Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

Monday, December 3, 2012

Day 5 of the Australian Journey 2012

Today is our second day in Warburton with Auntie Jennie and the Karith House of Prayer.   Every morning on the Australian Tour, I get up before the sun and run.   Yesterday I ran along the Upper Yarra River to Martyr Hill (a 27% grade) where I painstakingly ascended to the top, then entered the Donna Buang Trail, a 70 kilometer hike, of which I sampled just the first bit. The songs of the birds spectacularly surrounded me, resembling what I would expect from a rain forest, though in my naivete, I expected monkeys to be part of the auditory scenery.   I had the privilege to see a beautiful red fox, which surprised me since I didn't think foxes lived in Australia.   Later when I asked about the fox, I learned that they had been brought to Australia by the British rulers for their classic fox hunt.   The foxes quickly overran the local wildlife since they had no natural predators and became pests.   (Just like the English, someone at the breakfast table quipped.)   I pointed out that it wasn't actually the fault of the foxes, since they weren't the ones to buy the tickets to Australia and probably didn't enjoy the journey either.   You can get $10 for killing a fox and presenting its pelt.   It's equally not the personal fault of those who have English ancestry for bringing the foxes since they weren't alive when the fox idea was conceived and executed.   I don't think we have to hold guilt for the deeds of our ancestors.   There's enough in the world to make everyone dysfunctional without needing more.   I agree with don Miguel Ruiz and Olivier Clerc that we need to forgive and be forgiven more than we need to blame and be blamed.
This part of Australia superficially resembles Vermont, where I live.   The mountains are a bit higher in Vermont, but that's where the resemblance ends.   There's no rocks here.   The forest floor is thickly filled with ferns and exotic looking plants that resemble large pineapple plants without   the fruit.   The major tree is the eucalyptus or gum.   As one ascends to the higher altitudes, pines appear, but not like any Vermont pine.   Last year we were running when it was still dark and saw a wombat.   I only saw scat this year.   Surprisingly given daylight savings time, the sun rises late in Southeastern Australia.
This morning I took a different route.   I ran up a new road on the same steep hill to get to the O'Shaunessy Aqueduct Trail.   I ran along an old aqueduct for a ways before turning up the hill on the Mt. Victoria Trail.   I wondered how one keeps the water out of the aqueduct even as streams tumbled down the hill beneath it.   Nature was breaking up the concrete and taking back the land.   A short ways up the last trail, I had to turn around and ran back to Karith.   I can vouch that it's quicker to run downhill than uphill but it's harder on the thighs.
Warburton is a small town, barely one row of buildings on either side of the road.   The architecture is one I have only encountered in Australia, a kind of combination between English country homes and Indonesian style.   The closest I have seen elsewhere is the French Quarter in New Orleans.   The Upper Yarra River runs behind one of those rows, flowing all the way to Melbourne and into the ocean there.   I met a woman named Maya who wrote a marvelous book on her hiking journey along the Upper Yarra River from its source to the sea.   I asked her if she was going to honor any other rivers, but she said, "No, this is my homeland.   That is my River.   I wouldn't have authority or permission to write about anyone else's river.   She was obviously aboriginal in her thinking about land and territory.
When we arrived at the Village Hall where we were doing the workshop, the door was locked.   We milled around in front of the movie posters including George Clooney's latest film for the Town Hall doubled as the Village Cinema.   Since "the show must go on", we had to improvise.   Our hosts were frantically trying to track down one of the City employees to open the building.   I suggested we go sit beside the river and at least get started.   We meandered down our side of the river to the Brisbane Bridge and crossed over to the other side where I had spotted a nice grassy area suitable for our group.   Rocky and I proceeded to do the opening song to honor the Four Directions after we had acknowledged the land, the aboriginal people who were attached to this land along with their ancestors, and the spirits who walked upon the land.   Then we did a spirit calling song to make sure that proper notice had been given to the spirits that we were planning to do a ceremony.   Auntie Jennie then spoke some about the importance of men coming into the medicine.   In her family as in mine, there were at least two, if not three, generations which were entirely lacking in men.   All the men were dead or in jail or lost.   My grandfather was the only exception as was Aunt Jennie's.   She continued to talk about the men in her family and her ancestors which inspired me to propose that we do a tobacco ceremony in which we smoke for the spirits and anyone who receives a message from them stands up and delivers it.   This turned out to be a powerful ceremony.   I offered the tobacco and a number of people stood and spoke in Quaker meeting fashion.   In my mind's eye I saw my ancestors crossing the great divide (the Pacific Ocean) and embracing Auntie Jennie's ancestors and all sitting down in a circle and smoking together to signify unity and peacefulness.   One said that war actually hadn't been on the planet all that long and could still be eradicated.   I saw ancestors standing behind each person present.   Several others spoke of similar sightings.   We passed tobacco around the circle for everyone to smoke just as I had seen.   Then one of our hosts appeared and announced that the employee who was supposed to open the hall had finally arrived and we could return.   Many of us did not want to leave the river and its soothing sounds as it moved past the first rocks I had seen in this countryside.
After we settled back into the building, Rocky spoke about the untold and silent stories that become physical illnesses.   These stories need to be elicited.   The organs and the tissues who manifest the diseases need to be engaged in conversation to tell their stories.   The lessons we were learning were not just pertinent to mental health.   He gave an example of working with a woman who was having severe right hip pain.   He used acupuncture and some osteopathy while he encouraged her to let her hip tell its story.   As a surprising but highly relevant story emerged, the pain moved to the left hip, then the left knee, and then left her body.   It had been stuck in her hip.   I suggested Brian Broom's marvelous book, Meaning-full Illness.   Auntie Jennie confirmed that this view was also consistent with what aboriginal people believe and how they heal in her area of Australia.
After lunch we wanted people to experience how ceremony builds community, so we chose a ceremony that I created based upon my readings from ethnographies written before 1900 of a "Welcome to Camp" ceremony.   It hasn't been done since 1880, as far as I can determine.   I can imagine someone getting ready to bristle, so I'll quickly say that I believe it's acceptable to create ceremony for specific purposes as the need arises.   It's not a Native American ceremony because it's not currently done and there's no model to follow or elder to teach it.   It may have some Native American flavor (we can't help infusing our spirituality into the ceremonies we create), but it's really an ecumenical attempt at experiencing some degree of transcendence toward the spiritual, which is exactly what I would call it.   Or, since I'm also a member of the Unitarian-Universalist Church, perhaps I should call it a "U-U greeting ceremony".
   The inspiration for this ceremony comes from Plains peoples of North America, before they were penned into reservations.   In those days, camps frequently moved.   During certain times of the year camps would join each other for celebrations and larger rituals.   A ceremony was done to oversee this process.   In one that I read, seven tipis were set in each of the seven directions so that the person walked a spiral toward the center.   This was done outside and to the East of the main camp.   Those people wanting admission to camp participated in the ceremony along with those who controlled the admissions process.   The supplicant who wished to enter the camp started in the West and passed to each of the directions.   In the original ceremony, the intent was that each person proved that he possessed the virtue of that direction.   In my readings, only men participated, but that may have been a side effect of the gender-nearsightedness of many of the ethnographers writing before 1880 who were often sexist and might not have noticed women even if they outnumbered men.   At each direction, the applicant to the camp tells a story about a deed that exemplifies the virtues of that direction.   In my ceremony, I used courage for the west, strength and endurance for the north, receiving and following a vision for the east, compassion for the south, protecting someone for the sky, and nurturing someone for the earth.   Then he is welcomed in the center and led into camp.   I'm going to guess no one was ever turned away because the incoming group were known and had been previously vetted.   This was just a formal way to say hello.
I use my ceremony with Native American people though, as I said, it is not a traditional Native American ceremony.   I use it especially with people who have drug and alcohol problems because they are not used to saying anything positive about themselves.   The beauty of this ceremony is that it emphasizes one's good traits and deeds.   So many people are quick to tell stories about their faults and misdeeds, but isn't it much harder to tell stories about what we have done well, or times when we have been courageous, or strong, or compassionate, or protected someone or something else?   This ceremony forces people to reflect upon what is good about them and to share it with another person who only listens, standing in the position that symbolically represents one of the Directions.   Participants feel how it changes them to tell good stories instead of bad stories and they feel the camaraderie that comes from being heard without commentary or personal response and being accepted.   Those who have completed the process are led to a nearby part of the room where they can sing, dance, or help each other in some way.   We keep a continual steam of singing and dancing going, because, as a Sari elder told us in Mexico, you can never sing or dance enough for the spirits.   When we did ceremony with her, she would exhort us with "mas bailando; mas cantando".
We did this ceremony with the group and Auntie Jennie agreed that it did succeed in giving them some flavor of the transcendence and sense of group membership that participation in tradition ceremony in community provides.   People also spoke about how difficult it was at first to be positive about oneself and how embarrassed they were.   Isn't it interesting that we are more embarrassed to tell positive stories about ourselves than negative ones?!   They also spoke about how transformative it felt to actually get out the positive story and for it to be accepted. They described the joy of completing the process and being welcomed to the community.   For some that community will continue, since talking circles are held weekly for those who live in the area and efforts are being made to find constructive ways for people to spend time with each other.
Later that evening after the workshop, we talked with our hosts about the problem in aboriginal communities for some people that family gathering was centered around drinking or doing drugs. The physician in our party who worked in the aboriginal community reported that she wasn't permitted by some families to make home visits on Thursday, Friday, or Saturday because of the partying that they didn't want her to see.     In relation to this we talked about the power of ceremony, even the ceremony of drinking together, for it is, after all, a kind of eucharist or communion.   It's no accident that alcohol is called "spirits".   We talked about the necessity of engaging the elders to put healthier ceremonies back into place in communities in such a way that people can notice and can attend.
In Warburton, we finished the day by offering traditional pipe ceremonies for those present.   We left to return to Melbourne to prepare to travel into the East Gippsland countryside early the next morning for Culture Camp 2012.

Wednesday, August 1, 2012

Day 4 of the Australian Journey 2012: Musings with Auntie Jennie

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.

Sunday, February 26, 2012

Sweat Lodge, Prayer, and Community

"Long long ago the Muscogee Creek people lived in a dark misty fog and they were cold. They felt along the walls of something damp and realized they were moving upwards. Slowly they emerged from the Earth and the fog blinded them. Unable to see and stricken with fear, the people and even the animals cried out until the wind blew away the fog so that they could see... In all four cardinal directions, the forces of fire confronted the people, and they had to make a decision. From the south, a yellow fire faced the people, a black fire burned in the West, a white fire was aflame in the East, but the people chose the red fire from the North. The fire of the North warmed the people and provided bright light over the world and enabled the plants to grow, so that the Muscogee Creeks learned to respect all of the elements for life".Should the people fail in their respect for nature and forget the ceremonials, the people would disappear from the land and it would fall beneath the waters of the ocean." Muscogee Creek traditional story, 1922, from Donald Fixico, p. 1-2 The American Indian Mind in a Linear World This weekend I had the opportunity to lead an inipi, or sweat lodge ceremony, for a group of health care providers from the American Institute for Medical Education's annual February Creativity and Madness conference, in Santa Fe, New Mexico. Given the subject matter of the conference, it's not surprising that more than half of these providers were in the mental health field. After three hours of preparation on Sunday afternoon following the formal closing of the conference, we convened on a bright, blue, sunny, but windy Presidents' Day morning in the mountains outside of Santa Fe, at the Heyokah Center, a facility started by our recently departed friend, Julie Rivers, who also founded a not-for-profit organization called Supporting Women Across Nations (SWAN -- Julie's mascot animal) over 30 years ago. SWAN and Heyokah continue thanks to Julie's sister, Donna. SWAN began to support indigenous women around the world to overcome gender-related oppression and to be encouraged to bring forth their own cultural healing traditions that women have carried for centuries, sometimes in secret when governments have been particularly suppressive. We were there on a similar mission -- to bring some of the wisdom of Native North American into the mainstream world of medicine and psychotherapy. We were there to remind our attendees (10 people from a conference of over 200) about the importance of keeping the ceremonials, as emphasized above by the story told by Fixico. The inipi, or sweat lodge ceremony has been well-described elsewhere, so I will be brief. I understand its primary purposes to be prayer and community building. Sweat lodges, with rare exceptions, provide a place and a context in which people pray. I was taught to "think globally, but pray locally." "Pray for things you can see come true in four days," was another teaching. I learned to pray that sick people still be with us and even feel a bit better by the upcoming Full Moon. In this way, we can see that prayers are answered and that awareness will build our faith so that progressively larger prayers can come true. The notion of prayer and the importance of community are two concepts which have largely disappeared from contemporary health care. Our goal in leading this ceremony was to show these practitioners that the values of prayer and community are important, and to experience how they can be built. The sweat lodge is a low dome-like structure, covered with sheets and blankets and canvas tarps (once upon a time, covered with animal skins). Bucko has described the many variations in just the Lakota Nations sweat lodges, but some basics persist, including heating rocks in a fire outside the lodge until they are sufficiently hot to bring into the lodge. Water is poured upon the rocks to generate steam, and the people sit inside on the earth around the rocks. Generally everywhere, four cycles of door closing to door opening exist. The cycles are often called rounds. At some point a sacred pipe is smoked to signify prayers being answered, people sing, and people pray. Ubiquitous is the sense of connectedness and belong that occurs through participation in the ceremony. I wrote in Coyote Medicine about the style of sweat lodge I learned to lead. It came through the Black Elk family lineage. In this style, we begin with a ritualistic filling of the pipe with tobacco after singing a traditional song. Ceremony prepares the pipe to do its job of translating our human prayers into a form that can travel straight to the Creator. Stones are brought into the lodge, sage is placed upon them, the first seven are placed in each direction and blessed by the pipe, the pipe is placed upon the altar, water is brought inside, the door is closed, and the round begins. Water is poured upon the stones to create steam and four songs are sung. This first round is for purification and release, dedicated to the West and the Sacred Beings who dwell there. The door opens, people rest a bit, more stones enter, the door closes, a song is sung, and each person gets an opportunity to pray. When we have gone around the circle and everyone has prayed, the door opens, medicine water is brought inside for people to drink, and the people rest again. Then, more stones enter, the door closes, four more songs are sung, and the door opens again. The second round is dedicated to the North and the beings who dwell there and the strength and endurance they bring us. The third round is dedicated to the East and to receiving vision, guidance, and direction. While the door is open between the third and fourth rounds, the pipe is brought inside for the most sacred part of the ceremony. It is smoked as it passes around the circle. During the last round stones are brought inside, the door is closed, a song is sung, and each person gets an opportunity to pray, sing, talk, or even tell a joke. This last round is more relaxed because the people have purified, prayed, been doctored by the medicine, received guidance and direction, and their prayers have been answered. Then the ceremony ends with a final song and the people leave. We conducted this ceremony. The people began as relative strangers. As each person prayed, the intimacy in the dark deepened. We felt each other's humanity. We shared each other's pain. We felt the common tragedies that underlie human life. By the fourth round, when people spoke again, the trust had deepened and more heart-felt prayers emerged, coupled with quiet testimonials to difficulties and tribulations, songs, and words of gratitude. After our feast, we concluded the day with a talking circle in which people shared their experience one after the other, clockwise. Uniformly at the end of the day, everyone recognized how important it was for people to have opportunities to be in ceremony together, to share their common humanity, to tell their difficult stories to an audience who cared, and to feel as if they belonged. This is what the inipi ceremony provides and what modern people so desperately need. Donald Fixico writes that "'Indian Thinking' is "seeing' things from a perspective emphasizing that circles and cycles are central to the world and that all things are related within the universe." This is what we are trying to teach experientially when we bring mainstream health care providers into the sweat lodge -- the power of circle and how to see our interconnectedness. Many traditional indigenous people experience this directly in their daily lives. Participation in the sweat lodge ceremony also teaches us about the indigenous experience of a metaphysical world. The ceremony creates an opportunity to participate in that metaphysical world. Contemporary health care has eliminated the metaphysical completely in favor of empirical evidence. Ceremony allows us to see the connection between two or entities or beings, some of which are non-physical, and to see how ourselves in relationship to these entities and all others. Fixico (p. 3) says, "This holistic perception is the indigenous ethos of American Indians and how they understand their environment, the world, and the universe." Native Americans who are knowledgeable of their culture see things in more than just a human-to human context or from within the constraints of materialism. The sweat lodge is an educational laboratory in which anyone can learn this way of perceiving the world. Participation in this world view is healing in and of itself, meaning that it leads toward a greater sense of wholeness, connectedness, and belonging. Sometimes, this greater sense of harmony and balance leads to greater physical health, sometimes not, but the opposite seems much more often true, that isolation, alienation, fragmentation, and disharmony, lead to illness. Achieving belonging and community is an antidote for so many of our modern ails -- stress disorders, back pain, arthritis, and more. Bringing people together brings our bodies back together. Within the circles of humanity, we need counselors and storytellers who encourage us to tell our own stories, who provide a role model for others to believe that things can be different. We all originate from nations of storytellers and all of our houses were houses of prayer.

Adolescent Addictions and Las Vegas

This weekend I attended an adolescent addictions and mental health conference in Las Vegas, Nevada, which, of course, seems the perfect place to discuss addictions. The conference was sponsored by U.S. Journal Trainings, a group with which I enjoy working. My talk was about narrative psychotherapy. I began by sharing some of what we learned in Australia -- that the world's indigenous peoples are the trunk of the tree of narrative practices, their traditions extended downward into ancient roots of ancestral wisdom from deep within the earth to connect upon which they live. Their practices arise from the bones of all of our collective ancestors, as well as the bones of the animals and the plants. Our contemporary work in narrative practices represents branches outward from that tree. As is typical for many of my audiences, a handful of people had read one book on narrative psychotherapy and it had been Michael White. As I mentioned in my blogs from Australia, Michael White certainly represents one branch on the narrative tree, but there are many others. However, I did learn from my colleague at Union, Bill Lax, that Michael White did acknowledge the central role and contributions of Australia's aboriginal people to his thought and techniques. I had not seen that in the one Michael White book that I read, and Bill is looking for the citations. However, my point to the audience was that narrative practice is not synonymous with Michael White, who was one rather skillful narrative practitioner, but not the field's only theoretician. Narrative practice began over 43,000 years ago, I said, when people were recognizably telling sophisticated stories for the purpose of changing each other's perspective. This was the point at which long distance trade began and was linked to a series of volcanic eruptions that covered the earth in vog, blocking out sunlight, changing the climate, and forcing people to venture far from home. In many respects, we discovered Others in an entirely more dramatic way during this time. This is when story became even more important than it already was. I dipped into neuroscience -- to Marcus Raichle's (Washington University, St. Louis) studies showing that making up story is the default mode of the brain and burns the least glucose, especially compared to more difficult activities like mindfulness meditation. I reminded people of the obvious -- that when we don't direct our minds purposefully to a topic, we find ourselves "daydreaming" of social situations -- encounters with bosses, arguments with family members, upcoming situations in which we will find ourselves. We run "what if" simulations" imagining ourselves behaving in a variety of ways, while we observe how our imaginary others will respond. These social situation simulations form the basis for our plotting our social maneuvers to get what we want. In folk psychology terms, we can talk about beliefs and desires. We want to be held in high esteem by our boss, our spouse, our children, so we construct internal representations of these characters and run simulations to predict the best behaviors to achieve our goals. We believe that we should have what we want and we believe that our representations of these characters from our outer world are sufficiently close as to allow us to predict their behavior. We have "theory" of these other people's minds. Theories are just stories that tell us what other people are likely to do in particular situations. I have a collection of stories about what my boss has done in a variety of situations and I extract information and form future stories about what he is most likely to do in a hypothetical situation. We need our big brains to do this, because running social simulations and keeping track of all this information on other people requires much computational time. Brian Boyd, a professor at the University of Auckland, believes that our brains evolved exactly for this purpose -- social survival, since biological survival among our species is predicated upon social survival. Then I told the audience about Schank and Abelson. None of them knew these scientists from Yale University and Northwestern University. I described how these two believe that no human knowledge exists that is not storied. All facts, all information, all experience is stored in the form of a story about how to use those facts and when they were used and who used them and for what purpose. We humans do not waste brain space on facts that have no obvious use (Rainman, of, course, being an exception). I challenged people to imagine a fact that could be called into memory without a story about how it is useful and a time that it was used and for what reason should I continue to remember this fact. One person in an audience of about 400 people claimed to be able to imagine such a fact. The rest were with me. Therefore, I said, anything uniquely human is part of a narrative structure. Narrative structures incorporate a flow of time. There is a sequencing that involves befores and afters. They have characters who move about in a location. They have plot. The convey meaning and purpose. They are colored by emotion. They are plausible to an audience who find them engaging and entertaining -- worthy of paying attention. Then we turned our attention to the stories surrounding adolescence -- to the negotiation of an identity. During this socially constructed part of life that we call adolescence, the stories that saturate modern culture prescribe a crisis of identity in which the adolescent "finds" him- or her true self and discovers his or her unique talents -- what he or she is destined to do when grown up. This story didn't exist in 1491, I said, in North America, because everyone knew what to do when grown up. One's life was prescribed through stories about how people lived and what they did. The number of choices was limited. With the explosion of choice for how to live and what to do came stories about adolescent identity crises, mid-life crises, and the crisis of making meaning at the end of one's life. These activities were not necessary in North America in 1491. The same stories saturated everyone and dictated how to think and act. Adolescents, I said, are trying out stories to see what they like the best, what works best for them to get what they want (which is not always certain), and what feels the most uniquely satisfying. We know some of these characters that the can copy -- the gangbanger, the pothead, the jock, the cheerleader, the good student, the shop crowd, emu, and more. The list continues for as many variations in identity as we can find. Adolescents try on some of these stories the way they might try different clothes at the mall. They watch the reactions of important others for feedback about their performance of these roles/stories. Criticism by parents might reinforce the value of the role. Criticism by peers might make one rethink the desirability of a role in exchange for trying another or modifying that one. The story that saturates modern culture, I remarked, is the story of the magic potion. It's everywhere we go in the form of the water from the Fountain of Youth, the holy water of Lourdes, the sacred dirt of Sactuario de Chimayo in New Mexico, ayahausco, and the pharmaceutical aids on television. Our modern culture is in search of fast ways to get what we want. We want drugs to keep us up all night. We want drugs to put us to sleep after being up all night. How can we not get seduced into believing in magic potions? Here is our challenge -- to create alternatives to the magic potion story. To find a way to make the slower approaches to growth and development sexy! We do this in the Native American world through the sun dance, through the vision quest, through the sweat lodge, and through other ceremonies. We try to captivate the youth with the drama of positive questing. We need heroic stories that counteract the magic potion story. That's our challenge in working with youth substance misuse -- to make it more exciting not to use, than to use! www.mehl-madrona.com