Day 9 of the Australian Journey

I awoke to run only to be greeted by the sound of a driving rain.   Though I don't relish the thought of loading the boats while getting drenched, the sound of the rain on the roof is strangely comforting.   The temperature is chilly.   We were warned that summer is very hot in southeastern Australia, even up to 40 degrees.   I am sitting on the veranda under the sheltered portion wearing a shirt, a sweat shirt, and a jacket.   I almost didn't bring the jacket.

Today is our last day at Boole Poole.   We travel again today to the cultural center for further interactions with the community and the elders.   We had an extra day at Boole Poole last year and that allowed us to do "doctoring" for some of the elders who came over on the boat.   I wrote about that in last year's blogs which are still available at www.futurehealth.org.     By doctoring, I mean the aboriginal North American version of energy medicine/osteopathy.   I suspect that every culture had its own form of energy medicine and hands-own manipulative medicine, though some do not carry these practices in their current repertoire.

                Eventually enough people awoke that we could have a discussion on the veranda around breakfast while the rain continued to steadily fall.   Our breakfast question was how to bring spirituality into human services.   That led us to consider pathology as an organizer.   In medicine and psychology, what's wrong with you, the diagnostic category, has become the pivot point around which everything is organized.   The assumption is that diagnosis tells you everything you need to know to assist someone.   Then relationship comes not to matter because once the diagnosis is made, anyone can apply the treatment.   Spirituality becomes unimportant.   It is like the steam generated by a locomotive -- pretty to much but not necessary for the operation of the engine.   It is a byproduct that can be ignored.   How do we change that?

                Our conclusion was that we have to listen to the many stories surrounding the person and to grant validity to all those stories.   Everyone has a story about how and why they got sick.   Often their stories have fused with the stories of the dominant paradigm, such as "I'm sick because I got bad genes and there's nothing I can do about it."   Everyone also has a story about how healing is supposed to happen.   We have stories that guide us to what to expect when we consult someone who is supposed to help us.   My story in seeking a traditional healer is very different from my story in consulting an orthopedic surgeon.   I have different expectations for what they will do to me and for me.   But, what if I had an expectation that each of them should see the Divine in me and acknowledge it before proceeding with what they do?   That seems logical for the traditional healer, but why can't I also expect that from the orthopedic surgeon?   Thus, the human services toward which we are striving includes a willingness to meet people where they are and to experience their experience.   As a practitioner in a human service, I need to be willing to "be in the story" that's brought to me.   I need to "be in the details".   I cannot maintain the same level of clinical distance characteristic of the biomedical paradigm.   I actually have to be empathic.   I actually have to care even if I can't do more than that.   Caring and listening are powerful interventions even if nothing else can be done.

                This led us to discuss the indoctrination that new professionals receive. Their training and socialization makes them less able to interact with aboriginal people.   Some people enjoy formality and distance.   Most aboriginal patients do not -- at least not in the same way.   I know I want to feel heard.   I want to believe that someone cares enough about me to hear all the stories that I feel I need to tell.   Perhaps he or she will care enough to elicit some stories from me that I didn't know I had.   I need to enter into the stories of my clients enough to share some lived space ("Lebenswelt") with them.   That is considered unprofessional in some circles.   I am not saying I need to share my ongoing problems with them, though I do use stories about problems I have solved as teaching tales with clients.   I think we distance ourselves from clients related to our fear of ambiguity, mystery, and helplessness.   The biomedical model purports to give us a certainty that it doesn't deliver.   However, if we scrunch our eyes tightly shut, we can pretend that all is as it says it is and that we have certainty.   Sometimes we are helpless to do anything and we don't like that either.   We are afraid to not know the answer.   If I can maintain enough distance, I won't be affected by the vicissitudes of my clients' lives, including when they die.   In the biomedical model, I can't afford to care too much.   I can't afford to love my patients.

                Doctors and patients often come from radically different cultures.   Implicit within this is a difference in class and wealth.   Managed care in the United States has removed much of the wealth possibility from doctors, but the image remains.   In other countries, doctors never had the wealth potential that they had in the capitalist countries.   When we come from different cultures, we may have such stereotyped stories about each other that we are incapable of listening or interacting.   We interact as if both of us were wearing a mask.   Maybe we are!

                We agreed that our shared task, and what culture camp accomplishes, is to build bridges with others who are trying to see the world and human services differently.   Our current systems do not encourage emotions for and with the clients.   We want to change that and to experience the human condition with them and from them.   When we do that, we bring spirituality into our practice because that is one aspect of being human -- to reach out to what is greater than us, to contemplate larger powers, to appreciate our small stature in the universe and to be awed by the vastness of all we can perceive.

                Culture camp is giving us a shared language for how to move in this direction.   It is validating our experience of wanting to hear each other's' stories.   By observing each other working in our own context, we learn to more deeply appreciate the human stories and to see the richness of our own.   Seeing others' cultures helps us to find our own hidden assumptions, the beliefs and stories generating those beliefs that we don't know we have. We have trouble seeing the stories which surrounded us when we were born as stories.   We think of them as ineluctable facts.   Seeing others who don't share those most basic stories helps us to recognize our own.

                One of the aboriginal elders told us that those who have lost sight of the world as animated and magical need to practice seeing the artifacts and sacred objects as really alive.   They need to learn to see the energy around the object instead of the object itself.   Compassion is the ears getting bigger and bigger, she said.   "Call upon your ancestors," she said, "and hear everything without judging."   We talked about the difference between judgment and discernment.   I can discern that I don't want to be involved in a particular process or don't want it for myself, without being critical of those who are involved in that process.   We heard about the young men from Idaho who come to the Northern Territories to convert the locals to the Church of Latter Day Saints.   They are on a mission.   They look so out of place in the tropics wearing white shirts and ties.   They must always be home at 10pm.   "I don't want their religion or to do what they're doing," one man said, "but I don't judge them for doing it.   Being in this strange new place must be quite exciting for a sheltered young person from the rural United States."  

                I brought up my favorite Lakota concept of the nagi, which I have already discussed in these blogs.   Unique about this concept is the sense of person as swarm and the notion of swaminess, which is a mathematical/engineering concept now of how swarms behave.    We are swarms of conscious stories and tellers of those stories rather than concrete objects.    Where all the bees gather, there is a queen.   The queen represents the collection of concatenated stories that we privilege as better somehow than the rest.   My example of swarm behavior comes from deer nibbling on the leaves of acacia trees.   The acacia trees then secrete toxins to stop the deer from nibbling which every acacia tree in the neighborhood does simultaneously.

                A woman present brought our attention to how are bodies speak their story for us.   Laura told a story about a time when she felt traumatized.   She was also suffering from pain from her left shoulder down to her left hip.   She used phrases like, "I'm all twisted up about this."   "I overreached."   "I stretched myself too far." "I feel down."   "I bent over backwards."   We were able to point out to her how her language matched her body sensations.   The situations of her life were reflected or were parallel in her body.

                The discussions continued throughout the day with the eventual result of planning for next year's conference.   The rain continued so we made our soaking way to the boat with all of the sweat lodge blankets, some of which got quite wet.   We made a bumpy trip to the mainland and loaded the car for the drive back to Melbourne.

Day 8 of the Australian Journey

Today I got up early and ran the length of the island/peninsula (I'm not quite sure which it is).   I saw too many kangaroos to count and numerous hog deer.   No wombats, however.   One kangaroo dashed across the path so close that he startled me.   I think I startled him also.   They're not used to people running along the path before dawn.   At a distance you can tell the hog deer apart from the kangaroo because they run with constant height while the kangaroo bounce up and down as the race across the plain.

The island is beautiful and full of vegetation that I've never before encountered.   It's more marsh-like than I had imagined.   There are areas reclaimed by the water where dead gummy tree trunks stand testament to the forest that once ruled there.   Intermittently, the trail opens into panoramic vistas of the lake. Ferns predominate on the forest floor.   The earth is rich and black.

After breakfast, we prepared to make the journey across the water to the headquarters of the Coop where Lily and Shadow and family from the Northwest Territories were going to demonstrate some of their ceremonies for the local community.   We had a marvelous barbecued lunch, met many people we'd seen in the last two years, and then watched Lily and Shadow do their "burning cure".   I wrote about this last year in my blogs which are still available on www.futurehealth.org.   Briefly they heat palm tree bark in a fire and apply that to painful areas of one's body.   This year I asked them to treat my left sacroiliac area.   I've been doing more intensive stretching and yoga to open my hips and pelvis (which a healer in Warburton told me were way too stiff) and I've discovered an old injury from 30 years ago which has become painful again as I have removed the armoring that had collected around it.   The heat felt wonderful and I enjoyed as much of it as I could.   Then they did the ritual where they put people on top of a fire on paper tree bark and throw water onto the fire with the people covered by blankets.   It's like a mini-sweat lodge that lasts only a couple minutes.   This is their cleansing/smoking ceremony.   I also wrote about this last year and Shadow and Lily used their children again.   Then they demonstrated spear throwing and it was time to go home.

On the way home, I interviewed Laura, an aboriginal patient advocate (in both senses of the term) from Western Australia who was part of Culture Camp this year.

Laura works the whole of Western Australia.   I asked her about her job.   She said, "We connect with go-to people in the region.   We promote people's rights in the health system.   I ask people if they have any problems we can assist them with.   I offer to advocate to services about an individual complaint or problem but also more systemic issues because we find that a lot of people don't want to make official complaints either because they have no faith that the service will address their complaint or that they'll get worse treatment if they make a complaint.   I think people don't realize that it is an official process that services are obliged to respond to."

I asked Laura about the kinds of problems she often encounters.   She said,   "People feel discriminated against because they are aboriginal.   A lot of what we are addressing is miscommunication and misunderstanding.   Often people feel that they get stuck or left in between services.   Often it's up to them to get from A to B and people don't know how to do that.   Also people have to travel ridiculous distances to access a test or a specialist or an operation.   I'd qualify by saying some of that happens in the regions.   A lot of times it's about it being available in a timely way.   Like the specialist might be coming back in another three weeks or six weeks.

"I hear the same stories so often.   One example of racism and discrimination is a young mom being told upon arrival to emergency that her small baby must be suffering from drug and alcohol withdrawal even though she had never drank or smoked or taken drugs.   I hear this story regularly.   By definition all aboriginals are drunk or doing drugs.   Sometimes when people are sent to Perth they might be given a taxi voucher to get themselves to the hospital.   They might be sitting in the airport for hours because they don't know how to get a taxi or they don't know what a how to get is a taxi or they're afraid to get into a car with a strange person or they revert to their original language because they're stressed and can't remember how to speak English.

"We do have a service that is just to liaise with aboriginal country patients but it isn't big enough to meet the needs and it's Monday through Friday 9 to 5 and a lot of things happen outside those times.

"In the hospitals even though we do have recently more aboriginal liaisons, often they'll only be liaising on certain wards in the hospital where the majority of aboriginal patients are.   You can still be in the hospital and be told you're not entitled to the aboriginal liaison."

I asked Laura for her perceptions of the failure of the health care system for aboriginal people.   She said, "Too often it assumes and doesn't communicate or ask the patient anything.   They don't ask if they understand.   There is a huge divide between services.   The assumption is that someone else is taking care of it and it falls back on the patient.

"I think the aboriginal medical services do an outstanding job but we don't have enough health services or health workers to meet the need, particularly outside of Perth.   We still have a lot of services in Perth but people can't afford them.   Few services advertise that you have no cost for your appointment or that you have a much smaller cost.

"In Perth we have one aboriginal medical service where people get a free medical appointment under the close the gap initiative.   Any aboriginal person at risk for getting a chronic disease gets free medication.   Private practice gp's can bill the government for aboriginal patients or not.   It's up to them.   Any patient can take their receipt from the doctor and get a rebate from Medicare.   A lot of people don't have the money to pay up front for the appointment.   A lot of elders will put them last and not have funds for their appointment or their medication or even their transportation.

"Renal dialysis is one of the saddest examples of that division.   A lot of places have no public dialysis services.   You can get a machine in your house that the government pays for.   You have to have enough space to house the machine and keep it away from children, etc.   You have to own your own home or be able to stay for a long time.   A lot of people are in Perth just to get their dialysis treatment.   80% are in Perth because there's no dialysis at home or they're waiting for people to die so they can get their spot on the machine.   Quite often we have patients who have absconded.   We get calls about patients who are not turning up for dialysis.   I'll find them staying in the park down from my office because there's not very much in the way of affordable accommodations.   That's where they find other countrymen who care about them and look after them.   Or they've been kicked out of hostels which care for aboriginal patients because drinking is forbidden and they've had a drink.

"We advocated for a lady getting dialysis for quite a while.   They gave her a tablet.   She stopped turning up for her dialysis appointments.   The service alerted us.   We found her.   She thought she just needed to take the tablet now and no longer needed dialysis.   She didn't understand that without a transplant she'd be on dialysis for the rest of her life.   We don't really have accessible interpreting services for a lot of regions.   Even in Perth there's a lot of ignorance that aboriginal persons speak languages other than English.   Often they let a grandchild do the interpreting.   A lady found out she had cancer in Perth.   They got her granddaughter to interpret.   By the time she found out what her options were, they weren't possible any more.   The cancer had progressed too much.   We've had quite a few cases in the past 18 months."

"What about mental health care?" I asked.

"One of the biggest things because we ask people what issues they have is the lack of counselors or accessible programs or culturally secure programs for aboriginals.   It's a huge void.   Namely, the commonest thing is a family member ringing the service for help for someone else.   Service says it's unethical to help without the person coming into their office or the gp making a referral.   Then the crisis is not managed and the call ends in suicide.   Yet they consider acting and preventing a suicide unethical.   I think for our population a family referral would be very valuable.

"When people do manage to access services, the family is very out of the loop.   A lot of services say that would be unethical because that's a breach of confidentiality.   I know that a lot of patients want their family to come to the appointments but the providers still say it's a breach of confidentiality.   The person is living with the family and even if they don't want the family involved, the people who are living with them need to be involved.   Sometimes the patient doesn't even understand English and the services are using an interpreter and still refusing to involve the family.

"It's difficult for aboriginal people to leave country when they are sick or for births or deaths because country is their place for healing and their source of spirituality and support.   For some remote communities, everyone knows where they fit and how they relate to everyone.   It must be very difficult to come to Perth where no one cares about you and you don't fit.   There is assistance for people who need to travel to give them an escort.   That's up to the gp.   Administrative stuff happens at the hospital and the hospital argues sometimes even when the gp says they need the escort.   I had a man who was 70 years old who hadn't been to Perth for 50 years and all that the clerk wanted to know was if he could walk or not to go to his appointment.   Particularly if people are going down for a test, they are outpatients so their accommodations are separate from the hospital.   We have very limited services to help people get from the airport to their accommodations to their appointments.   People lack the savvy to do this.   A family was given a voucher for the public transport but they had never seen a bus in their life so they walked a couple kilometers to the train and didn't understand how to pay and then they got a fine.   If they had a German accent they would have been tolerated but because they look aboriginal they were not tolerated.   A young family couldn't find accommodation in Perth.   The husband was from over 3000 km away.   We helped him transfer to Darwin because it was closer to home.   He was quite grumpy and bit snappy, but he was in his mid-30's suffering renal failure.   It's not reasonable to expect him to be nice under those circumstances and" In the end he went home to be with family when he needed to and got an infection and died.

"I remember when we first went into the region people said you get to Perth in a plane and you return in a box.   Our mob doesn't seek services until they're quite unwell which contributes to that perception.   The understanding may need to be two way."

Next I asked Laura about the relationship of health care to traditional community healers, She said,   "The aboriginal medical service because they're part of the community are able to link into traditional healers though they don't employ   them.   Often families do that off their own back [meaning pay for healers with their own funds].   Some willingness exists in mental health to work with traditional healers.   Coverage doesn't exist for the moment.   We have an expanding statewide mental health service.   It will take a while to filter out what that means.   We're not really sure what the status of their obligation is.

"It depends upon what region you're from whether or not you have healers.   Sometimes it's the willingness of a particular staff member to see something like that especially for acute mental illnesses.    The person might require an acute place to stay.   People have to go a long way from home to access anything.   That's hard for their recovery and for the family engagement.   A lot of services say that social emotional wellbeing is not a part of what they provide. For example, the 70 year old man who needs an escort being told he doesn't.   When someone doesn't have the means to get to the hospital for their appointment, that's a problem.   Culture is treated as a layer you put on the end to make it seem a little nicer.   They don't understand that people might not access service at all because it conflicts terribly with their own beliefs."

That seemed to be the theme of this week.   Culture is not an afterthought.   It is all important.   Here is where the health system and the community disconnect.   For the health system, culture is just cute art, because science has the answers and patients should just do as we say.   Of course, even the recent history of medicine reveals that what medicine believes to be absolute fact turns out to be incorrect.   We are curiously without history in medicine.   Whatever we believe today, we act as if we have always believed it.  

Here is an example from the United States.   The cost of treating people who have had at least one hospitalization for depression and are on public funding has increased by 30% over the 10 years from 1996 to 2006 in a study just published.   During that time no improvement in outcome was seen.   Hospitalization frequency dropped, and so did psychotherapy from 58% to about 35%.   Medication use increased from 81% to 87%.   The increase in cost was attributed to the use of more expensive drugs, such as the adjuvant use of antipsychotics to treat non-psychotically depressed patients.   Are we doing the right thing if costs go up with no improvement in outcome?

Implicit within the appreciation of culture is the understanding that medicine itself is just a story.   Theories are stories and stories change.   Treating the story is often more important than treating the disease because the disease is the story and the story is the disease.   Our stories about the world arise from our bodies and represent our bodies' ways of communicating internal states.   Change the internal state, change the story.   Change the story, change the internal state.   This is not obvious at all from within the biomedical paradigm.

Day 7 of the Australian Journey

The rain continued all night.   Before bed, we made offerings to the sky spirits to ask to hold the rain if possible in the morning so that we could light the sweat lodge fire.   As I awoke, that seemed unlikely.   The rain continued.   Breakfast came and just as we were putting our plates away from a marvelous Aussie brekky of bacon, sausage, fried tomatoes, fried mushrooms, and eggs, the rain stopped.   Quickly we ran out to the fire pit with all the dry kindling we could muster and got the fire started.   I have been taught that the sweat lodge fire cannot be started if it is raining because one doesn't intentionally combine two different types of purification.   If the rain starts after the fire is lit, that's ok because the thunder spirits have made a decision to augment the purification.   Then it's not hubris on our part.   We did manage to get the fire started with fairly damp wood thanks to some excellent dry kindling.

I'm not going to say much about the actual sweat lodge ceremony because I have written about this elsewhere and the details of sweat lodges are well known in the North America.   Bucko has written extensively about the various styles of inipi (meaning breath of life) ceremonies in a book called The Lakota Sweat Lodge, which is excellent reading.
The only surprise was to meet pelicans in my preparations and prayers and to hear that this lodge was under the auspices of the pelicans.   Later I learned that the pelican is the totem of this land where we stand.   I was guided to dedicate the lodge to two people who were struggling whom we had met on our last trip and to their families.

The lodge experience was powerful for all.   Marion, the aboriginal elder about whom Miriam spoke in Day 6, attended, which was an honor for everyone.   The CEO of the Coop attended along with some of his key assistants.   He talked about having visited Edmonton, Canada, where he learned about the summer ceremonies such as the sundance in which all the urban Indians are bussed up the road to Jasper for a week together.   I wasn't sure if he meant sundance, but it certainly could have been.    Jason told us how much he wanted to create a weeklong opportunity to bring his community together for ceremony and healing.   We invited him to join us in June for our annual sundance.

We began trying to light the fire at 8am and had finished the lodge by 4pm.   That included some schmoozing afterwards and a bit of snacking for dinner was yet to come.   Also the cameraman had to interview us for the documentary being made about Culture Camp 2012.

During the evening a man from Millingimby (also known as Crocodile Islands) in the Northern Territory spoke to us about his walking from there to Darwin, which is over 800 kilometers.   The walk required 3 months.   He took nothing with him and lived on what food he found or caught along the way.   That seemed normal to him.   He caught a boat back.   He did not speak English and was translated by an anthropologist who accompanied.   That man was working on aboriginal land claims with frequent court testimony and was fluent in the language of Millingimby.   The story of the walk was impressive and quite inspiriting.

Then Shadow, also from that community, and known to us from the last three years, regaled us with crocodile tales.   I suppose one cannot come to Australia without the requisite crocodile stories, many of which are exaggerated, but I doubted none of Shadow's stories.   He told stories of his kids catching a small croc and keeping it in their bathtub until it got to big and they had to let it go.   He said it recognized their voices and responded, knowing they were probably bringing it frogs, fish, or other goodies.   He told a story he told last year about a crocodile chomping a man on his head and the man managing to get free by sticking both of his fingers in the crocodile's eyes.   He told about a crocodile coming up under his dinghy and trying to push him and his mate out into the stream as they were just about to dock on the shore.   The took a running leap, jumped off the boat onto the crocodiles back, and leaped onto shore just an instant before the croc figured out what they were trying to do.   That was as close as he had ever come to being eaten, Shadow told us.   He told stories of several people being pulled under water and playing dead while the croc stuffed them into mangrove roots and then escaping as the croc went away in search of other pray.   Apparently the do eat fresh meat from time to time, but more often than not, they like to marinate their food under water for a week or two before eating it.   He told about cutting one croc open and finding a man inside who had been swallowed whole without a mark on him.   He told funny stories about throwing his kids in the water instead of the rock to see if there were any crocs.   The kids were there and laughed at that.   They certainly had an amazing life in nature living where they did.   Shadow told of a constant string of encounters with birds, spiders, snakes, crocs, and other wildlife as they went around trying things that he told them not to do.    Shadow told about him and a croc stalking each other.   They would play a game where he would come down to the shore and the croc would disappear into the water at which point he would run to high ground just as the croc surfaced and lunged at where he was standing an instant before.   I was convinced not to enter his part of the Northern Territories without his protection and guidance.   Crocs sound dangerous.   Shadow said they were the most perfectly designed predator in the world.   They were silent and fast.   A man didn't even have time to shout when attacked by a croc.   He was already underwater.  

We spent more time talking to Miriam the physician about her work in the community with people on benzodiazepines and narcotics and sleeping aids.   She mentioned that many of the elders were taking benzo's and sleeping pills to help them cope with the stress of their role in the community.   We reflected together on our health care system's promotion of magic potions and pills for every woe.   In her community as in mine, people are trained to believe in instant relief instead of learning the slower techniques that are more long-lasting.   We see that in television commercials with instead abs (abdominal muscles), instant fitness, instant relief from sadness, and the like.   Her patients were in the same boat as mine.   I talked about my pain group which seemed to interest her.     I make as a requirement for receiving pain medications from me that people attend pain group at least once monthly.   They must also do something physical at least once weekly.   That could include taking a yoga class, going for physical therapy, taking a t'ai chi or chi gong class, or something like this.   Most of my pain patients are reporting back pain.   They are under the mistaken impression that their X-rays correlate with their pain (which they do not). We talked about whether or not Miriam could implement such ideas into her practice at the Coop.   Talk continued late into the night, but now it's time to go to sleep.   More tomorrow".

Day 6 of the Australian Journey 2012

Today we arrived at Boole Poole, the ancestral land and burial grounds owned by the aboriginal cooperative for the formal start of Culture Camp 2012.   Several of us were wearing Culture Camp 2011 T-shirts in bold red, black, and yellow, the colors of the Australian aboriginal flag.   Boole Poole is only accessible by boat which was a rough ride in a rainy sea.   Flocks of pelicans sailed overhead, experts at riding the currents of wind.   Black swans floated gracefully on the swells, while young cormorants appeared to be walking on water as they got out of the way of the boat, flapping their wings faster than imaginable.   The rain had begun as we unloaded the boat at the pier.   By the time we had pulled the trolley with our things to the house, it was a downpour.

The food at Boole Poole is continuous and one meal runs into the next.   Looking for an alternative to eating, I decided to interview Miriam, the newest physician to work for the Aboriginal Cooperative and their first and only full-time physicians.   My colleague, Rocky, had already spent time with her on his last journey to Australia when he consulted to the physicians who worked for the Cooperative.    The rain drummed on the roof as we talked in the living room of the house while most everyone else watched films of aboriginal dancing from the community at Mullingimby, the home of Shadow and Lily.

"How long have you been at the Coop now?" I asked.

"Since last August, 2011.   Now, it's six months."   Miriam answered.    She had trained in Brazil and had practiced for some time with aboriginal people there.   In Brazil she had a catchment area of 4000 people.   She worked for the public medical care system.   In her clinic, she had four health workers, one nurse, and her.   I wondered how it was to have that many families under your care.   She said it was a matter of doing the match.   In any given month, one expects 4% acute care visits.   She used the morbidity tables for the percentages of chronic diseases in her practice to calculate how much time to allocate for chronic disease care.   Time was very scientifically managed.   Next I asked her what was her biggest challenge in coming to the Coop in her first week.

"My first week was one of introductions and cultural awareness.   I was taken to the different sites I needed to know about; taken to meet the people with whom I would be working and whom I would be calling. They (the coop) introduced me to elders.   That first week was also an introduction for the community to me.   It was a pleasure.   They believed it was fundamental for me to understand the geographical space in which the patients lived.   They were open to all my questions.   They introduced me to all the places that were important to know.   The two aboriginal health workers did that -- Shane and Judi Ann.   Judi worked with the midwife and could bring her all the issues with pregnancies in young people and what they need, their expectations.   That was my first week." I was impressed with how culturally sensitive the Coop was to Miriam.   I hoped we had contributed something to that awareness. Then I asked Miriam about her second week.

"During my second week I was in the unit of my mentor, Dr. Jane Greason.   She was able to introduce me to the program and what they had been doing in the community.   She has been there more than 12 years."   Then I asked her what other doctors work for the Coop.

"Dr. Greason is my supervisor.   There is Dr. Gene Wofurt who was raised in Bairnsdale, then Dr. Schoefeld, and Dr. Black.   We have two offices at the health center.   Usually only one session or two sessions occur at the same time."   I learned that the other doctors had contracts with the Coop and did their own billings.   Miriam was on a salary.

"My challenge is, not by the production, but to help people get well.   I am not billing medicare like the other doctors who have to see patients one after the other, 1, 2, 3, 4.   I have A, B, and C consultations.   An A consultation is scheduled for 10 to 15 minutes.   B is 40 minutes and C is one hour.   Because we have the other doctors, if I have another doctor at the unit, the other doctor does their patients and I do the health assessments with the aboriginal health worker and do the gp planning."   I hadn't heard the term "gp planning" so I asked what that was.   Assessments are always category C consultations.

"After the assessment, you have at least some idea of the risk factors, medications, and social information.   That supports the gp planning.   We identify the patients with the chronic disease and the special needs.   After that, you have to work in a way that you agree with the patients and negotiate with them what can be done and how.   We set some goals between us.   I have to write this down.   That is the product we call GP planning.   The Coop is a very special situation because they have more than just general practice.   They have the family service, the alcohol and drugs follow-up, the midwifery service, and many more community outreach services.   With these special services, it's easier for us to go further than a simple gp plan in mainstream medicine.   There they have hard work because they don't have the facilities to refer as I have here.

"When I arrived in the heatlh center, I realized some of the aboriginal health workers were not having time with the doctors.   Every doctor had a small time with the patient.   I started doing the health assessments with the aboriginal health worker and the patient together.   I also did the gp planning with the patient and the aboriginal health worker together.   This seemed like a natural way to do this. It would be a longer appointment if we did it together, but we would get so much more done.   It is the job of the aboriginal health worker to visit the patient in the community and to make sure the plan that we have negotiating is being implemented.   If I cannot finish the gp planning with the patient, I will finish it with the aboriginal health worker.   Sometimes that's necessary because I didn't have all the necessary background.

"We have a clinic coordinator who is a nurse practitioner and we have Leslie who is a nurse practitioner who is more responsible for immunizations and wound management.   She's a more unit centered nurse.   Another nurse does diabetic education.   We have another midwife who works with Liz Boyer, who is one of the doctors responsible for antenatal care and deliveries at the hospital.   The midwife is a nurse, too.

"After gp planning, I keep in contact with the aboriginal health worker to be sure every action that we have planned is happening.   In that stage I had some concerns because the aboriginal health workers belong to the families.   If I have a male patient, they have male business and they will be ok with these patients, but if they belong to other families, maybe they will not be ok.   We lost one aboriginal health worker because she couldn't do the male business.   Judi worked with the midwife and had good support in the women's business.   It's very hard because you know they belong to their families and sometimes they don't want to get involved in other families' business.   I have to be very careful, because I don't know where I am walking.   Some of them are close to these patients.   I have to be very respectful.   Once I went to aboriginal health worker and said what I wanted to do with this patient and he said, doctor, I prefer not to work with this patient, because she is my wife.   He could help her as a husband but not as a health worker.

"Patient confidentiality is minimal.   Everybody is a relative.   You have to be very careful what you have as a goal.   What we have to do is ask the patient.   I have the opportunity to talk with the patient myself before we discuss things with the aboriginal health worker.   I explain what is a good aboriginal health worker and they agree with me.   Then I ask them if they are ok with who will be assigned to them.   Some of them don't accept the aboriginal health worker."   I asked Miriam about the challenges to health in the community.

"People in the community want to be heard.   They have a hard time with drug addiction, alcohol, domestic violence, but when you open the door, they go through it.   If you listen to them, they will tell you things which will give them some relief.   I remember one patient who was very upset.   In their community, it's not normal practice to have an elder in a retirement home.   She was very upset with that.   She came for high blood pressure.   She was very upset.   She was fighting with the family because one of the sisters got the guardianship of their mother.   The sister wanted their mom in this specific retirement home.   I started to treat her blood pressure but I knew the stressful situation was    part of what was raising her blood pressure. Part of my job was to be a problem solver strategist.   To help her make small changes to cope with the situation was what I needed to do.   She is still working through her issues but she is changing.   She asked me to support her with her alcohol issue because that was why her mother was in the retirement home.   She was not able to take care of her mother because of her drinking.   She was then able to go to alcohol treatment.   She could choose an alcohol counselor. " I have this problem and how can I solve with the resources we have here.'   Now her mom is in the retirement home and she is struggling to cope with alcohol problems and she accepted the situation as transitory because she wants to recover so she can take care of her mother.   She is in the middle of her process now.   She has access to the consultations.   Every time she needs to contact me, I have an agenda for her to come every week as a crisis like, trying to support her in this journey.  

"Second I have a list of resources we can present to the patient.   Patients can choose what they want.   If it's housing, I have people who can help with that. One of her [the above patient] issues was that she didn't have a house.   She got connected to the aboriginal legal services and I could do a letter supporting her for housing.   It was important for her for the crazy stress.  

"The aboriginal health worker is very important, because they know how to work the system.   If the patient doesn't allow me to contact the aboriginal health worker, I have the list of the resources and I ask the patient how to help them.   Sometimes they say it's impossible.   They give me the limitations.

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.

Day 3 of the Australian Journey 2012: Hearing Voices in Melbourne

 
 
 
 
 

By Lewis Mehl-Madrona (about the author)

Become a Fan  (24 fans)   -- Page 1 of 1 page(s)

futurehealth.org

 

Day 3 is the final day of the Hearing Voices Conference.   I'm going to finish telling about my keynote address and also the workshop that I did and other connections that were made.   One of the most remarkable events occurred at the panel on the last hour of the day when Ron Coleman announced that a young woman who was being tortured by her voices had nowhere to go to get help and no money.   He told the audience that she could come to his farm in Scotland and stay for free as long as she wanted if the assembled people would all contribute money toward her ticket.   He announced that he was going to put a jar by the door and everyone could contribute what they could.   I learned later that the money had been raised and she would be on her way to Scotland in three weeks!   That was amazing.   I was so impressed that Ron Coleman had a farm where people could go to work on their voices for free.   I wish I had such an environment and the funds to make it work.   We've (Coyote Institute) been casting about for funding to create a safe house in Brattleboro, Vermont, for people who are going through a psychotic experience, but so far, we've raised very little money.   Apparently, we don't move in the circles of people who have extra cash to donate.   We'd like to change that, of course.

Today there were a number of concurrent talks by aboriginal elders about their culture and how they managed voices and people who hear voices.   As I said in yesterday's   blog, it was so inspiring to have aboriginal people fully integrated into the conference and presenting their successful strategies for voice management.

I tried to make my workshop completely experiential since I had given enough theory in my keynote address.   I started with a guided imagery process in which people travel through a portal to the dimension in which their voice resides and in which it has a physical form.   I mentioned that all voices must be attached to physical images.   No disembodied voices allowed for they are frightening.   If a voice has a physical form, we can modify that form to make it look ridiculous if it's being too scary.   In one of the Harry Potter movies, students in "Defense against the Dark Arts" learned to turn their worst fears into ridiculous looking versions as the fear came out of a cupboard.   The spell word was "Ridiculopathy", or something like that.   In the exercise, people were asked to enter into the world where their voice lived in a body and find it.   A number of strategies were proposed for how to do that.   My favorite is to follow a path through the woods, around a pond, up a ridge, and to see it standing in the middle of a meadow, though there are many more.   Then the person asks for the voice to tell its story.   Many voices are boringly repetitive.   They just keep saying over and over, "You should kill yourself because you're not even worth the air that you breathe," or something similar and equally inane.   However, rarely do we get the story from the voice about how it came to be in the person's mind in the first place.   We want to know where it came from, where it was born, who were its parents, and all the interesting details of its life.   We want to know how it came to the conclusion that led to what it's been saying.   We want to know what other beings agree with it.   Who are its friends?   What coalitions has it formed?   We actually want to start a relationship with the voice in which dialogue occurs and change can happen.   If the voice is stubborn and refuses to change or even to converse, we have to find other voices to stand up to it.   We have to start finding stronger voices to drown out the mean ones.

Following this exercise, each person told their experience to another person so that sharing could take place to an audience.   In our work with voices, we are striving for increased narrative competence -- better story telling skills.   It's important to have an experience and then to be able to come back and tell a coherent, congruent, understandable story about that experience.   Next I asked each pair to let one of its members become the voice so that a dialogue could take place.   Like most exercises taken from improvisational theatre techniques, I tell people to just trust their gut impulse and say whatever they are driven to say.   Don't worry that you aren't sure what the voice would say.   Just say whatever   you're moved to say.   The conversation lasted 10 minutes or so and then we switched.   Finally, one person volunteered for the last exercise.   She had three voices and picked three other people from the audience to play her voices and one to play her.   She took them outside the room and briefed them on what her voices were.   Then we started the "skit".   This woman's voices had been gone for 10 years.   They were trying to return and were demanding her to let them in again.   She was refusing.   They promised to show her a good time.   They promised to tell her to get naked in front of lots of people.   She continued to refuse to let them back into her head.   The actors and actresses did an excellent job of portraying the struggle she had been experiencing.   Finally we discussed what had been happening in the workshop and ground it into aboriginal thought about extraordinary realities and our capacity to negotiate them.   I mentioned the problem with some young people of our day trying to journey in other dimensions without guides.   That's why we have elders, I said.   Elders and teachers are there to help us navigate extraordinary spaces and to give us the stories to understand what's going on so that we don't get too far away from the ordinary world and not know how to get back. More later.