Today we are in Warburton
where we encounter Auntie Jennie, an aboriginal elder from Queensland.
I wrote about Auntie Jennie last year. She is doing her medicine
for her community
and much the same way as aboriginal elders in North America. Our
revelation from last year was that we are
more similar than different and that continues to be true. We stayed
at Karith, a Catholic retreat
center for people of all faiths. Karith
means a place for prayer, and this is what it is, managed by Sister Catherine
and Brother Ken.
We began our
workshop/worship in Warburton by singing and calling in the spirits of
the land
and its original people. Then we did an
introduction process in which each person says what they are called,
where they
come from, and introduces one of their ancestors to the other person in
one
quick sentence or so. I learned that
sentences are not quick in Australia and people have much to say and
tell. Introductions took over two hours. People were starved for
the opportunity to
tell their stories and to be heard.
After lunch we continued with the theme of hearing the silenced voices,
one that is apropos to Australia in which aboriginal people were silenced to
ourselves in which we silence the voices within that we don't like or don't
appreciate. In the post-lunch exercise,
much as what we did in the Hearing Voices conference, the goal was to meet one
or more of our voices that we have silenced and to remove the gag and allow
them to talk and be heard. This turned
out to be powerful, too. So many of our
voices have been silenced by the dominant culture, which is one of greed and
individuality. The voices of sustainability
and cooperation have been drowned out by the sounds of greed and what Thomas
King, the Canadian aboriginal writer, has called the "Ferenghi laws of
acquisition (see his collection of stories called A Short History of Indians in Canada".
The Ferenghi are from Star Trek and primarily represent the "all for
me, and none for you" point of view.
Allowing the silenced voices to speak is a powerful process.
I went on to talk about
the ways in which the mind is a model of the larger social world. Just as we have marginalized indigenous
people in the broader social world, we have marginalized the indigenous voices
within us in the social world of our minds.
We need to allow them to be heard.
Here comes dialogical self theory again, which was the topic of my
keynote address at the Hearing Voices conference. Dialogical self theory sees the mind as a
collection of voices all of which are speaking at once trying to be heard. Therapy consists of imposing a kind of order
of politeness and respect in which all the voices can be heard and can dialogue
with each other. Richter (author of integraring Existentialism and Narrative
Therapy) has written about the many me's within us. Each "me" manages one of my relationships and
carries voices, experiences, and stories for negotiating that
relationship. Some "me's" are more
appropriate for some contexts than others.
Social skill consists of knowing which me's to bring out for any given
encounter.
Relevant to this is Marius
Romme, Professor of Social Psychiatry at the University of Limburg in
Maastricht, The Netherlands, who is credited as being one of the European
founders of the Hearing Voices movement, though in my talks, I was quick to add
that what Romme proposed has been practiced and believed by aboriginal elders
for centuries, perhaps even 43,000 years.
Romme was practicing psychiatry in The Netherlands when one of his
patients, Patsy Haagan, said "You believe in a God no one can see, so why
don't you believe in the voices which I at least can definitely hear and which
are real to me." Romme thought
about her proposition and found that he could agree with it. Why not?
He accepted the ontological reality of Patsy's voices (just as
indigenous elders do). He invited other voice hearers to talk together about
their experiences but found that although they could talk they didn't really
help each other. So, he and Patsy
appeared on Dutch TV and invited others who heard voices to call into the
program. Four hundred, fifty viewers who
heard voices phoned. Of these, 150
people said they coped without the assistance of psychiatry; indeed some said
they were happy to hear voices. Romme
asked, "Could perhaps the techniques used by those who coped well with the
voices be used by those who didn't?" A conference was organized to encourage
broader discussion, similar to the conference we had in Melbourne. From this Healing Voices groups formed around
the world. Ron Coleman, who spoke at the
Conference, founded the first one in England 25 years ago.
My proposition was that
narrative medicine has much to offer the Hearing Voices movement just as does
dialogical self theory and therapy. Rita
Charon, MD, PhD, one of the leaders in the world narrative medicine movement wrote
that narrative medicine is "Medicine practiced with narrative competence, that
is, the ability to acknowledge, absorb, interpret, and act on the stories and
plights of others." (Charon R. Welcome and introduction. Presented at:
Narrative Medicine: a colloquium; May 2, 2003; Columbia University, New York,
NY). As doctors/, we act on the narratives presented to us daily by patients,
their families, and other health care team members. This is what Romme did. He accepted the story brought to him by Patsy
Haagan and worked within that story. The
late Canadian family physician, Miriam Divinsky wrote that, "[Stories] help us
see other ways of doing things that might free us from self-reproach or shame".
Hearing and telling stories is comforting and bonds people together." This is what people had found at the Hearing
Voices conference and what we found at the Warburton workshop. Coming together in circle to tell and hear our
stories with each other creates relief and builds community. Within the Lakota concept of nagi, once we hear another's stories
they are forever a part of us.
In Warburton, I spoke
about the nagi, which is the swarm
surrounding us of all the stories that have ever been told about us, by us, and
by those who have influenced us coupled with a part of the spirit of the teller
of that story. Nagi is what forms and shapes us and makes us who and what we
are. It is our legacy. Once we tell or hear a story that story
becomes forever a part of the listeners nagi. Miriam Divinsky further wrote that "Stories
offer insight, understanding, and new perspectives".They educate us and they
feed our imaginations." (Divinsky M. Stories for life. Introduction to
narrative medicine. Can Fam Physician 2007;53:203-5 (Eng), 209-11 (Fr)) Through
story
(1) we structure and interpret
our life experiences;
(2) we create a coherent
life story;
(3) we construct, display
and reinforce our sense of self;
(4) and we manage this
self in relation to others in our social worlds.
As I said
in Melbourne, story is the default mode of our brains. It is our best way to store and manage
information. The narrative structure is
ubiquitous in human experience and emerges, according to the Scottish
developmental psychologist, Colwyn Trevarthan, even in the early exchanges
between mother and infant. In these
interactions, infants engage in stories without words or with words supplied by
their mothers. We have the task of
creating a coherent life story, often with the help of our family and
friends. Through the use of narrative
structures, we invent an "I" to integrate our many me's. In fact, we know at least one part of the
brain located in the mesial pre-frontal cortex which eliminates our ability to
tell a coherent "I" story if it is rendered dysfunction by stroke or other
damage. We use story to run countless
simulations about what might happen if we behaved in particular ways in future
encounters with others. I gave an
example of this in which I asked everyone to remember a time in which he or she
had an argument with their spouse or partner and had to leave home for work or
another errand before the argument was resolved. "All the way home," I said, "you are running
various "what if"." scenarios in your mind, rehearsing the discussion that will
take place when you arrive home.
Depending upon the outcomes of these various simulations, you decide
whether to stop for Chinese take-out, flowers, chocolates, or perhaps a drink
at the pub." Everyone could relate to
this.
Then I defined a narrative unit
(following the work of Labov) as one containing at least 2 Complicating Action
clauses where the verbs are in the past or historic present tense, and where we
can infer an order to the clauses. There
are also one or more Orientation clauses setting out who was involved in the
events, when and where the events took place, and giving other necessary
background information. I used an
example of a short narrative from one of our clients who comes to our
complicated minds group. Mandy said, "Then there was the time when I killed my
boyfriend, except that he didn't die, and there he was at my back, trying to
strangle me again." This actually has
three Action clauses. True to the
requirement for an Orientation clause (which can be implicit in the
conversation), Mandy added, "That was when we lived in Georgia and I was
dealing coke and he was really jealous, but then we broke up and now we're best
friends. I know all his girlfriends and all his kids." I asked everyone if they could feel Mandy's
charm as a person from the story and everyone could. This occurs because we recognize the other
aspect of a narrative -- the affective strand of meaning where narrators reveal
their feelings about the events they are accounting. This justifies the telling and shows the kind
of person the speaker claims to be: "narrative is a presentation of the
self, and the evaluative component in particular establishes the kind of self
that is presented". This
illustrates the narrative competence of the speaker in putting together a
multi-voice, multi-faceted story in accessible language.
Next I moved onto
illnesses, discussing how narrative competence allows us to Use the different
perspectives of storytelling to create a complete picture of the illness and
its meaning to the patient.
The
narrative of an illness needs to not only give the patient a voice, but also to
re-present the dialogue between patient and caregivers, inclusive of the voice
of the caregiver or health professional.
I gave the example of the story of the first encounter with the illness
being named. Mandy said, Linda: We
fought for 6 hours that day because I fought back. At one point I was slamming his head into my
knee. I went to the hospital and that's
when I found out I was pregnant. That"s when they diagnosed me." To her credit, Mandy had received every
psychiatric diagnosis available from someone.
This is how she came to have a "complicated mind". Mandy also told habitual stories that
illustrate usual activities. For
example, she said, " I get so angry, I mean he would wake me up for no reason,
and he knows I can never get to sleep and so I have a 3 hour panic attack
because he needs $5, right now, so I would lock him in the basement. I would just get so sad. I would take all my
pills, whatever I had around. I'd still do it but my son put me right, he said
he didn't want to be without me. They would call me from the other side, my
best friend, my son's father. And he was really good looking." Mandy was talking about her usual activity of
taking all the pills at hand when she was upset. She was however, entertaining a counter story
during her time she had been in the Complicated Minds group -- that her son
loved her and would miss her and needed her to stop overdosing on pills. People also have "reported speech" narratives
in which they describe important conversations with others. Mandy said, "The doctors don't want to hear
what I tell them. They get really
nervous when I come in the office. I made one of them brownies but it doesn't
help." Mandy's experiences with
physicians were generally negative. She
made them uncomfortable and recognized it.
These stories are important. During
our interactions with health professions decisions are made about the
management of the illness and the health practitioners story about the illness
is transmitted to the patient. Interactions between patients and health care
professionals thus play a major role in the social construction of illness
narratives. We rely upon physicians to
tell us what we have and why we have it.
This generates "because narratives" in which we explain ourselves, often
in reference and comparison to others, which are called narratives of
comparison with others.
We completed the workshop in
Warburton with examples and exercises of people telling each other stories and
listening for the smaller narrative units comprising the story, thereby
recognizing points of potential intervention.
Then we went across the street to the Polish Jester for a wonderful
Polish meal of pickled vegetables, smoked herring, and stuffed cabbage. I fell asleep immediately upon returning to
Karith.
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