Medicine Wheel Wisdom

It's my understanding that the medicine wheel directions represent perspectives and not necessarily the physical direction though we use the physical directions as symbols for the perspectives which is what confuses some people. So your ancestors, just as the wind, could come from any direction. Also the perspective from which you view your ancestors could be all four -- you could look at their physical contribution to you through DNA (West), you could look at the wisdom they impart through the stories passed down from them (North), you could look at their contribution to you spiritually in this moment (East) and you could look at how they influence your family relationships today (South).

This post arose from a question I was asked: A friend thought the West was related to our Ancestors another workshop leader (besides me)
said it wasn't. This other woman said the North is the directions of our ancestors.

I think generally people want to make Native American culture simpler than it is and sort of formulaic -- like X comes from Y and A means B instead of the rich multi-layers that it has.

It's my understanding that the medicine wheel directions represent perspectives and not necessarily the physical direction though we use the physical directions as symbols for the perspectives which is what confuses some people. So your ancestors, just as the wind, could come from any direction. Also the perspective from which you view your ancestors could be all four -- you could look at their physical contribution to you through DNA (West), you could look at the wisdom they impart through the stories passed down from them (North), you could look at their contribution to you spiritually in this moment (East) and you could look at how they influence your family relationships today (South).

Waste in our system

Here's a dogbite story.  Every blog about health care reform needs a dogbite story.  My friend who lives outside of Los Angeles has a very large dog.  One day her dog got into a fight with another very large dog and she made the mistake of getting in the middle. He bit her. Bad doggie.  Don't bite the hand that feeds you!  But dogs will be dogs.  She wasn't going to do anything about it but her family and friends convinced her to go to Urgent Care.  There, a nurse practitioner (who didn't identify herself as a nurse practitioner) sewed it up. Unfortunately, even a third year medical student probably knows not to suture a dog bite tightly closed.  That visit cost $1600.00.  The time involved was less than one half hour.  Then she had to go to the emergeny room when the inevitable infection began in her arm.  The sutures had to be removed. The wound had to be thoroughly irrigated.  She needed three days of intravenous antibiotics and then continued on oral antibiotics. That process cost $20,000.00.  If she had stayed home and cleaned the wound with soap and water, probably she would have been fine, and that would have cost $0.  Think about this.  Probably the nurse practitioner is making $40 per hour and the ER doctor is making $80 per hour.  Where did all the money go?

Undoing the Mechanical: Narrative Medicine

Continuing my thread, about the mechanical, there are some ways to undo this story and replace it with another story.  I began with the simple question, "How long have you had this pain?"


Answer: "Low grade all my life, but severe for the past three years

Me: "What does the pain interfere with your doing?

Answer: "Everything I love to do: swim, weed, take care of chickens, walk the dog, be out on the land…"

We need a new story to support before we do a ceremony to ask for a change. Ellders have consistently explained to me that most of the work happens before the ceremony, which happens last.  Ceremony is meant to be what Malcolm Gladwell calls the tipping point, the last snowfall before the avalanche.  Before doing ceremony, we need to line up those ducks in a row (a long line of dominos makes another great metaphor) so that one touch change everything. One breath of spirit of spirit is sufficient.

I have seen healing elders go to someone’s house for a week, talking to everyone and engaging in a story changing process so when the ceremony came, everyone was already in line to expect a major shift. We need more richness to the story in order to change it.

So, I ask, "three years ago did something changein your life? I start in the western perspective of the medicine wheel with "did anything traumatic happen to your body?" She answered No.The northern perspective would be about change in community relationships? No. The eastern perspective is about change in spiritual relationships. She answered, no. The southern perspective is about changes in relationship and family.  She said, "Around that time I started resenting my husand because he wanted me to do things I didn’t want to do."  Now we are getting somewhere!  More later....

Eliminate Home Health Care?!?

Today's San Francisco Chronicle headlines announce that Congress has figured out how to insure 30 million people -- eliminate Medicare home health care and reduce Medicare payments to physicians.  Brilliant!  Imagine what a cost savings that will be.  Then even fewer physicians will accept the pitiful payments that Medicare offers and all the seniors who are maintaining in their homes with the help of home health nurses can go to the hospital or to a nursing home. That should save lots of money.  The physicians who will be hurt the most by this policy, of course, are the geriatricians.  What apparently no one wants to address are the enormous wastes of dollars spent on lab tests and on end-of-life care that is relatively futile.  Today, I heard about a 105 year old man who was taken to the coronary cath lab.  Does that make sense?  Or my friend, whose orthopedic surgeon orders an MRI every three months just in case he finds something that he can surgically treat.  I have story after story of people who had hundreds of thousands of dollars of laboratory tests, but no one had ever taken a careful history.  I had a patient who received 2 MRIs, one CT, two ultrasounds, one HIDA scan, colonoscopy, and duodenoscopy, only to be put on narcotics, when the history revealed in 20 minutes that her symptoms worsened on birthdays and when she ate whole wheat bread.  The diagnosis was celiac disease and she was normal after three weeks of gluten.  Probably didn't need all those tests -- just a careful history.  Until we wake up and look at the state of medicine today, health care reform will not work.

Our tendency to make everything mechanical

I wanted to dialogue with anyone who's reading about our tendency to make our health entirely mechanical. We certainly have the capacity to invent amazing stories, so why don't we use some of our imagination to wonder why things like back pain could be more than just mechanical.

I was speaking this week to a woman with neck pain.  We discussed her orthopedic surgeon's ordering repeat X-rays every three months.  She didn't know that the research literature shows no correlation of X-ray findings with pain.  "Why would he order so many X-rays?" she wondered.

"He's looking for something he can treat." I answered.  "He's not actually treating you; he's treating your X-ray.  If it's bad enough, he can justify surgery in the hopes that it will make you better."

I told her about Dr. Sarno in New York City and his book on back pain. He is an orthopedic surgeon who wrote a book about back pain rarely being mechanical and much more often being related to how we live.  He helps people resolve their back pain with a process that looks very much like cognitive behavioral therapy.

My friend hadn't heard about him either. I suggested she see him the next time she was in New York since I suspected he would have more impact than a mere friend (his office is fancier, his furniture more designer; probably hangs his diplomas framed on the wall).  Eighty percent of his patients improved with CBT and many fewer with surgery.  I suggested to my friend that surgery could make her better, worse, or no different. I told her about the arthroscopic surgery study that was reported in the New York Times in which sham surgery (an incision only) was equal to arthroscopic knee surgery in outcome one year afterwards (all patients improved dramatically).  She remembered reading that story.


I asked her, "What do you tell yourself about your pain?"

WOMAN: I hace a twisted cervical spine. It happened at birth. I started dancing too young. I’m just getting old."

This answer implies that the issue is purely physical. Native healers can’t conceive this way. The body is not separately mechanically from evertyhing else.I iremember my friend who was asked how would you treat arthritis? I don’t know – I don’t know her bring her to see me!

Nature of self

Isn't it amazing how hard it is for we humans to appreciate this holistic perspective? I am reading a book by Marianne Wolf called Proust and the Squid, and it's about the birth of reading and writing. She argues that the creation of symbolic language changed our brains. I was wondering if this might be what was being called left-brain in that old metaphor that wasn't so accurate. Then I thought about Jill Bolte Taylor and her experience of having her left brain completely shut down for a while. I wonder if over-reliance upon reading and writing perhaps alienated us from the holistic perspective, which is, ideally, a total brain phenomenon in which right and left are both active and balanced. After all, we need to tell others about our experiences and to share them in a way that others can have those experiences.




I have been writing about the Lakota perspective on this inner and outer stuff, and have been struggling to understand the Lakota concept of nagi, which is as close to "self" as Lakota comes. Nagi is every being who has ever influenced us (human, ancestral, natural, spirit) along with every story that they have ever told that has affected us. Also, apparently Lakota is low on words for I, me, my and high on words for you, our, us. I suspect a lot of our thinking about boundaries is an artifact of learning how to read and write and that the work of the next 100 years will be to discover how to balance our brains to perceive both wholes and details. We have to balance the brain changes achieved by symbolic language and its utilization with total being experience and what that has to teach us.



So here's my idea: your thinking negative thoughts about yourself is someone else thinking negative thoughts about you because "you" don't exist except in relationship and "you" are a bunch of internalized voices that you have heard anyway. The idea is that the brain makes a social map of your outer world and each node in that social map is a voice that you can hear saying something that you heard once upon a time and of course modified potentially each time you activate that node and hear that voice. So there's no you. There's only stories that include you.



When do "you" become the co-creator of "you." I suspect when we begin to wonder about the desirability of the voice we are hearing and begin to wonder if we can strengthen or weaken it. As we explore how to do that (especially including other people) we become co-creators of "us". That means that potentially a person who never reacted to their inner voices or wondered about them could actually have zero agency in the world, could actually not create any aspect of "them". I suspect that's rare because people are naturally curious and we wonder why we are saying what we are saying to ourselves. See how difficult this concept is to express in English. I wish I knew more Lakota.



An elder told me that every story has a spirit and every story once told is there forever. Telling counter-stories weaken bad stories and that's what he said he did.

Professionalism

How do we teach students how to help other people? We currently have created such a hierarchical system which serves those (apparently) on top of the hierarachy. I am currently teaching what is called "professionalization group" which aims to teach students how to act like professionals. Yes, the model for professionalism is so distancing, so aloof, so alienating compared to traditional healers. What about the practice of generosity, humility, appreciation, and connection to the earth that characterize healers. What if these attributes are what help others to heal? The separation of professionals from their clients by the symbols of power (white coat, desk, etc.) can be powerful placeboes if they stimulate the faith, belief, and trust of the client, but, ultimately, I think they lose out to the power of a genuine, humble, more equal relationships, which doesn't mean that the healer doesn't know more about healing than the person coming to him. It just means that outside the healing encounter, they are equal. I read an ethnographer saying that healers told him that their medicine wasn't as powerful as it used to be because fewer people believe. Frank Fools Crow was an amazing healer and he exemplified all the attributes of healers, including humor and being a bit rascally at times.

Ursula in Coyote Healing and how do people become sick?

Ursula raises the larger question of how does physical illness come about. I think illness emerges as either a consequence or an epiphenomenon of the embodied enactment of stories. All thoughts have physiological consequences just as I mentioned for imagination. Medical students who watch horror movies show decreases in immune function just as medical students who wtach comedies show increases in immune function. We can't explain the mechanism by which that happens, but we know that it does. So, your emotional experience, which is a direct result of your perception of the world, which arises from the stories you hold about the world and enact in the world, affects your physiology. The story of guilt and self-blame and self-loathing is probably a bummer for the average white blood cell who's more interesting in responding vigorously to happiness and joy. Our emotions, however, arise from our position in a social world and the stories in which we grow up. It's the flip side of the competition story. For every winnter, there are 100 (or more) losers. What's it like to be the winner or the loser? I think Taleb (in the Black Swan) and Gladwell (in Outliers) both make the excellent point that after you put in your 10,000 hours to become an expert (Doidge uses that number also), it's largely luck and social capital, not talent or genius. Yet, the more we believe the individual genius story, and the more we're not the big winner, the more we beat ourselves up. The more we beat ourselves up, the more beaten down we feel. Up, down. Up , down. It weighs heavy on a body, and is probably in service to capitalism because the more down we feel, the more stuff we buy and services we consume.

My new blog

I am starting a new blog because my old one was linked to an old email account and now that I'm ready to start seriously blogging, I thought I'd just start fresh.