Of course, the bigger news than our Australian adventure is the tragedy of the earthquake in Japan and the accompanying tsunami, which remind us of our relative insignificance relative to the forces of Nature. We suffer with the rest of the world for those who were harmed in this natural disaster.
However, our trip continues and today we are in Warburton, Victoria, and met some members of the local community who work with children. I gave a lecture at the Warburton Town Hall and, of all people, the Governor of Nambe Pueblo in New Mexico, attended. We were able to chat afterwards and I learned about "The Gathering of Eagles", which will take place at Nambe Pueblo in New Mexico during the last week of July. We were staying at Sancta Sophia Meditation Center in Warburton, a center started by a Carmelite, Sister Kathleen, and a Benedectine, Father Ken. Their mission was inter-religious dialogue, of which we were having much.
Next we focused upon how we would interview within a storied paradigm as compared to diagnostic interviews based upon conventional diagnostic categories. I had the opportunity to interview an aboriginal woman who had defied diagnosis for 12 years except for her asthma and back pain. Her main symptom was severe fatigue, for which her doctors had just prescribed an antidepressant. We quickly reviewed her laboratory studies which were largely unremarkable as is so often the case. There were some signs of chronic, low grade inflammation like a slightly elevated erythrocyte sedimentation rate, a slightly increased platelet count, a slightly low level of triiodothyronine, a slightly reduced estradiol level, a slightly reduced blood hematocrit, and a slightly elevated evening cortisol level, none of which were diagnostic of anything. Her symptoms consisted of some menstrual irregularities, some extra ovarian follicles, moderately severe asthma, back pain, and stomach pain from duodenitis. She had seen conventional doctors and natural healers, including a traditional Chinese doctor, a reflexologist, and a naturopath. She had been raised in an urban environment and had a large aboriginal extended family and many contacts, but none of them were elders who did healing, or it had never occurred to her to ask this of her relatives and acquaintances. Nothing had really helped her. The Chinese medicine had resolved her canker sores, which wasn't a major problem for her anyway. The reflexologist had successfully mapped the sore areas on her foot to the body areas that were problematic, but that hadn't changed anything, however amazing it was. The naturopath had tried eliminating all sugars, pork, spice, sauces, dairy, soy, and wheat, which had made no difference. The supplements he prescribed had worsened her stomach pain. She had recently started eating bread and dairy again and was no worse the wear, though she had realized that especially rich foods gave her more stomach discomfort, bloating, and constipation. She had taken the birth control pill, Yaz, to regulate her menses as well as Accutane for acne.
Then I began to look for the story. The last time Sandra remembered being completely well was when she was age 16. That was when her partner, with whom she had been living since age 13, killed himself. She sadly moved back home only for her mother to die two years later. She found another partner with whom she had two children in two years. Then, her favorite aunt died unexpectedly. That's when she had her first asthma attack. Back pain followed suit. Sandra didn't have a theory about how she got asthma but thought that her back pain was the result of carrying two young children around. She continued having moderately severe asthma and back pain for ten years until she became pregnant with her third child. During that pregnancy, her asthma and back pain improved, but then they came back with a vengeance after she gave birth. Suddenly a new very severe symptom appeared -- absolute and complete fatigue, which had continued unabatedly severe until today.
During all this time, Sandra had been running an art cooperative that her mother had started. It managed a number of aboriginal artists' work and had retail outlets throughout the area. Sandra had some tears as she talked about her mother, who had been absolutely driven to succeed and bring her family out of the relative poverty in which they had previously lived. Sandra's grandmother had also been an accomplished artist, had nine children, but had lived in relative poverty even as she supported Sandra's mother to go to art school and be successful in a contemporary sense.
I asked Sandra what she would be doing if she were well and she said she would be out in the world continuing to expand and grow the business that her mother had started. She worried about the business all the time, even though it was doing well. She feared that her limitations would make it suffer.
I asked Sandra what gifts the illness had brought her. Again, she responded immediately. Without the illness, she wouldn't be spending nearly so much time with her children at home and with her husband. She'd be out working. "Like your mother?" I asked. That led to a powerful, tearful story about her mother and how burned out her mother had become and how desperately she thought her mother had wanted to relax and be with her family and be cared for. Her mother had never had that. She feared that she was becoming her mother and worried that she would die at age 36, the same age at which her mother had died.
"How much help do you have?" I asked.
"Help!" she responded incredulously. "Everyone's too busy with all the things they have to do to help me. " She recited a litany of examples of how her children were too busy with their homework, or too young. Her husband worked 6-1/2 days per week to support the family. Her relatives were equally busy. Slowly it became clear that Sandra couldn't ask for help and wouldn't take it, if offered.
"So," I said. "We have a SuperWoman story! Modern aboriginal woman defies all odds, continues to build her mother's business while raising a family and refuses all help because she can do everything, including leaping tall buildings with a single bound and running faster than speeding locomotives."
"Wonderwoman," she said. "Better costume. Invisible airplane. Lasso." I had to agree that Wonderwoman was more cool that SuperWoman. So, here's the story, I said. And your two dogs fighting (a metaphor for conflicting beliefs) is this: one dog says you have to do it all without help and the other dog says your ill and you can't do it all and you need and have to accept help. "Right," she said.
"So," I said. "Did any of your many health practitioners talk to you long enough to get this story?"
"Never," she said.
"And that's the problem with conventional medicine," I said. "Here's what I'd do next. I'd call a meeting of everyone you know -- family, friends, co-workers, fellow artists -- and we'd do a large talking circle in which everyone got to contribute their story about you to your story, and then we'd brain storm about how everyone could be helpful to you." This made her very uncomfortable since she didn't like to ask for or receive help. "This is the indigenous way, in which community heals people whether they ask for it or not. An aboriginal woman elder in the audience invited her to join a women's circle that she led, "whether she needed it or not." This would set the stage for day 4's discussions on community.
Wednesday, March 23, 2011
Sunday, March 20, 2011
Drug Abuse Prevention; Why do the American media avoid discussing research findings?
This week on American television, as part of its coverage of the 2010 Vancouver Winter Olympic Games, particularly on the CNN Network each morning at the gym were I exercise, the morning news was astir with discussions of Insite, a Vancouver-based project that provides addicts with a safe site to inject, including clean needles. The American TV was awash with criticisms of this policy, the primary one being that it promoted drug abuse and caused people to abuse drugs even more than they otherwise would. What amazed me was the complete lack of attention to data in the American media. Substantial research has been conducted on Insite and on harm reduction models. It is known that programs like Insite reduce the spread of HIV/AIDS and of hepatitis C and reduce drug overdose. No evidence exists to support its spreading drug abuse.
Why do the American media avoid discussing these research findings? Why are the opinions of uninformed people in towns like Decatur, Georgia, and Cumberland, Maryland, more meaningful than the results of carefully conducted scientific research? Why is evidence-based medicine abandoned when it comes to drugs? Why is the existence of credible research not even mentioned? The best that was done was to mention that the director of the Insite Program believed that lives were being saved. Not mentioned was the hard scientific evidence amassed to back his position. Why does science not matter when it comes to drug policies?
CNN implied that Insite was operating under the legal radar and that the Vancouver Police Department were pretending not to notice its existence. In fact, in 2003, the regional health authority in Vancouver successfully applied to the federal government for a legal operating exemption to pilot Insite.3 This exemption was granted following the release of feasibility data which suggested that Insite had the potential to reduce public drug use and overdose deaths.4,5 Insite was established following prior experience of similar facilities in European and Australian settings. Corresponding research suggested that these facilities had unique potentials to reduce public illicit drug use while promoting the use of sterile syringes and providing emergency care in the event of overdose.6-9 Since opening in 2003, Insite has been a place where people could inject drugs and connect to health care services from primary care to treating disease and infection, to addiction counseling and treatment. Few areas suffer more from the lack of response to research than illicit drug use.1,2
Dr. Evan Wood, Director of the University of British Columbia's Center for Excellence in HIV/AIDS research reported in The Calgary Herald on January 31, 2010, that despite criticisms levied by Conservatives (and the American media), the benefits that Insite provides are real and verified.
Dr. Wood pointed out that drug prohibition has created a massive global revenue stream for organized crime, worth an estimated $320 billion US annually. These enormous proceeds threaten the political stability of entire regions, including Mexico and Afghanistan. In the U.S., where the war on drugs has been fought most vigorously, the incarceration of drug offenders has placed a huge burden on the taxpayer and contributed to the world's highest incarceration rate. Primarily as a result of drug-law enforcement and mandatory minimum sentences, one-in-eight African-American males in the age group 25 to 29 is incarcerated on any given day, despite the fact that ethnic minorities consume illicit drugs at the same rate as white and other sub-populations. Paradoxically, ever-increasing drug enforcement expenditures and incarceration levels have not prevented the drug market from becoming more efficient.
The association between drug prohibition and increased inner-city violence is consistent. A recent international example is the upsurge in severe drug-related violence in Mexico subsequent to Mexican President Felipe Calderon's escalation in the fight against Mexican drug traffickers. Increasing gun violence in Canadian cities has been directly linked to clashes between organized crime groups over the enormous drug market profits.
HIV and overdose death rates are highest in areas where law enforcement is prioritized over evidence-based public health strategies. These harms are significant given HIVs spread beyond its traditional risk groups and its burden on the health system. Each and every case of HIV is estimated to cost $250,000 in medical expenses. For the above reasons, conservative economists like Nobel Prize winner Milton Friedman have long argued that the "war on drugs" does much more harm than good.
Due to their effectiveness, harm reduction policies are now endorsed by all evidence-based scientific consensus bodies, including the U.S. Institutes of Medicine and the World Health Organization. This consensus is based on rigorous reviews of the large volume of international scientific evidence indicating that harm-reduction programs save tax dollars and improve public health by reducing HIV rates while increasing uptake of addiction treatment. To read more from Dr. Evan, see click here
In Europe, more than 65 programs like Insite bring street-based drug addicts indoors where they can be prevented from sharing needles and overdosing while increasing enrollment into addiction treatment. Insite has replicated the European experience, and is undoubtedly the most highly studied health clinic in Canadian history. More than 30 peer-reviewed studies show that Insite reduces public injecting, reduces HIV risk behaviors (e.g., needle sharing), and increases rates of addiction treatment. Studies seeking to identify potential harms of the facility found no evidence of negative impacts. Studies were independently peer-reviewed and published in top scientific periodicals, including the New England Journal of Medicine, The Lancet and the British Medical Journal.
During the period from March 10, 2004 to April 30, 2005, 4,764 individuals registered to use Insite. Heroin was used in nearly half of all injections, and cocaine was injected 37% of the time. There were 273 witnessed overdoses, none of which resulted in a fatality. There were also 2,171 referrals to addiction counseling and other support services. These early results indicated that Insite was being successfully integrated into the community. The facility was attracting a wide cross-section of injection drug users, and staff were successfully intervening in overdose events on site and actively referring drug users to addiction treatment and other services.10
A 2006 study showed that Insite was attracting a large number of hard-to-reach intravenous drug users and that the existence of the facility presented an excellent opportunity to enhance HIV prevention through education, the provision of clean injecting equipment, and the availability of a supervised and sterile environment to self-inject. Finally, the facility was also an important point of contact for HIV-positive individuals who were not yet participating in HIV care and treatment.11
One concern prior to the opening of Insite was whether the facility would encourage injection drug use by making drug injection easier and more comfortable for intravenous drug users. Therefore a study was made to determine whether or not the opening of the facility would be accompanied by a worsening of community drug use patterns. The drug use behaviors of 871 intravenous drug users were observed in the one year period before the opening of Insite and in the one-year period after. The drug use behaviors studied included the rates of relapse into injection drug use among former users and the cessation of injection drug use among current users. The study found that after Insite opened there was no substantial increase in the rate of relapse into injection drug use among former users (the rate of relapse was 17% prior to the opening and 20% after). There was also no substantial decrease in the rate of injection drug use cessation among current users (the rate was 17% prior to Insite's opening and 15% after). This research showed that the benefits of Insite on reducing the high-risk behaviors of intravenous drug users and on increasing public order were not offset by negative effects on drug use patterns among Vancouver's intravenous drug using population.12
Critics suggested that the availability of a supervised injection facility might discourage drug users from seeking treatment for their addiction. A study was conducted to examine the effect of Insite on the use of detoxification services, which is the entry point into the addiction treatment continuum in Vancouver. The study followed more than 1,000 Insite users between December 1, 2003 and March 1, 2005. Of this group, 185 (18%) began a detoxification program at some point during the study period. Individuals who used Insite at least weekly were 1.7 times more likely to enroll in a detox program than those who visited the centre less frequently. The study also found that contact with Insite's addictions counselor significantly increased a person's chances of enrolling in detox. Contrary to fears that Insite might be deterring drug users from seeking treatment, these findings strongly suggested that Insite was facilitating entry into detoxification services among its clients.13
In another study, researchers measured the effect of Insite on the use of detoxification services by comparing rates of detox service use among injection drug users in Vancouver in the year before Insite opened and in the year after it opened. The researchers also investigated whether those individuals who attended Insite and enrolled in detox were subsequently more likely to enroll in methadone maintenance or other drug treatment programs. They learned that, in the year after Insite opened, there was a 33% increase in detoxification service use, compared to the year prior to the opening of the facility. The study also showed that Insite clients who entered detox were 1.6 times more likely to enroll in methadone treatment and 3.7 times more likely to enroll in other forms of addiction treatment. As well, individuals who entered detox visited Insite less frequently in the month after enrolling in detox services than in the month prior to enrollment. This research indicated that Insite encouraged intravenous drug users to enter detox. It also suggested that drug users who enrolled in detox were more likely to remain in subsequent treatment programs and reduce their use of Insite.14
I don't have an answer for why ideology trumps scientific evidence in the United States and its media. Why are the opinions of ordinary people in cities across the United States considered more valid than three dozen rigorous scientific studies? Is this just the American way?
Why do the American media avoid discussing these research findings? Why are the opinions of uninformed people in towns like Decatur, Georgia, and Cumberland, Maryland, more meaningful than the results of carefully conducted scientific research? Why is evidence-based medicine abandoned when it comes to drugs? Why is the existence of credible research not even mentioned? The best that was done was to mention that the director of the Insite Program believed that lives were being saved. Not mentioned was the hard scientific evidence amassed to back his position. Why does science not matter when it comes to drug policies?
CNN implied that Insite was operating under the legal radar and that the Vancouver Police Department were pretending not to notice its existence. In fact, in 2003, the regional health authority in Vancouver successfully applied to the federal government for a legal operating exemption to pilot Insite.3 This exemption was granted following the release of feasibility data which suggested that Insite had the potential to reduce public drug use and overdose deaths.4,5 Insite was established following prior experience of similar facilities in European and Australian settings. Corresponding research suggested that these facilities had unique potentials to reduce public illicit drug use while promoting the use of sterile syringes and providing emergency care in the event of overdose.6-9 Since opening in 2003, Insite has been a place where people could inject drugs and connect to health care services from primary care to treating disease and infection, to addiction counseling and treatment. Few areas suffer more from the lack of response to research than illicit drug use.1,2
Dr. Evan Wood, Director of the University of British Columbia's Center for Excellence in HIV/AIDS research reported in The Calgary Herald on January 31, 2010, that despite criticisms levied by Conservatives (and the American media), the benefits that Insite provides are real and verified.
Dr. Wood pointed out that drug prohibition has created a massive global revenue stream for organized crime, worth an estimated $320 billion US annually. These enormous proceeds threaten the political stability of entire regions, including Mexico and Afghanistan. In the U.S., where the war on drugs has been fought most vigorously, the incarceration of drug offenders has placed a huge burden on the taxpayer and contributed to the world's highest incarceration rate. Primarily as a result of drug-law enforcement and mandatory minimum sentences, one-in-eight African-American males in the age group 25 to 29 is incarcerated on any given day, despite the fact that ethnic minorities consume illicit drugs at the same rate as white and other sub-populations. Paradoxically, ever-increasing drug enforcement expenditures and incarceration levels have not prevented the drug market from becoming more efficient.
The association between drug prohibition and increased inner-city violence is consistent. A recent international example is the upsurge in severe drug-related violence in Mexico subsequent to Mexican President Felipe Calderon's escalation in the fight against Mexican drug traffickers. Increasing gun violence in Canadian cities has been directly linked to clashes between organized crime groups over the enormous drug market profits.
HIV and overdose death rates are highest in areas where law enforcement is prioritized over evidence-based public health strategies. These harms are significant given HIVs spread beyond its traditional risk groups and its burden on the health system. Each and every case of HIV is estimated to cost $250,000 in medical expenses. For the above reasons, conservative economists like Nobel Prize winner Milton Friedman have long argued that the "war on drugs" does much more harm than good.
Due to their effectiveness, harm reduction policies are now endorsed by all evidence-based scientific consensus bodies, including the U.S. Institutes of Medicine and the World Health Organization. This consensus is based on rigorous reviews of the large volume of international scientific evidence indicating that harm-reduction programs save tax dollars and improve public health by reducing HIV rates while increasing uptake of addiction treatment. To read more from Dr. Evan, see click here
In Europe, more than 65 programs like Insite bring street-based drug addicts indoors where they can be prevented from sharing needles and overdosing while increasing enrollment into addiction treatment. Insite has replicated the European experience, and is undoubtedly the most highly studied health clinic in Canadian history. More than 30 peer-reviewed studies show that Insite reduces public injecting, reduces HIV risk behaviors (e.g., needle sharing), and increases rates of addiction treatment. Studies seeking to identify potential harms of the facility found no evidence of negative impacts. Studies were independently peer-reviewed and published in top scientific periodicals, including the New England Journal of Medicine, The Lancet and the British Medical Journal.
During the period from March 10, 2004 to April 30, 2005, 4,764 individuals registered to use Insite. Heroin was used in nearly half of all injections, and cocaine was injected 37% of the time. There were 273 witnessed overdoses, none of which resulted in a fatality. There were also 2,171 referrals to addiction counseling and other support services. These early results indicated that Insite was being successfully integrated into the community. The facility was attracting a wide cross-section of injection drug users, and staff were successfully intervening in overdose events on site and actively referring drug users to addiction treatment and other services.10
A 2006 study showed that Insite was attracting a large number of hard-to-reach intravenous drug users and that the existence of the facility presented an excellent opportunity to enhance HIV prevention through education, the provision of clean injecting equipment, and the availability of a supervised and sterile environment to self-inject. Finally, the facility was also an important point of contact for HIV-positive individuals who were not yet participating in HIV care and treatment.11
One concern prior to the opening of Insite was whether the facility would encourage injection drug use by making drug injection easier and more comfortable for intravenous drug users. Therefore a study was made to determine whether or not the opening of the facility would be accompanied by a worsening of community drug use patterns. The drug use behaviors of 871 intravenous drug users were observed in the one year period before the opening of Insite and in the one-year period after. The drug use behaviors studied included the rates of relapse into injection drug use among former users and the cessation of injection drug use among current users. The study found that after Insite opened there was no substantial increase in the rate of relapse into injection drug use among former users (the rate of relapse was 17% prior to the opening and 20% after). There was also no substantial decrease in the rate of injection drug use cessation among current users (the rate was 17% prior to Insite's opening and 15% after). This research showed that the benefits of Insite on reducing the high-risk behaviors of intravenous drug users and on increasing public order were not offset by negative effects on drug use patterns among Vancouver's intravenous drug using population.12
Critics suggested that the availability of a supervised injection facility might discourage drug users from seeking treatment for their addiction. A study was conducted to examine the effect of Insite on the use of detoxification services, which is the entry point into the addiction treatment continuum in Vancouver. The study followed more than 1,000 Insite users between December 1, 2003 and March 1, 2005. Of this group, 185 (18%) began a detoxification program at some point during the study period. Individuals who used Insite at least weekly were 1.7 times more likely to enroll in a detox program than those who visited the centre less frequently. The study also found that contact with Insite's addictions counselor significantly increased a person's chances of enrolling in detox. Contrary to fears that Insite might be deterring drug users from seeking treatment, these findings strongly suggested that Insite was facilitating entry into detoxification services among its clients.13
In another study, researchers measured the effect of Insite on the use of detoxification services by comparing rates of detox service use among injection drug users in Vancouver in the year before Insite opened and in the year after it opened. The researchers also investigated whether those individuals who attended Insite and enrolled in detox were subsequently more likely to enroll in methadone maintenance or other drug treatment programs. They learned that, in the year after Insite opened, there was a 33% increase in detoxification service use, compared to the year prior to the opening of the facility. The study also showed that Insite clients who entered detox were 1.6 times more likely to enroll in methadone treatment and 3.7 times more likely to enroll in other forms of addiction treatment. As well, individuals who entered detox visited Insite less frequently in the month after enrolling in detox services than in the month prior to enrollment. This research indicated that Insite encouraged intravenous drug users to enter detox. It also suggested that drug users who enrolled in detox were more likely to remain in subsequent treatment programs and reduce their use of Insite.14
I don't have an answer for why ideology trumps scientific evidence in the United States and its media. Why are the opinions of ordinary people in cities across the United States considered more valid than three dozen rigorous scientific studies? Is this just the American way?
Suicide and Mental Health: Australia Journey Day 2
Refresh Tag(s): Aboriginal; Aboriginal; Community; Culture; Healing; Health; Health; Mental Health; Mental Health-Therapy; Mental Illness; (more...) Mind; Spirit; Spirits; Suffering; Suicide, Add Tags (less...)
Add to My Group
March 11, 2011 at 17:12:14
We (Coyote Institute) are on Day 2 of our cross-cultural mental health exchange with aboriginal people in Australia.
Today we met with representatives of Life Is " Foundation to explore some aboriginal concepts of mind and mental health. We began with the problem of suicide. As in most of North America, in Australia, suicide from sadness didn't exist prior to European contact. Suicide, when it occurred, was the result of a social error or transgression so great that they only remedy was to offer up one's life in return. Apparently, some people who were banished from the tribe also chose suicide over life without community. The notion that people get so sad that they kill themselves did not exist. This confirms what we have heard from elders in North America, as well. In North America, to suffer loss and trauma produced a pitiable state which was associated with respect from others. Those who suffered greatly were admired and looked at as examples for how to bear the human condition. One aspired to be worthy of others' pity. This was consistent with what we were told about Australian aboriginal pre-contact conditions.
Apparently the idea that one can become so sad or "depressed" as to kill oneself is a European importation. An elder told us that suicide would have not seemed to have offered much of a solution, because generally people believed that one felt the same way after death as one felt during life. Death was not an end but a passage into spirit world. One's problems didn't go away, but followed one into spirit world. What didn't get resolved in ordinary world would have to be resolved in spirit world.
The fantasy of most of my patients who consider suicide is that it will make the pain go away. All pain will stop. Death represents the ultimate sleep. This idea would have seemed ridiculous to aboriginal people.
As we continued our discussions, we settled on the idea that modern blended culture presents suicide as a way to get back at others, as a way to show them how much they have hurt you, and as a way to make a statement about how bad one feels. Suicide gestures are ways of making definitive statements about one's emotional state. Sometimes people accidentally die in making this communication.
In a sense, suicide is a modern phenomenon. In a world in which no one seems to listen or care, suicide makes a stark statement that "I will be heard". Making a suicide attempt is a way of stating how bad one feels. It becomes a way of expressing inarticulate distress. As such our modern day suicide appears to be a cultural template for expressing severe distress in a way in which others who don't tend to notice how we fee can't help but pay attention. Suicide in modern America and Australia is a cry of distress. The exception, of course, is the people who really want to be dead, who usually quietly succeed in killing themselves without much preamble, though this did not appear to exist either in pre-contact aboriginal life. When one has ongoing relationships to spirits and ancestors and feels accountable to them, then the meaning of suicide becomes entirely different. The felt criticism of those ancestors and spirits can be prohibitive since one would then have to hear their criticism for eternity.
Others have written about the romanticizing of suicide in modern culture. The suicides of prominent role models have made suicide seem like a reasonable choice. Substance abuse also makes suicide all the more likely, which also didn't appear to exist at any appreciable rate in pre-contact aboriginal life.
This discussion led to our discussion about how to respond to the modern crisis of suicide. Everyone present agreed that the biomedical model and the hospitalization model is not working. We wondered what an aboriginal alternative would be. The idea emerged for community safe houses. These would be places where people in distress could go to become instantly ensconced in community. No questions would be asked. The person would not be diagnosed or stigmatized. Community volunteers and elders would be regular visitors to the house. People could participate in talking circles, talk to elders and volunteers, eat a good meal, get "doctored", or perhaps participate in other cultural healing activities like yoga, chi gong, t'ai chi, and the like. Referrals could be made to professionals when appropriate. This model fits well the hocokah concept we have been developing at Coyote Institute. We have been looking for grassroots models for helping in keeping with the idea that ordinary people are well-equipped for being healing for each other. The hocokah concept is that every person needs to be part of a healing circle, preferably including an elder, but able to function without one if none were available. Healing circles meet regularly and provide people with an opportunity to be part of a community of others who care for them. Being able to care for others can also be healing. To have healing circles expand into safe houses or sanctuaries is appealing. For some healing circles to be strong enough to offer sanctuary and respite for the deeply distressed could transform our currently broken mental illness system. Clearly a demonstration project is needed and models exist for more peer-led services. One concept is the clubhouse concept which is for long-term housing. In this concept, people live together and co-manage their lives collaboratively with the help of advisors rather than being administered or managed by others as is often the case today in supported housing for the mentally ill. There are peer counseling centers with drop-in opportunities. In Rochester, New York, the Creative Wellness Coalition runs such a center with free classes in yoga, dance, art, drama, and more. They provide support groups and other potentially therapeutic encounters without participation of any clinicians. It's entirely run by peers and former mental illness system clients. Psychologist Andrew Feldman is helping to create houses in Hungary where people with psychosis can go for peer assistance and the healing voices network has gone international. We have seen groups offered in as far apart areas as Melbourne, Australia and Keene, New Hampshire. The resolution was to form a working group for consideration of safe houses and sanctuaries that could exist outside of the mental illness system. Coyote Institute and Life Is" Foundation will coordinate this and I (Lewis) will explore the creation of a faculty interest group at Union Institute & University. This is one outcome already from our trip. Until tomorrow, g'day mates.
Add to My Group
March 11, 2011 at 17:12:14
We (Coyote Institute) are on Day 2 of our cross-cultural mental health exchange with aboriginal people in Australia.
Today we met with representatives of Life Is " Foundation to explore some aboriginal concepts of mind and mental health. We began with the problem of suicide. As in most of North America, in Australia, suicide from sadness didn't exist prior to European contact. Suicide, when it occurred, was the result of a social error or transgression so great that they only remedy was to offer up one's life in return. Apparently, some people who were banished from the tribe also chose suicide over life without community. The notion that people get so sad that they kill themselves did not exist. This confirms what we have heard from elders in North America, as well. In North America, to suffer loss and trauma produced a pitiable state which was associated with respect from others. Those who suffered greatly were admired and looked at as examples for how to bear the human condition. One aspired to be worthy of others' pity. This was consistent with what we were told about Australian aboriginal pre-contact conditions.
Apparently the idea that one can become so sad or "depressed" as to kill oneself is a European importation. An elder told us that suicide would have not seemed to have offered much of a solution, because generally people believed that one felt the same way after death as one felt during life. Death was not an end but a passage into spirit world. One's problems didn't go away, but followed one into spirit world. What didn't get resolved in ordinary world would have to be resolved in spirit world.
The fantasy of most of my patients who consider suicide is that it will make the pain go away. All pain will stop. Death represents the ultimate sleep. This idea would have seemed ridiculous to aboriginal people.
As we continued our discussions, we settled on the idea that modern blended culture presents suicide as a way to get back at others, as a way to show them how much they have hurt you, and as a way to make a statement about how bad one feels. Suicide gestures are ways of making definitive statements about one's emotional state. Sometimes people accidentally die in making this communication.
In a sense, suicide is a modern phenomenon. In a world in which no one seems to listen or care, suicide makes a stark statement that "I will be heard". Making a suicide attempt is a way of stating how bad one feels. It becomes a way of expressing inarticulate distress. As such our modern day suicide appears to be a cultural template for expressing severe distress in a way in which others who don't tend to notice how we fee can't help but pay attention. Suicide in modern America and Australia is a cry of distress. The exception, of course, is the people who really want to be dead, who usually quietly succeed in killing themselves without much preamble, though this did not appear to exist either in pre-contact aboriginal life. When one has ongoing relationships to spirits and ancestors and feels accountable to them, then the meaning of suicide becomes entirely different. The felt criticism of those ancestors and spirits can be prohibitive since one would then have to hear their criticism for eternity.
Others have written about the romanticizing of suicide in modern culture. The suicides of prominent role models have made suicide seem like a reasonable choice. Substance abuse also makes suicide all the more likely, which also didn't appear to exist at any appreciable rate in pre-contact aboriginal life.
This discussion led to our discussion about how to respond to the modern crisis of suicide. Everyone present agreed that the biomedical model and the hospitalization model is not working. We wondered what an aboriginal alternative would be. The idea emerged for community safe houses. These would be places where people in distress could go to become instantly ensconced in community. No questions would be asked. The person would not be diagnosed or stigmatized. Community volunteers and elders would be regular visitors to the house. People could participate in talking circles, talk to elders and volunteers, eat a good meal, get "doctored", or perhaps participate in other cultural healing activities like yoga, chi gong, t'ai chi, and the like. Referrals could be made to professionals when appropriate. This model fits well the hocokah concept we have been developing at Coyote Institute. We have been looking for grassroots models for helping in keeping with the idea that ordinary people are well-equipped for being healing for each other. The hocokah concept is that every person needs to be part of a healing circle, preferably including an elder, but able to function without one if none were available. Healing circles meet regularly and provide people with an opportunity to be part of a community of others who care for them. Being able to care for others can also be healing. To have healing circles expand into safe houses or sanctuaries is appealing. For some healing circles to be strong enough to offer sanctuary and respite for the deeply distressed could transform our currently broken mental illness system. Clearly a demonstration project is needed and models exist for more peer-led services. One concept is the clubhouse concept which is for long-term housing. In this concept, people live together and co-manage their lives collaboratively with the help of advisors rather than being administered or managed by others as is often the case today in supported housing for the mentally ill. There are peer counseling centers with drop-in opportunities. In Rochester, New York, the Creative Wellness Coalition runs such a center with free classes in yoga, dance, art, drama, and more. They provide support groups and other potentially therapeutic encounters without participation of any clinicians. It's entirely run by peers and former mental illness system clients. Psychologist Andrew Feldman is helping to create houses in Hungary where people with psychosis can go for peer assistance and the healing voices network has gone international. We have seen groups offered in as far apart areas as Melbourne, Australia and Keene, New Hampshire. The resolution was to form a working group for consideration of safe houses and sanctuaries that could exist outside of the mental illness system. Coyote Institute and Life Is" Foundation will coordinate this and I (Lewis) will explore the creation of a faculty interest group at Union Institute & University. This is one outcome already from our trip. Until tomorrow, g'day mates.
Tuesday, March 15, 2011
Treatment Programs - Do they work?
Treatment Programs -" Do they work?
Become a Fan (14 fans) "Live" from the Creativity and Madness conference in Santa Fe, New Mexico, February 14, 2010, Valentine's Day, we consider the question of treatment does it work? Treatment is a billion dollar industry in America. We have treatment programs for everything from alcohol users to drug users to people who have too much sex, to people who have too little sex, to people who eat too much, to people who eat too little, to people who eat and then purge, to people who cut themselves, to people who are too sad, to people who are too happy. So many people go for treatment and so many experts purport to tell people how to reform. The question does it work? Does treatment actually help anyone?
When I worked in Saskatchewan, we attempted to address the simple question of whether "28 day alcohol treatment programs" worked. In general, they didn't. People came home and quickly resumed drinking. At the time I was working with Native people in Northern Saskatchewan. The irony was that we had unlimited funds to send people south to 28 day treatment programs and no funds to organize local support for people coming back from treatment programs.
Previoiusly, when I consulted to an Eating Disorders Treatment Program, I was asked to do a follow-up study of their clients. I discovered that the most successful patients were the "bad patients", those identified by the staff as unlikely ever to succeed. The least successful patients were the "good patients", those who complied, who did everything they were told, who were pleasant and easy. Ironically, the relapse rate of this $1,000 per day, 28 day treatment program was greater than spontaneous recovery rates reported in the literature. Five years after people were diagnosed with eating disorders, 65% had recovered with no treatment. In the treatment program I studied, after 5 years, fewer than 30% recovered with treatment. Apparently treatment did no good.
At this conference, I spoke to a friend about this. He had worked in an adolescent treatment program. He had the same insight. The teenagers who were labelled as bad patients appeared to do the best. These individuals appeared to have "self-agency". They had enough sense of personal power that they could fight the authorities of the treatment program. They could rebel against the treatment staff. In his experience, these patients had the highest likelihood of responding, of recovering. What they had, which apparently we all need, is self-agency, a sense that our efforts can and will make a difference. The compliant patients, the good patients, lacked self-agency. They did what they were told and played the role of good patients, and, once discharged, had no role to play, no direction, and promptly relpased.
Treatment programs of all sorts consume a large amount of the health care budget. Let's examine the assumptions upon which these programs are based. Almost uniformly, they are based upon the assumption that a class of experts exist, who know more about other people than the people themselves know. These experts tell an inferior class of patients how to reform themselves and how to behave to live "the good life". The problem with this is that it doesn't work. Rational expositions of how to live rarely change people's behavior. Largely this is a waste of breath. Why? Because we do not behave as we do out of ignorance. We behave as we do because of our beliefs. They tell us how to behave. Cognitive-behavioral therapists figured this out. But from where do beliefs come? They come from our interpretations of our experience which exist in the form of stories. If you want to know how I cam to believe, ask me to tell a story about an experience which led me to form the conclusion that I have formed. Ask me to tell several stories. I will do so and, whether or not you agree with my interpretations of these experiences, you grasp that I believe my interpretations, and that these stories I tell have come together to generate my conclusions which I now believe wholeheartedly. If you want to change my beliefs (which is necessary to change my behavior), then you need to find stories that contradict the stories I tell to support my belief(s). They need to be compelling, believable stories. They need to convince me. Telling me to think differently or arguing with my beliefs doesn't work.
My friend had an excellent example. He told me a story of a patient who came to him to tell him that the treatment program was a crutch for the girls who were attending it. She described how they preferred to "freak out" and scream and come to treatment than to deal with their problems. He arranged for her to give a lecture to staff about her stories and conclusions and beliefs. She did, but mostly staff ignored her insights, since they definitely knew what was true and this teenager who had no training couldn't possibly know anything.
He told me another story about a girl who was assigned to him because no one else had been able to help her stop cutting. He asked her to talk to "cutting". What did it want? How did it help? She responded with the story of Austin Powers. She said, she had been frozen like him and awakened. When she awakened, she was full of pain. She needed to shut down the pain and cutting did that. It refroze her. My friend proposed a metaphor to her. He asked her to imagine herself as a greenhouse. Each time she tried love, someone broke a window and it got replaced with a wooden board. Eventually, he said, "your greenhouse is mostly covered with plywood and inside has become dark. You need to pick one board at a time to replace with glass, he said. This metaphor worked for her and her cutting reduced.
What was different? He listened to her story. He found a metaphor that resounded to her. He found a metaphor that she could use for change. He didn't tell her what to do. He didn't lecture her. He didn't pretend to know more about her than she knew. He listened to her and then responded to what she said in a way that indicated that he had understood her and then offered her a new twist on her story which could be even more useful. This is the essence of what we call narrative therapy.
My point is that we need to be suspicious of experts. We need to question those who purport to know how to treat others. We need to suspect those who claim to know our minds better than ourselves. We need to question those who would control us and tell us how to make our lives better. We need to suspect those who would do other than empower us.
From a public policy point of view, from a health care reform point of view, from a health care finance point of view, we need to question expensive 28 day treatment programs and focus on more local programs, respectful and empowering, respecting of each person's story, and capable of helping people to transform their story into a better one.
Saturday, September 4, 2010
The Miracle of Peacefulness
The Miracle of Peacefulness
By Lewis Mehl-Madrona (about the author) Page 1 of 3 page(s)
Become a Fan (9 fans)
Become a Fan (9 fans) excerpted from Coyote Healting, chapter 2
The people who consult me are often scared and distressed. An illness threatens the length and quality of their lives. They want to be well. They want to be cured. They want a miracle.
Unfortunately, miracles cannot be guaranteed or produced on demand. What is more certain is our ability to cultivate a sense of peacefulness and meaning even in the face of illness. This is miraculous in itself given today's world and medical culture. So many people sit namelessly, faceless and alone on nursing home floors, passing the time before death.
People typically feel blamed for causing their illness, for we know on some level that we have contributed to our getting sick, if only by being in the wrong place at the wrong time. We sense that how we have lived has had some impact, if only through our lack of kindness for ourselves, the diet we have followed, or the resentment we have never given away. We have some deeper, subliminal sense that our illness somehow relates to the way we live. We have some awareness, however unconscious, that the illness makes sense in the context of our relationships and the choices we have made or that our families have made for us. Regardless of how often doctors and others reassure us that the illness is entirely accidental, that sense of blame does not go away. We have an intuitive awareness that we and the illness are related, and that illnesses are not random. This awareness is implicit within Native American medicine and spirituality. Buddhists call this awareness an appreciation of the causes and conditions of an illness. What torments us and causes us to feel worse about ourselves, is the widespread Western European belief in the power of the individual.
Native cultures teach that the individual does not have the power to get well or sick all on her own, because illness occurs through participation in a life of many constraints. We are born into families with particular beliefs, cultures, values, and habits. These patterns are embedded in our identity. Only through later personal growth activities or therapy do we become sufficiently aware to change these patterns. We tend to think, relate, live, and feel the way our families do.
Beyond that, families are embedded in communities and cultures. Families do not consciously choose their values, beliefs, patterns of relating, and habits. The culture expresses itself through the family.
The "New Age" idea that "you caused your cancer, now fix it," doesn't work. If cancer arises, as Native philosophy teaches, from every aspect of our being, including family, community, spirit, emotions, relationships, genetics, diet, environmental exposures, and more than we can imagine; how can anyone say that one person could cause such an event? I struggle to help people understand that they did the best possible given their resources and beliefs.
With rare exceptions, people are always trying to do their best. Limitations come from how we were raised, our economic and political environment, and our continuing relationships, including those to our families and our cultures. Even life's mistakes can be viewed as unsuccessful or partially successful attempts at self-healing.
When a healing elder said, "Every thought is a prayer, and every prayer is answered," he meant to call our attention to the many prayers that are made each moment by each person. Many are contradictory. Two football teams pray for victory. Only one can win. How is this negotiated?
To my academic friends, I joke that God must be a parallel processing, neural network computer. This joke refers to the way that these devises separate, integrate, and respond to conflicting and contradictory input. On a human side, many philosophers, including Native Americans, speculate that our thoughts create our reality. The Native perspective is that the Universe (Creator, God, or other name) must negotiate these thoughts to produce what we see before us. One elder told the story of a community praying for jobs. A power plant was built upriver and people began to get sick from the pollution. The prayers for jobs had been answered, but at a cost.
Therefore, I work to help people see that the world is too big and too complex, to believe that they single-handedly caused the illness. We may have been taught to want something (like jobs) without understanding the consequences (pollution and illness). We may have no choice but to participate in a society that exposes us to toxic wastes in the name of corporate profit. The ways of relating that we have learned from our families may have the side effect of eventually suppressing our immune systems. But we didn't know this consciously. These processes were not under our control.
The healing journey often involves our becoming more aware of those processes (causes and conditions) that contribute to the illness. Why? To change what we can change! To accept response-ability -- the sense that we can respond and change relationships and habits of behavior, even economic and political ones.
Therefore, a healing journey must begin by addressing the blame a person feels for his role (real or imagined) in getting sick. That sense of feeling blamed opposes the sense of peacefulness that is necessary for any possibility of cure. This sense of peacefulness is what one person called the greatest benefit of working with me. It must solidly exist regardless of what the actual medical outcome will be.
This problem of self-blame is rampant in our culture. Doctors ask me if I don't encourage people to feel worse if they don't get well. I respond that my first task is to help them abandon the concept of blame. I aim to nurture compassion and loving kindness. I understand that people are always doing the best they can, given what they have learned (beliefs and experience) and what resources are available to them (income, social class, education). No one would intentionally give herself cancer. No one would purposefully give herself AIDS. No one would press a button to destroy her kidneys, except for the most desperately suicidal, and even they are still doing the best possible given their beliefs and resources.
People do not make mistakes; they make unsuccessful attempts to heal. Even the antisocial criminal is struggling, however unconsciously, to heal some aspect of his or her life, perhaps to steal back the love he or she was never given.
An example brings these concepts alive within a unique human being, and shows some of the ways I help people find peacefulness. Ursula was a 47-year-old woman healing uterine fibroids and migraine headaches. Through our work together, her fibroids had dramatically shrunk and her headaches were almost gone. She came to the session I want to describe, abruptly different, feeling drained and wanting to give up. Suddenly, she was having fantasies of dying in her sleep. During the past week, her 16-year-old daughter had spent a night of intense retching after getting terribly drunk at her birthday party. Her son had been arrested for assault. One of her psychotherapy clients had killed himself. Her younger boyfriend had declared his inability to make a commitment because she was too old. Business was falling off and she worried about money. A major client had bounced a check on her and hadn't yet replaced it. Finally, she felt as if she was coming down with a major sinus infection, or at least a bad cold.
Ursula looked absolutely drained. I suggested she lie down with her head to the north so that her brain was closer to wisdom (comes from the direction of the north on the medicine wheel), and that I do energy/body work with her. I began by placing my right hand on the sinus areas above her eyes. My left hand roamed above her body, several inches out of contact, feeling her energy field. All of her energy felt subdued, as if she had contracted her soul into a small ball inside her heart the only area that felt normal (In Chinese Medicine, the heart is the seat of the soul).
Energy healing is hard to describe with words, and some readers will doubt its very existence, imagining that my mind fabricates the feelings and sensations of moving my hand through and above another person's energy field. Science, I would say, is catching up with this, and studies are appearing to demonstrate the validity of these phenomena. Nevertheless, for our purposes in this book, their validity isn't as important as how people respond to the process of therapy.
As my left hand moved above Ursula's body, I felt her energy slowly increasing. I imagined moving healing energy through my right hand and into her sinuses. Having been raised "hybrid Christian," I sometimes imagine when I am working in this way, that the Christ Spirit, or Christ Consciousness, moves through my hand, rearranging molecules and structures in the person's body, thereby creating the healing. I feel comforted by the connections of this feeling with my childhood visions of Christ, even though I understood that my grandmother's version was not basic Christianity. Nevertheless, as I read Christian mystics (Meister Eckhart, Hildegard of Bingen, Matthew Fox, Thomas Merton), I realized that my Christ was their Christ, a higher principle of love and consciousness of all humanity (what my grandmother called the chief spirit of the humans), who heals by mere thought or glance. I felt this healing energy coursing through my right hand into her sinus area. I can't always make this happen on demand, so it's an honor and a privileged when it does.
On impulse, I began to talk to Ursula about stepping back and looking at her life the way angels would see her. "How would they see me?" she asked, genuinely puzzled, turning her head on the blue naugahide of the massage table to peer at me. She was sweating at the edge of her short, brown hair. The setting sun was still bright against the white wall.
"They see you as exquisitely precious and lovely beyond belief," I answered. "They see your life as a beautiful work of art, whether you heal or not, whether you live another day or not, whether you solve any of your problems or not, whether your children succeed or not, whether your clients live or die, pay or don't pay. You and your life are art in their dimension, and no human life is bad art. Even the most sordid life is appreciated and honored there. Their joy in you, your suffering and pain, your happiness and pleasure, is so complete, that you need not do one more thing for them to love you passionately forever." Street lights were beginning to flicker on outside the window.
"How do you know this?" she said. I could see people crossing the street at the corner by Carnegie Hall.
I sheepishly replied, "I've had some conversations with them." Here's where I find myself walking on thin ice. My brief conversations with angels have been among the most profound, peak experiences of my life. Though some would argue that these experiences are just imagined, I think not, because they have always changed me for the better. They gave me more compassion, more kindness, more love for humanity, more flexibility, more tolerance, and more willingness to accept and forgive the foibles of others. They made me a better human being and a better doctor. If imaginary, I need more of these fantasies, and wish I could produce them on demand. In distinction, the visions of psychotic patients, imagined or real, are definitely not angelic, for theirs aggravate their fear and deepen their suffering. The signs of Shelley's steakhouse reflected red against the opposite graying wall.
"One of my most powerful experiences," I continued, "happened during midnight mass on Christmas Eve in a wooden, Catholic Church in South Burlington, Vermont. The choir was singing the Hallelujah Chorus. I looked at the window above the cross, and saw an angel outside, seemingly hanging in space, wings folded behind him. Then feelings and words exploded inside my mind. (Others have reported similar experiences.)
"'We have to be careful when we talk to you,' he said, "for even a small part of the love we feel for you would destroy your nervous system. We have to give you very small doses of what we feel or we would hurt you.' I sensed the potential for pain even in the ecstasy of that contact. He proceeded to explain, or rather, give me an instantaneous understanding that surpassed what is possible with words or pictures, of their view of us -- of us as works of arts, of their dimension as holding a kind of gallery in which each of our lives can be seen in its entirety as a multi-dimensional structure, a dimension outside of time in which beginning and end are present together.
"I try to communicate that vision directly or indirectly to my patients. I try to teach them to love themselves at least a small part of how an angel would love them. So maybe we could just begin to imagine that level of unconditional love. Humor me, and play with imagining that everything about your life is exquisitely perfect just the way it is."
I did have other perspectives on Ursula's life problems. I knew that her daughter was a very bright, athletic, straight-A student in a difficult private school. I knew that her son had fought back from a bitter depression in which he had almost killed himself, and was doing quite well. I had heard the story of his "assault" and felt certain the charges would be dropped. I had met her boyfriend, and believed she would be happier without him. He was self-centered and unable to care for her in the manner she deserved. I knew she was a very good therapist. We had talked about her patient at length when he was still alive, and I knew she had done everything possible. He had actually died in a psychiatric hospital, relieving her of any liability or even culpability for his demise in the eyes of established psychiatry. She had done everything correctly in the conventional sense of psychotherapy. She had just not saved him, as she had so desperately wanted to do. That was why she blamed herself for this death that had happened only days before. Therefore, I could afford to focus on unconditional love, self-forgiveness, and loving kindness. As we did, her energy field grew stronger and stronger. Her nose seemed less stuffy. She breathed easier.
I finished by rubbing points on her neck and skull that are related to sinus problems. I had felt blockage in the movement of energy at these areas. Then I used a technique called craniosacral therapy in which subtle pressure is applied to the cranial bones to make shifts so that energy (and spinal fluid inside) can flow more smoothly. Her breathing deepened. Her body relaxed. She felt more calm and peaceful. She was ready to continue the work we were doing on shrinking her uterine fibroid* and eliminating the remainder of her migraine pain. *See my paper on alternative treatment of uterine fibroids.
I was encouraging Ursula to lovingly see herself as perfect. She could only do so by letting go of self-blame. Eliminating self-blame is so different from the individualistic concept of some "New Age" approaches that tell people, "you created your illness, now get over it." From this limited understanding of the complexity of health and disease, people feel like failures if they can't heal their cancer (for example). The complexity of health and healing is phenomenal, and means that our small minds can't control (or even begin to imagine) the myriad of forces involved in making us sick or making us well. But everyone is capable of some degree of personal and spiritual transformation, and even of imagining the possibility of angelic intervention and miraculous healing. These are possible, but not something to feel guilty about if not achieved.
Once we eliminate feelings of personal blame, we must address hope. Hope is hard to define, though we can immediately recognize those who have it and those who don't, even if we don't know how we make that distinction. Real hope is a by-product of creating a sense of peacefulness.
For many years I thought my job as a physician was to help people get well. I didn't recognize the importance of peacefulness, and of helping people discover meaning and purpose in whatever experience they had. I sometimes humorously described myself as a clinical engineer, matching treatments to patients. My job was to solve the problem of finding a path to wellness. The problem with the engineer analogy was that not everyone got well no matter how diligently I plotted their paths. Some people died regardless of my efforts. Then, the engineer metaphor failed me, and I felt lost. No amount of analyzing or understanding could bring the desired results to some patients, who died despite my best efforts.
We have all grown up believing that science and its expertise will save us, and it is sobering when it doesn't. Our belief in medicine is so strong, that we usually turn to alternatives or to God as a last resort, when conventional treatments have failed. We are trained to believe in the experts and their technologies.
Wednesday, August 4, 2010
Walking with Dementia
From http://www.futurehealth.com/
This weekend was to be my weekend to visit my son, Takoda, in Burlington, Vermont, where he has been attending college. Instead, he finished classes sooner than I had anticipated and used some of my United Airlines miles to fly to Hawaii to visit his girlfriend. Suddenly I had a completely free weekend, so I decided to visit Toronto where a friend was helping his mother put his father into long-term care. My friend's father had progressively deteriorating vascular dementia, meaning that his dementia had been caused by multiple strokes, each one leading to a stepwise deterioration in brain function. He had the usual risk factors hypertension, overweight, high fat diet, excess hard liquor consumption, history of long-term cigarette smoking, family history, but, of course, that doesn't make it any easier on the family when the inevitable stroke occurs. This was the long awaited weekend in which my friend's mother had finally had enough she couldn't care for her husband at home any longer. No one could blame her. He couldn't control his bowels or his bladder. He talked incessantly and understood little. He required half an hour of coaxing just to take his morning medication. The only way he could read the newspaper was to sing it, since that recruited a part of his brain that could still read. He couldn't recognize words unless he sang them. Even then, it wasn't clear whether he comprehended the words he was singing.
I was recruited to take Ian for a walk while my friend took his mother shopping. I was a bit apprehensive because I had heard stories about his aggressively accosting people and wandering into strange houses. I wasn't sure what I would do if he pooped his pants in the middle of the walk. What would people think if we were walking with poop dripping out of his shorts. Nevertheless, I kept my worries to myself like a good guest. After all, I am a geriatrician and a psychiatrist. I should be able to take one octagenarian with dementia for a walk. My friend's mother laid out the route on a map of their neighborhood one large square designed to take him past several parks and on roads that were not too busy.
My first challenge was to get Ian to the washroom before his walk. I had been strongly advised to do so to avoid mishaps on the walk. However, regardless of how hard I tried, Ian wouldn't go into the washroom and was suspicious of why I wanted him to do so. He kept suggested I go to the washroom or that I come inside and see what he could do. That sounded like more than I could handle on a Saturday morning, so I declined, abandoned the pre-walk washroom idea, and steadfastly resolved that I would muddle through whatever came. I told him in no uncertain terms that we were going for a walk. At first, he heard talk. I spoke louder and repeatedly, and he finally heard walk. I handed him his hat and his walking stick, and then he clearly understood. We stepped out of the house and preceded North along his street, walking a slight incline. His wife had warned me that he walked with the speed of a turtle, and she was not entirely wrong, though I have seen wombats in Australia move this slowly, as well as koalas who've eaten too many intoxicating gummy leaves.
Nevertheless, we had a marvelous walk and I learned much about the workings of his brain. In a fascinating way, his brain matched the patchwork that one would expect with a vascular dementia in which there were intact islands of function surrounded by much more immature brain processes. His patterings on the walk gave me some insight into how the brain of an infant or a young child might work. First, he was fascinated with trees. He kept saying, "they put them here." "They put them here." Sometimes they fall down or they take them down." He had the concept of trees being placed instead of growing on their own, and I learned later that he had been instrumental in arranging for trees to be planted along many of the streets in his neightborhood during the earlier years of his retirement. Trees, in his world, had literally been placed instead of springing naturally up from the sides of busy Toronto streets.
Then he explained rocks and stones to me. I came to realize that he was classifying stones according to their color and texture. The darker grey of the roadway was clearly a different stone than the lighter gray of the sidewalk. We walked by a college that had a low stone wall, and those irregularly shaped, roundish stones were not stones at all, but rather "things that you strike them and they go bang." Other stones were "things that you hit and they fall down." I could see his brain struggling to make classification systems to assign rock-like, stone-like objects into their appropriate container. He had another great definition of houses as "the place where the keep people in between their coming and their going." He wondered who lived in each house we passed and asked me if I knew. Of course, I didn't, having never been to this section of Toronto ever before in my life. He asked me what the people were doing inside the houses, which, of course, I didn't know either. He was very interested in the people and their relationship to the trees in the yards and wondered why the people had put each tree where it was placed. What remained, despite his severe dementia, is the incredible curiosity that seems innate to we humans. He wanted to go into houses to "see what was going on in there." He saw a mother with two children and speculated about who she was and what she was going to do with the children next, though he couldn't invent any proper nouns about what they would do next. He said, they would be "going and doing." That's what children are about, he said. "They go and do." They certainly do, I agreed.
He was also fascinated by a man who was hammering a post into the ground. "Let's ask him what he's doing," he said. "He's hammering a post into the ground," I said. "Probably he's going to hang a sign off that post." "Let's ask him what he's doing," Ian responded. Apparently he wanted to hear the answer from the man himself. He didn't want my interpretation. Here is evidence for that tendency of humans to want to prove things to their own satisfaction, to investigate phenomena on their own and not to rely upon other people's stock answers, which may or not be wrong.
When people walked or ran by, Ian would directly and loudly confront them. "Who are you?" he would say. "Where are you going?" Some people were taken aback. Others recognized the dementia within him and responded kindly and carefully. Perhaps they had relatives with dementia. Those who didn't were either defensive, explaining their right to be in the neighborhood, or worried that someone would confront them so directly. I tried not to interfere. He was showing the natural curiosity we humans have about other people where they are from, what is their motivation, where are they going, what are they doing. These were his questions about everyone we met, and his questions about the houses and what was happening inside them. Nothing drew his attention more than other people not trees, not squirrels, not houses, not cars, not airplanes, though he noticed cars and planes, and wondered about the people inside those cars and planes.
He kept asking me where I was from, equally surprised at each answer that I was from the United States. Where did you come from? I kept answering him that I had driven there from Buffalo, New York, since that was where I had been working during the week. He found that surprisingly amazing.
At the end of the day, the earth is our ultimate mother, perhaps a better mother than our own mothers. I remember a story about a friend coming upon a bear with cubs and freezing in her tracks, expecting the bear to maul her. The bear only breathed on the back of her nect and then moved away. Dementia had done more than breathe upon Ian. It had come to almost completely occupy his brain. Nevertheless, it contained mysterious teachings, messages from spirits, people that Ian could see when I could not. Now Ian was seeing and talking to spirits as if they were real people. My friend had remarked that previously he had held an obiesance to abstract Anglican Church spirits, but only as an abstract concept, not with genuine ontological status. Now his spirits and ghosts were more than real.
The message of the week is that we need to spend more time with those who are demented or psychotic, listening carefully to the teachings of their words. Throughout this week, my psychotic patients and my friend's demented father have given me great, mysterious teachings, so much more than I had expected, and so much more deeply connected to the Great Mysteries, the Spirits of the Land, and the ghosts that walk upon the earth. Perhaps dementia is really just a very slow passage into spirit world, for those who fear the sudden passage that would be thrust upon them
This weekend was to be my weekend to visit my son, Takoda, in Burlington, Vermont, where he has been attending college. Instead, he finished classes sooner than I had anticipated and used some of my United Airlines miles to fly to Hawaii to visit his girlfriend. Suddenly I had a completely free weekend, so I decided to visit Toronto where a friend was helping his mother put his father into long-term care. My friend's father had progressively deteriorating vascular dementia, meaning that his dementia had been caused by multiple strokes, each one leading to a stepwise deterioration in brain function. He had the usual risk factors hypertension, overweight, high fat diet, excess hard liquor consumption, history of long-term cigarette smoking, family history, but, of course, that doesn't make it any easier on the family when the inevitable stroke occurs. This was the long awaited weekend in which my friend's mother had finally had enough she couldn't care for her husband at home any longer. No one could blame her. He couldn't control his bowels or his bladder. He talked incessantly and understood little. He required half an hour of coaxing just to take his morning medication. The only way he could read the newspaper was to sing it, since that recruited a part of his brain that could still read. He couldn't recognize words unless he sang them. Even then, it wasn't clear whether he comprehended the words he was singing.
I was recruited to take Ian for a walk while my friend took his mother shopping. I was a bit apprehensive because I had heard stories about his aggressively accosting people and wandering into strange houses. I wasn't sure what I would do if he pooped his pants in the middle of the walk. What would people think if we were walking with poop dripping out of his shorts. Nevertheless, I kept my worries to myself like a good guest. After all, I am a geriatrician and a psychiatrist. I should be able to take one octagenarian with dementia for a walk. My friend's mother laid out the route on a map of their neighborhood one large square designed to take him past several parks and on roads that were not too busy.
My first challenge was to get Ian to the washroom before his walk. I had been strongly advised to do so to avoid mishaps on the walk. However, regardless of how hard I tried, Ian wouldn't go into the washroom and was suspicious of why I wanted him to do so. He kept suggested I go to the washroom or that I come inside and see what he could do. That sounded like more than I could handle on a Saturday morning, so I declined, abandoned the pre-walk washroom idea, and steadfastly resolved that I would muddle through whatever came. I told him in no uncertain terms that we were going for a walk. At first, he heard talk. I spoke louder and repeatedly, and he finally heard walk. I handed him his hat and his walking stick, and then he clearly understood. We stepped out of the house and preceded North along his street, walking a slight incline. His wife had warned me that he walked with the speed of a turtle, and she was not entirely wrong, though I have seen wombats in Australia move this slowly, as well as koalas who've eaten too many intoxicating gummy leaves.
Nevertheless, we had a marvelous walk and I learned much about the workings of his brain. In a fascinating way, his brain matched the patchwork that one would expect with a vascular dementia in which there were intact islands of function surrounded by much more immature brain processes. His patterings on the walk gave me some insight into how the brain of an infant or a young child might work. First, he was fascinated with trees. He kept saying, "they put them here." "They put them here." Sometimes they fall down or they take them down." He had the concept of trees being placed instead of growing on their own, and I learned later that he had been instrumental in arranging for trees to be planted along many of the streets in his neightborhood during the earlier years of his retirement. Trees, in his world, had literally been placed instead of springing naturally up from the sides of busy Toronto streets.
Then he explained rocks and stones to me. I came to realize that he was classifying stones according to their color and texture. The darker grey of the roadway was clearly a different stone than the lighter gray of the sidewalk. We walked by a college that had a low stone wall, and those irregularly shaped, roundish stones were not stones at all, but rather "things that you strike them and they go bang." Other stones were "things that you hit and they fall down." I could see his brain struggling to make classification systems to assign rock-like, stone-like objects into their appropriate container. He had another great definition of houses as "the place where the keep people in between their coming and their going." He wondered who lived in each house we passed and asked me if I knew. Of course, I didn't, having never been to this section of Toronto ever before in my life. He asked me what the people were doing inside the houses, which, of course, I didn't know either. He was very interested in the people and their relationship to the trees in the yards and wondered why the people had put each tree where it was placed. What remained, despite his severe dementia, is the incredible curiosity that seems innate to we humans. He wanted to go into houses to "see what was going on in there." He saw a mother with two children and speculated about who she was and what she was going to do with the children next, though he couldn't invent any proper nouns about what they would do next. He said, they would be "going and doing." That's what children are about, he said. "They go and do." They certainly do, I agreed.
He was also fascinated by a man who was hammering a post into the ground. "Let's ask him what he's doing," he said. "He's hammering a post into the ground," I said. "Probably he's going to hang a sign off that post." "Let's ask him what he's doing," Ian responded. Apparently he wanted to hear the answer from the man himself. He didn't want my interpretation. Here is evidence for that tendency of humans to want to prove things to their own satisfaction, to investigate phenomena on their own and not to rely upon other people's stock answers, which may or not be wrong.
When people walked or ran by, Ian would directly and loudly confront them. "Who are you?" he would say. "Where are you going?" Some people were taken aback. Others recognized the dementia within him and responded kindly and carefully. Perhaps they had relatives with dementia. Those who didn't were either defensive, explaining their right to be in the neighborhood, or worried that someone would confront them so directly. I tried not to interfere. He was showing the natural curiosity we humans have about other people where they are from, what is their motivation, where are they going, what are they doing. These were his questions about everyone we met, and his questions about the houses and what was happening inside them. Nothing drew his attention more than other people not trees, not squirrels, not houses, not cars, not airplanes, though he noticed cars and planes, and wondered about the people inside those cars and planes.
He kept asking me where I was from, equally surprised at each answer that I was from the United States. Where did you come from? I kept answering him that I had driven there from Buffalo, New York, since that was where I had been working during the week. He found that surprisingly amazing.
At the end of the day, the earth is our ultimate mother, perhaps a better mother than our own mothers. I remember a story about a friend coming upon a bear with cubs and freezing in her tracks, expecting the bear to maul her. The bear only breathed on the back of her nect and then moved away. Dementia had done more than breathe upon Ian. It had come to almost completely occupy his brain. Nevertheless, it contained mysterious teachings, messages from spirits, people that Ian could see when I could not. Now Ian was seeing and talking to spirits as if they were real people. My friend had remarked that previously he had held an obiesance to abstract Anglican Church spirits, but only as an abstract concept, not with genuine ontological status. Now his spirits and ghosts were more than real.
The message of the week is that we need to spend more time with those who are demented or psychotic, listening carefully to the teachings of their words. Throughout this week, my psychotic patients and my friend's demented father have given me great, mysterious teachings, so much more than I had expected, and so much more deeply connected to the Great Mysteries, the Spirits of the Land, and the ghosts that walk upon the earth. Perhaps dementia is really just a very slow passage into spirit world, for those who fear the sudden passage that would be thrust upon them
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