The highlight of Day 9 in our Australian cross-cultural mental health journey was a workshop for indigenous mental health and human service providers on how to make their services more indigenous friendly. This involves, of course, conscious decolonization of our clinical practices. We talked about the need to become more narrative, to listen longer and more deeply to the stories people tell us and to hear stories of others.

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Today is Day 9.   We awoke with the dawn for a run along the water of Paynesville.   We met many happy, friendly, and excited dogs en route, including one belonging to the Co-op employee who was supposed to pick us up later.   He lived in the neighborhood and was walking his dog before gathering us.   Besides participating in a community barbecue and our Choctaw friend presenting his tribe's flag to the head of the Board of Directors in thanks, we were scheduled to give a workshop to mental health workers about how to implement indigenous-friendly practices into their health care system.   We had discovered on Day 8 that this meant implementing a storied approach.  

The participants in our workshop had all been front-line health workers, though many were now in senior management positions.   They were familiar with the big areas of need: domestic violence, substance misuse, diabetes, criminal justice, elder care, youth services, and more.   Most were aboriginal.   We started by asking them to tell us to move along if we were telling them anything they already knew very well.

We began with our realization of Day 8 -- that the first step to becoming indigenous friendly is to narrativize.   We talked about the need to do more than write clinical histories, make diagnoses, and assign treatments -- that to be aboriginal friendly means working from a storied perspective.   I told about my elders saying that al that exists are stories.   I mentioned Shank and Abelson, two scientists who write that all knowledge is stored as a story.   I used my example of a hammer -- that if I mention a hammer, I can't think of one without a story about it.   I can't remember "hammer" without remembering stories about its use and times I have used it.   My favorite example is my association of hammer with a story a man told me about driving into a lake only to have his electric windows short out and his almost dying before he managed to kick open the window.   "And that's why I always carry a hammer in my glove compartment," I said.   Everyone agreed that they couldn't contemplate a hammer without associating to a story involving hammers.   I challenged participants to find an example in which they could contemplate an object "purely" without associating to a story about a time of using that object or a story they had heard about what that object was used for.   No one could.   Then I mentioned neuroscientist Marcus Raichle from St. Louis who discovered that the default mode of the brain is to tell story.   Anything else burns more glucose and takes more effort, including mindfulness meditation.   Everyone agreed that when our brain is idling, we are "simming", which is what we call running mental simulations of social situations to anticipate how different possible actions and responses on our part could influence the eventual outcome.   Everyone also related to that.

Thus, the first step in becoming indigenous friendly is to hear and appreciate the stories associated with the illness.   To do that, we have to get more than the bare minimum required to make a diagnosis, we have to fill in the gaps and the silences and recognize the metaphors and symbols used by the person, of which he or she may not even be consciously aware.   This is what narrative competency means.   Thus, a practice who wants to become indigenous friendly has to build narrative skills and competence.

Step 2 is the recognition that the illness does not belong to the person who appears (from a biomedical perspective) to house it.   The illness is shared among all stakeholders.   Thus, to understand an illness and the person who houses it, we need to hear the stories that everyone would tell about that person and that illness.   I talked about my routine practice of asking people to bring everyone they knew to the second appointment so that I could meet the person's community and hear more of the stories being told about that person.

Then I mentioned the Lakota concept of the nagi, or the swarm of all the stories and tellers of those stories who have influenced us and forged us into who we are today.   Some of these stories could even be from the future, some from the present, and some from the distant past.   Some of these stories are those that everyone shares in a culture and some are the minority stories that only some people know.   For instance, not enough mainstream Australian people know the story of how this continent was taken from its original inhabitants.   Not enough know the stories of mistreatment that ensued.   Not enough know the residential school stories or the stories about the theft of people's children, or the other traumas that befell indigenous people in Australia.   Part of being indigenous friendly as a human service provider, is to know all these stories, or as many as possible, for these stories are influencing our clients, whether they know it or not.   Then we discussed the impact of intergenerational trauma.   I spoke about epigenetics and how we now know that people inherit from their parents the effects of life experience on their parents through the ways that life experience modifies the shape of our DNA.   The effects of life experience can be passed on for at least four generations, and probably more, unless changed by a corrective emotional experience.   Thus, indigenous friendly means recognizing that many of our young clients are behaving as if they lived through the trauma experienced by their great grandparents.   We have to recognize that many of our clients have taken on or absorbed stories that were never theirs and have forgotten or not adequately heard the stories that were their legacy or inheritance.   To help people change, we help them connect with better stories to guide their lives.   This is what participation in traditional culture does.

One of our participants told us about a marvelous exercise he uses with his men's groups called "The Golden Chair".   One man sits in "the golden chair" and all other men in the group tell him positive stories about him.   Our participant remarked upon how amazing it is how uncomfortable people are made by hearing positive stories about them.    Someone wondered why, and another woman spoke about the many stories you hear as children telling you not to be vain or uppity, not to be arrogant or full of yourself.   Maybe those stories are told too often, she said.   Maybe we don't need to hear them as much as we do.

Another participant told about the negative consequences to his clients of no longer having to do community work for their welfare payments.   The community work got them out of the house and made them feel valuable.   The work gave them a sense for themselves as bread winners, as providers for their family.   It made them proud of the money they were receiving.   The cancellation of the work resulted (in his view) in more violence and substance misuse and crime because of the erosion of self-esteem that resulted from no longer being a provider.

Then, our colleague Rocky talked about diagnosis as a naming ceremony.   We moved on to the topic of shame.   I spoke about how shame prevents change.   Presumably some shame or anticipation of shame is important in an accountability network, but we have gone beyond that so that people who feel shame get defensive and lash out at those whom they perceive as judging them, which prevents those who may not be judging them from helping them to change.   Anything that reduces shame facilitates change, I said.   I mentioned my Uncle Rod, who is a healer.   When Rod was asked what allowed him to become a healing elder, he said, "thirty five years of being a wino."   That's wearing one's past proudly!

Another participant who worked with violent men talked about the very negative impact on men of publicity that made every aboriginal man look like a violent man in the eyes of others.   He talked about his search for stories to counteract those stories, stories in which aboriginal men were non-violent and peace promoting.   Rocky then mentioned the prophecies of His Crazy Horse, who told how the children of the Europeans would flock to Lakota spirituality 7 generations hence and would realize that they couldn't survive on the planet without indigenous knowledge.   He talked about a shift he has seen in Yaqui country, where he works, of men being told that they have knowledge crucial for planetary survival and to be proud of having that knowledge.   Rocky, who is a physician, spoke about biomedicine as being somewhat of a fundamentalist religion.   Anything it generates is accepted; anything that comes from outside of it is not.   He described 2001 brain research by UCLA neuroscientist Paly who found that nothing lit up the brain like story and metaphor.   Rocky told a story of a 4 year old he had seen in his practice who wouldn't control his peeing.   He was pissing on everything.   When Rocky asked the parents what was going on at home, they told him about their fighting and confirmed that it was happening around their only child.   Rocky asked them to speak to their child and get him uninvolved with their fighting.   When they did, he stopped peeing inappropriately.   "Clearly," Rocky said, "he was pissed off."   He said that stories have to find their way out or they get stuck in the body.   As an example, he asked everyone to visualize a lemon slice going into our mouths.   Most of us salivated extensively.  

We closed the workshop with an exercise using the talking circle.   In the talking circle format, one person poses a question for the circle.   A decorated stick is passes to the left.   Whoever holds the stick is not interrupted, no matter what.   We only speak when we hold the stick and there is no cross talk.   The assignment was to discuss a controversial issue without giving an opinion or giving advice or talking someone what they should do.   The task was to tell a story about our association or connection with that topic but from a particular, personal level.   The others were to practice listening completely to that story rather than rushing to find a "close enough" matching story from their own experience.   Furthermore, participants were asked not to judge or interpret anyone else's story, but just to listen.   This was a practice exercise in hearing all the stories associated with an issue before moving to solve the problem.   Too often we jump into problem solving mode before we've heard all the stories and then we're puzzled when people won't do the perfectly obvious solution (to us) that comes from partial listening.

And this was the end of Day 9.

Authors Website: www.mehl-madrona.com

Authors Bio:
Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and Narrative Medicine.