here's a screen shot from the game.)

So, what does this have to do with “real” life? Well... There’s a 50-minute forest path not far from my house that I often walk, often just because it’s a nice day and I feel like a walk, but also when I’m feeling particularly stressed or upset about something. There is nothing more effective (for me, anyway) than getting outside in the fresh air and setting of at a brisk pace down the forest track to settle the churning stomach, the tight chest, or the harried, jagged thoughts that are my natural bodily reaction to stress.

So the other night a situation arose—it had been building all day—and I just had, I JUST HAD to get out. So I put on my walking shoes and, even though it was dusk and night was fast approaching, I headed down to the park. Concerned about the encroaching darkness, I hadn’t really intended to do the forest walk, but my feet knew the way, and my pent-up energy was such that I not only headed up the path, but I broke into a jog. Now I’m not a runner. Not at all. No way! But I had the most AMAZING experience jogging that path in near darkness, and it was so like my character in Skyrim that I almost imagined myself with my bow slung over my back, ready for any encounter or situation that might arise. I was also surprised to find several other people out on the trail that late at night, walking dogs or just walking—appearing first as vague forms in the gloom in front of me and gradually gaining definition as we approached each other—and even that was Skyrimmian.

Now the fact that I don’t run, and have never before chosen to take this trail in the dark before makes this a significant departure from my usual behaviour, and yet I found myself doing so, and it felt so incredibly natural it just sort of blew my mind. I didn’t feel winded, or tired, and I didn’t struggle to see in the dark. So what kind of brain training must be going on when you play a video game like this?

Computer simulation has been a popular and effective method of training in numerous industries: pilots and astronauts, police, business and more. And I understand they are finding wii games assist stroke victims in recovery. But the whole idea that playing a computer game for a few hours would translate to a new and unpredictable behaviour choice concurrent with apparently enhanced physical abilities seriously challenges my pre-conceived beliefs about how we learn and the mind body connection.