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.

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.

Medical Writing: The Healing Power of Narrative

Today begins my 2012 journey to Australia for Culture Camp with the Gippsland and East Gippsland Aboriginal Cooperative. We continue our mission to assist them to incorporate more of their culture and heritage into their health care. Particularly, we hope to midwife a process of their discovering their own ways instead of just grafting onto their world the practices of the people from the Northern Territories who never lost their ceremonies and their language. However, Gippsland and East Gippsland are very different from the North. They are the farthest Southeast tip of Australia. Only the island of Tasmania lies any further East. They are a lake, ocean, and woodland people from a temperate climate where snow occurs in the winter in the high mountains. They are not people of the tropics. Their culture and language (Gunnai/Kernai) is different from those of the Northern Territories. Through a convergence of our delegation of Native Americans and of those from the Northern Territories and of those from Gippsland and East Gippsland, perhaps something magical will occur. Changes have occurred in our party. My colleague, Rocky Crocker, is still coming. He is a family physician who teaches in the Center for Integrative Medicine at the University of Arizona -- Andy Weil's program. He is also the President of our Board for the Coyote Institute for Studies of Change and Transformation, based in Brattleboro, Vermont. Rocky is Choctaw from Mississippi and talks like a real Southern gentleman. We were also going to bring two Lakota colleagues from South Dakota, but the woman had to have surgery and also couldn't come. Barbara Mainguy, however, could not come. She has come each year for the past three years. We are high over the Western New Mexico desert in a United Airlines flight from Albuquerque to Los Angeles. So Rocky and I will carry on for everyone. Beneath us are clouds and desert. No snow. The land is arid and dry -- so opposite of our home in Vermont. Melbourne will be in the height of summer, like the latter half of July in the United States. I've never been there in summer but I'm told that temperatures can top 40 degrees, though still not as hot as Tucson. My hottest day ever was +53 degrees one summer in Phoenix where we fried eggs on the car hood just because we could and mercifully spent most of the day in the swimming pool. I can't even remember why I was there anymore, but I was. We are coming from the Creativity and Madness Conference in Santa Fe, New Mexico. My talk was physician writers: the healing power of Narrative. Besides a marvelous Saturday night dinner, we spent most of our time preparing this talk. Our only other activities consisted of lunch with our friend Marga and her daughter. Marga is an amazing fitness expert and filmmaker who is currently unemployed thanks to the vicissitudes and foibles of St. Vincent Hospital in Santa Fe. She had been working there as a patient's complaints manager, but most of her department was "retired". I wondered with her who the hospital would get to talk the angry patients out of suing, since that had been her primary task. We wondered if the malpractice insurance premiums were perhaps less expensive than the salaries of people to prevent malpractice actions. We didn't know. We saw our friend, Amy Stein, who does a marvelous workshop for physicians and other health practitioners on how to draw a self-portrait. Amy has published a paper on her work in the Permanente Journal, a medical publication. It can be accessed at no charge by typing into google's search engine, "Amy Stein Permanente Journal self-portrait". In a beautiful place like Santa Fe, it's important to remind them that other places have beauty, also. We began with a quote from the physician, Anton Chekov, who said, "'Medicine is my lawful wife; literature is my mistress.'' I quipped to the audience, by the time we're done, "I hope you'll agree that Chekov should have said, as Dr. Tom Janisse (Editor of The Permanente Journal) said, "Medicine is storytelling; storytelling is medicine." Writing about our patients brings out the huge amount that is left unsaid in the encounter between physician and patient and physician and world. Writing allows us to be more than a clinical voice. It not only humanizes the patient, but also the physician. Current availability of media and access to ways of creating text is a revolution in medicine, allowing us now to write our clinical histories (stories) with our patients and allowing patients to edit and re-write those stories so that a rich, life-capturing document can emerge from the clinical encounter. Writing also allows us to manage the difficulties of medical practice. Writing the case story gives us more perspectives and awareness than we had before. Helping the patient to write his/her story reveals details and clarity never present before. It is also therapeutic (aka healing) for the person telling the story. I mentioned a 1999 study in the Journal of the American Medical Association in which writing about traumatic experiences helped people to make additional improvement over optimal medical management for both asthma and rheumatoid arthritis. For these people, storytelling is medicine. Engaging in this storying process also facilitates a more ethical and socially just relationship with patients because of the equalization of power that it entails and the respect the hearing people's stories creates. Then I made a humorous "black box warning" like the FDA does for drugs. James Gates Percival, an early 19th-century physician poet from Connecticut wrote: "If pleasure meet my ever-weeping eye, I see a demon lurking 'neath its flow'rs; The smile of joy but wakes the heavy sigh, And seems as sad as when the tempest low'rs" Diane Cox of the New York Times wrote that "Dr. Percival spent most of his life rejecting medicine for writing, then rejecting writing for medicine, all interspersed with nervous breakdowns and suicide attempts." So apparently writing doesn't work for everyone, though we could make the counter-argument that perhaps Dr. Percival would have succeeded at suicide had he not had poetry as an outlet. It's all in how you see the road: as leading to the bleak, horrors of winter, or toward the joys of another season's passage. Writing helps us get clear on that. Then I offered a poem by Mary Dowd, MD, from The Permanente Journal, Fall 2008. 12 (4): The door clangs shut. All eyes turn toward the diversion. The nurse and I walk in, two little female sticks, bobbing in a sea of men. Refresh Tag(s): Aboriginal; Culture; Healing; Language; Medicine; Poetry; Story; StoryTelling; StoryTelling; Suffering; (more...) Add to My Group(s) February 23, 2012 at 12:35:46 View Ratings | Rate It Promoted to Headline (H3) on 2/23/12: Permalink Medical Writing: the Healing Power of Narrative Add this Page to Facebook! Submit to Twitter Submit to Reddit Submit to Stumble Upon Tell A Friend Become a Fan SAVE AS FAVORITE VIEW FAVORITES Get Embed HTML Code By Lewis Mehl-Madrona (about the author) Become a Fan Become a Fan (22 fans) -- Page 2 of 5 page(s) futurehealth.org The room is large, but small, dimly lit, swarming with elbows, feet, faces dozens of men in orange scrubs talking, joking shoving, pushing pacing, roaming. The ceiling is high, but low, from two tiers up it presses down on me, filled with a gray-brown cloud, invisible, of something nameless, edgy, hostile and immeasurably sad. I feel the stares of men looking, and not looking at me wanting contact, conversation, attention, sympathy, distraction, anything, anything at all Wanting, so much wanting I feel it pressing in squeezing me bruising me like thumbprints, collapsing me. I shut down all my doors and windows and focus on a spot across the room Refresh Tag(s): Aboriginal; Culture; Healing; Language; Medicine; Poetry; Story; StoryTelling; StoryTelling; Suffering; (more...) Add to My Group(s) February 23, 2012 at 12:35:46 View Ratings | Rate It Promoted to Headline (H3) on 2/23/12: Permalink Medical Writing: the Healing Power of Narrative Add this Page to Facebook! Submit to Twitter Submit to Reddit Submit to Stumble Upon Tell A Friend Become a Fan SAVE AS FAVORITE VIEW FAVORITES Get Embed HTML Code By Lewis Mehl-Madrona (about the author) Become a Fan Become a Fan (22 fans) -- Page 4 of 5 page(s) futurehealth.org where a thin bar of sunlight filters through barbed wire to light a concrete court. I met Mary at a narrative medicine day for a literary arts conference at Goddard College. She works as a physician for the Department of Corrections in Maine. Her beautiful poem represents how physicians use poetry to make sense and meaning of difficult experiences. Then we looked at Kimberly Myers and Michael J. Green's paper from the Annals of Internal Medicine. January 18, 2011 (vol. 154 no. 2 129-130). They wrote how telling (and listening to) stories has long been held to have a positive effect on health. Narrative medicine studies suggest that telling others about one's illness can help ease suffering, by imposing a narrative order on frightening events. This was by way of introducing a paper by Thomas Houston and colleagues from the University of Massachusetts Medical School which was entitled "Culturally Appropriate Storytelling to Improve Blood Pressure: A Randomized Trial (same journal, pp. 77-84). They studied 230 African Americans with hypertension in an inner-city safety-net clinic in the southern United States. They provided people with 3 DVDs that contained patient stories about how people got their blood pressure under control, told by people who were very much like the patients who were watching the DVD's. The outcomes were changes in blood pressure for patients in the intervention versus the comparison group at baseline, 3 months, and 6 to 9 months. Most patients (71.4%) were women, and the mean age was 53.7 years. Among patients with baseline uncontrolled hypertension, watching stories statistically significantly reduced blood pressures. Patients with already controlled hypertension at baseline did not change over time between study groups. So writing and storytelling matters! Then I used the example of Oliver Sachs, best-selling author, physician, and professor of neurology and psychiatry at the Columbia University Medical Center. In 2007, he was named the first Columbia University Artist, in recognition of his contributions to the arts. He is best known for his collections of neurological case histories, including The Man who Mistook his Wife for a Hat (1985), Musicophilia: Tales of Music and the Brain (2007) and The Mind's Eye (2010). Awakenings (1973), his book about a group of patients who had survived the great encephalitis lethargica epidemic of the early twentieth century, inspired the 1990 Academy Award-nominated feature film starring Robert De Niro and Robin Williams. The New York Times has referred to him as "the poet laureate of medicine." Sachs is an example of turning case histories into literature and reveals much about how writing and literature can help us understand human suffering. Here's a short quote from The Man who Mistook his Wife for a Hat, which is an example of cortical blindness, in which a man "sees" without actually knowing that he sees. His optical system works and his brain works with it, but he has lost awareness of it because of a stroke. "And yet there was something a bit odd. He faced me as he spoke, was oriented towards me, and yet there was something the matter -- it was difficult to formulate. He faced me with his ears, I came to think, but not with his eyes. These, instead of looking, gazing, at me, "taking me in', in the normal way, made sudden strange fixations -- on my nose, on my right ear, down to my chin, up to my right eye -- as if noting (even studying) these individual features, but not seeing my whole face, its changing expressions, "me', as a whole. -- p. 9 ""Can I help?' I asked. "Help what? Help whom?' "Help you put on your shoe.' "Ach,' he said, "I had forgotten the shoe,' adding, sotto voce, "The shoe? The shoe?' He seemed baffled. "Your shoe,' I repeated. "Perhaps you'd put it on.' He continued to look downwards, thought not at the shoe, with an intense but misplaced concentration. Finally his gaze settled on his foot: "That is my shoe, yes?' "Did I mishear? Did he mis-see? "My eyes,' he explained, and put a hand to his foot. "This is my shoe, no?' "No, it is not. That is your foot. There is your shoe.' "Ah! I thought that was my foot.' Was he joking? Was he mad? Was he blind?" This passage gives us such a wonderful sense of what it's like to sit with someone who looks like they can see but can't actually see. The man eventually puts his hand on his wife's hair thinking it's his hat and tries to lift up her hair to put it on his head, which is how the story gets its name. On March 10th and 11th, I'll be in the Woodstock, NY area for a two day weekend workshop on narrative approaches to creating community through ceremony. On April 29th, I do a one week event at Kripalu Center for Health and Healing which involves Cherokee bodywork and ceremony and ritual. The details are on their website at www.kripalu.org.