The Healing Power of Narrative History
by Iona Miller
CHAPTER 3: METAPHORS BE WITH YOU
"To heal the symptom, we must heal the person, and to heal the person we must first heal the story in which the person has imagined himself." --James Hillman
Emphasis in the West, has particularly been on the linear, orderly unfolding of life and the emphasis on the individual journey, the self in relation to society. Return to progress, activity, productivity, perseverance, achievement, determination, goal-orientation, and self-reliance are emphasized in our cultural ideologies in the face of uncertainty, loss of hope, and the anticipation of death. Yet our lives clearly don't follow predictable, coherent, linear paths.
This paradigm is not as pronounced in cultures which have a distinctively cyclic worldview, and maintain more integrated family and community lives where collective human values are prioritized. This is evident for example in Canada and Europe where healthcare is not treated solely as an individual responsibility. This sociopolitical aspect permeates healthcare in the U.S. which is the only country in the world to include its receipts in the Gross National Product.
Treatment in the health field starts with the assumption that clinical treatment of disease is a cost-efficient way to maintain health. In the past centuries, public health practices eliminated many diseases at a fraction of the cost possible with clinical treatment, so more holistic or sociological approaches have developed. Clinical medicine, with its emphasis on curing disease has gradually replaced the less remunerative public health emphasis, since it is much more lucrative and prestigious.
The medical ecology of the 1950s, focusing on disease and individuals, was based in a simplistic environmental stimulus-response model. It virtually eliminated scourges like polio, tuberculosis, many bacterial infections, and smallpox, at least in the US. But it failed to cope with the global spread of capitalism and its impact on health and societal development, which require more sophisticated ecological concepts. Critiques of biocultural paradigms, medical ecology, and medical anthropology need a common field of discourse, such as political ecology, but that is beyond the scope of this work, and the political power of our public health centers for disease control.
Our point is that our healing arc in the west is conditioned by the mandates of our Puritan work ethic, the underlying ethos of the U.S. Clearly this productivity bias goes hand in glove with our mechanistic, Cartesian upbringings -- we are trained from birth to notice and value certain things over others.
The history of Western civilization contains a fundamental theme of dissociation (Ross). It is manifest in the Cartesian treatment philosophy which splits mind from body. Its reductionist aspect is physically embodied in medical science; its dissociated romantic side in psychology. We are caught in the social web of dualism, dissociation, and projection. Curiously, the Western mind projects the products of its own function onto the unconscious and mistakenly concludes they originate there. Reductionism denies the reality of the psyche.
Contemporary medicine projects its vision of a mechanistic function onto the body and physical universe. Psychology's philosophical doctrine sentimentalizes the natural world and projects abnormal ideas onto the body and the "unconscious" mind. But is it unconscious, or merely dissociated? Culturally divorced from the body, of course the mind becomes dissociated. We need a spiritual return to a dynamic unified perspective.
Dissociation of mind and body was followed by fragmentation of social function. Looking at how we respond to disruption helps reveal our core tenets, and how deeply we are embedded in the cultural contours of our society. Can we have value as human beings, or must we force ourselves to respond as 'human doings' to maintain our self image and esteem, because our culture demands it?
Narratives, both personal and collective, arise from the desire to have life display coherence, integrity, fullness, disclosure, and closure. Even psychotherapy is based in part on the premise that reshaping or reframing events lends a sense of coherence where there has been chaos. Change the history or reframe the story and the attitudes associated with it automatically change.
The development of these narratives is preeminently, a cultural process. Even though the premise is unspoken, we have come to tacitly expect a "beginning, middle, and end" to our personal stories. Most of us would like to imagine an optimistic end to our stories, one that provides meaning and purpose for our lives...a "good" ending, if not always a "happy" one.
We all witnessed this, both at the personal and national level, even worldwide, in the aftermath of the 9/11 disaster. Part of the healing process commenced immediately with the constant telling of tales to one another -- how we were involved, or changed, and further impacted by this graphic demonstration that the sanctity of our native soil would never be the same again. The psychological and cultural healing became as important as the practical clean up and strategic reactions.
The distressed body plays the largest role in our response to and the impact of chaos. Stress alone can affect us even when we are not emotionally or personally connected to an event. Sometimes empathic viewing of an event, and the personal associations and issues it brings up, such as existential safety and trust, fear and personal pain can be enough to mobilize the body for the fight-flight response. A wake of psychophysical and immunological changes follow, and persist, depending on the degree of involvement.
Our understanding of ourselves and the world begins with our reliance on the orderly functioning of our body. Our expectations in this regard are somewhat conditioned in childhood by our own experiences and those of our close caregivers. A relatively uneventful childhood may lead to an exaggerated sense of strength, immortality, undefeatability; while exposure to catastrophic or chronic illness may lead to a deep sense of vulnerability, even weakness. We can't know just how strong or resilient we are until we are challenged to mobilize our inner reserves and resources.
We carry our histories, as well as the whole history of humanity, with us into the present through our bodies. Our feelings and thoughts become manifest in our physical structure. The past is "sedimented" in the body -- that is, it is embodied. Our bodies' sensory apparatus is the only way we experience the larger world. It is the medium through which we meet and respond to that world, feeling its reciprocal impact on us. Thus our symptoms can reflect our cultural as well as personal attitudes.
We may ignore, diminish, or hide symptoms, use specific kinds of supplements, folk or new age remedies attempting to control or minimize our symptoms. We may delay seeking treatment to avoid the fear of being "abnormal," or perceived in that way by others. There is a pervasive feeling that most of us don't want to become a "burden" to our loved ones.
Thus, the body is foundational in the emergence of culture and cultural norms. Its as if a deep part of us remembers the hunter-gatherer days of humanity when the infirm were simply left to fend for themselves or die when they could not "keep up." Culture essentially began with shamanic healing, lore, and ritual burials. We can presume teaching stories were used to bind the tribe together.
We are also able to ground our resistance to the power of cultural norms in bodily experience. Our resistance is tempered by our bodily knowledge as we listen to our bodies in deciding whether care is necessary. Failure to listen for symptoms, or to gauge them accurately, can have serious and even fatal medical consequences. Thus, bodily knowledge informs our actions, including resistance to the status quo. Part of that status quo is the availability of heathcare we feel is simpatico with our worldview and sense of self -- our view of the healing professions -- physical, emotional and spiritual.
Often in our illnesses, breakdowns, or grief, we seek a new norm for ourselves in larger social collectives, such as support groups or spiritual groups. It is comforting to be around others who share the same infirmities and issues, and are navigating the same turbulent waters.
We draw succor from knowing we are sharing the same passages, and can share information, resources, solutions and benefit from the experience of those who have gone before. By telling our sad tales, or tales of recovery over and over, we project images of ourselves into the world through performance. This is actually a form of creativity which helps the healing process, and creates resilience in the general community.
Order and Chaos
Our notions of order and chaos change as we attempt to come to grips with disruption in our lives. We reexamine the given ideas of our culture when we become marginalized from the bustling demands of daily life. When our life circumstances don't fit with our preconceived image we have to look at the disjunction, the discrepancies, the disconnections, and make adjustments.
Often efforts to create coherence and provide closure to situations are at odds with notions of order shaped by complex cultural dynamics. Where we find support for this reassessment can make a profound difference in our ability to move beyond the problem phase toward healthy choices, solutions, and resolutions. Depending on the nature of the disruption, various cultural ideals of, for example, health, womanhood, manhood, parenthood, independence, and the aging process emerge.
When our stability is threatened, we begin to wonder if the unspoken "end" of our personal story will take a different tack. Yet, stability is individually defined. We can adjust to a diminished capacity without feeling that our sense of self-identity is diminished, but it may be a big part of the healing struggle. Our culture has programmed us to derive a great part of our sense of self from doing, rather than being. Ideally, even when infirm, we can partake of an active life of the spirit.
Thus, our value is wrapped up in what we are able to do in the world, rather than simply being valued for existing, for our basic humanity. When challenged, we learn there are often a wide variety of other ways we can contribute. Our attitudes are a good predictor of how we will respond to challenge. A good attitude, even though it may not cure, supports the healing of the bodymind since it doesn't put an extra stress load on it.
Our self-narratives help us make "sense" of our ordeals, the gauntlet we are forced to run by the impact of disruption. What is most striking about the portrait of issues that emerge when we wrestle with disruption is that in the U.S. at least, core beliefs persist despite ongoing social change.
Even if we have been progressive, illness may cause us to regress to the values of our youth, when we felt more helpless, less independent. Of course, there is variation according to ethnicity, gender, class, and age. Disruption throws these cultural distinctions into high relief so the underlying core foundations and unspoken beliefs become more visible.
Most people strive to be somewhat "normal." But the realities of life can carry us far afield from that imaginal ideal. We all have compelling concerns and precious stakes to defend and sustain, including relationships and life goals and dreams that guide and sustain us.
Yet events occur continuously that do not fit in with our vision of how life should be. When they strike like a bolt from the blue, what we do affects our individualized view of the world. We may present a brave front to the world, and yet be quaking internally with fear and pain. To be authentic, to be congruent in our self-expression we need to make our inner truth part of our story.
Disruption makes us feel different from others, due to our existential position, traumas, or reactions. Once we feel marginalized we begin to define ourselves in terms of difference rather than normalcy. Over and over the conflict arises between the desire for normalcy and the blunt acknowledgment of difference playing over and over in one's experience and consciousness.
Our abilities to care for our selves in terms of pre-planning and response patterns effect those around us. Disruption makes us feel different from others and can render social relationships uncomfortable and even cumbersome. Our narratives repeatedly attest to the emotional pain that difference causes and to the struggle to reduce or eliminate that sense of difference from others.
On the other hand, some people exploit their infirmities for the social payoffs of what are called "secondary gains," in medicine and psychotherapy. This survival strategy may or may not manifest the desired manipulation, and can often backfire on the person, who may be totally unconscious of this goal.
The stories we construct surrounding the disruption of our lives are essentially moral accounts. This is virtually the only way we can endow our reality with so much meaning. But, clearly, bad things happen to "good" people. We call this tragic or say it's a "tragedy."
When thrust into a different lifestyle, into an experience of otherness, we seem to require a moralizing antidote to mediate the experience of the radical shift in self-image. This experience has been canonized in the dramatic form called tragedy, which devolved from ancient Greek rituals of Dionysus, god of chaos and disruption and Apollo, traditionally the god of light and healing, but also disease.
We struggle in the moral dimension rethinking our values under assault from chaotic disruption. Thus, our faith in ourselves, or perhaps a higher power is either confirmed or disavowed. Some of that resistance gets directed at the status quo. At this point many people rebel against the limitations of conventional treatment and seek alternative treatments or healing for the soul and spirit, as well as the body. [3] Our internal dialogue on differences and normalcy is riddled with metaphors that reveal cultural foundations.
CHAPTER 4
Soul Support: Healing the Disordered Bodymind
"The gods have become diseases; Zeus no longer rules Olympus, but the solar plexus, and produces curious specimens for the doctor's consulting room." --C. G. Jung (1929, p. 37)
Carl Jung believed the soul or psyche to be autonomous from ego consciousness. Soul, according to Jung, is a manifestation of the collective unconscious: the deepest substrate upon which existence rests. Its function is to animate life. In Archetypes of the Collective Unconscious , Jung writes: "Soul is the living thing in man, that which lives of itself and causes life ….She is full of snares and traps, in order that man should fail, should reach the earth, entangle himself there, and stay caught, so that life should be lived…"
The voice with which Ivan Ilych dialogues, is that of soul. It is soul, the objective psyche, which inquires in the midst of one’s suffering "What is it you want?" Symptoms are generally believed to derive from an external event, or an internal neuro-biological imbalance. From this ego perspective, symptoms are in us because that is the way they are experienced. Symptoms are experienced as an alien other.
When our mental or physical health is suddenly disrupted, we are thrown into chaos. It can be likened to a "descent into hell," "dark night of the soul," "being dragged over the coals," a "bad dream," or "nightmare," "limbo," "falling into a black hole," "reaping the whirlwind," or a "brush with death." The chaos and disorientation is reflected most strongly in our hopes and dreams as we attempt to cope with onslaught of our body, mind and spirit.
It splits our perception into two separate realities -- "before and after," -- the known world of normalcy before catastrophe or disease struck, and the chaotic world of the dis-ease, mental or physical. All sources of disruption disturb the psyche. Our spirit is assaulted by the agents of chaos. We can feel let down or even betrayed by our bodies. It raises a host of issues, such as lasting, leaving, longevity, mortality, repetition, being left behind, compassion, isolation, abandonment, marginalization, etc.
The spontaneous human activity of creating healing narratives to restore order is the basis of psychotherapy, particularly talk therapy. However, the healing journey and milestones of all therapies, including biomedicine and energy medicine, are congealed in the narratives we produce spontaneously about our life journeys. The life journey is a core metaphor. We don't need to formally enter therapy for its directive power to come into play.
It is a guiding force. We can creatively employ this natural process to mobilize healing by helping the process along in an integrated way. We can address the needs of the whole person: the bodymind, with its need to restore a sense of emotional balance, order and meaning, and the moral dimension with its need for spirituality.
All human actions are worked out to the end, passing through the unforeseeable contingencies of a "world we never made." The conscious purpose with which we start is redefined after each unforeseen contingency is sufferance. At the end, in the light of hindsight, we see the truth of what we have been doing.
When we experience illness and health conditions requiring considerable medical intervention, we monitor and discuss our bodies. How we talk about them tells us much about the nature of embodiment and how cultural particulars influence the way we experience embodiment. How we talk also tells us much about the portrayal of bodily experience.
There is a connection between how people talk about their bodies -- bodily concerns and bodily experience -- and how they experience them. This action is a kind of natural history of the psyche's life. But action does not means deeds, event, or physical activity but the motivation from which deeds spring. The action this art seeks is to depict a psychic energy working outwards, the focus or movements of the psyche toward what seems good to it at the moment -- a movement-of-spirit.
A Moving Experience
Action is active: the psyche perceives something it wants, and "moves" toward it. Passion, or pathos (suffering) is passive. The psyche suffers something it cannot control or understand, and "is moved" thereby. But in our human experience action and passion are always combined.
There is no movement of the psyche which is pure passion -- totally devoid of purpose and understanding. There is no human action without its component of ill-defined feeling or emotion. Pain, lust, terror, grief, and passion continually arises out of the more formless pathos or affectivity. Purpose arises out of the passion of fear, and is given form through the continued effort to see how the common purpose might still be achieved.
When disruption occurs, the temporary or permanent destruction of our sense of "fit" with society calls into question our personhood, sense of identity, and sense of normalcy. It can strike at every aspect of life from self-image, to sexuality, life plans, even ability to get a good night's sleep.
Usually the theme is loss, but simultaneously many aspects of the experience may give life meaning, distressing though it is. Biomedical diagnoses shape our discourses on normalcy. Diagnosis makes concrete what was previously indeterminate. It creates the goal and desire to return to normal, which is also shaped by societal discourse.
Like good biographers, we instinctively edit our life stories into an "organic" form - the plot.
The purpose of plot-making is to represent one 'complete action.' We don't tell everything about ourselves, even to ourselves. We choose only those salient features which lead toward a satisfactory culmination, in the short or long term. We are being selective, rather than secretive, to lend coherence to our tale. It gives us a sense of greater consistency, and introjects a cultural or universal, as well as personal angle. Plot unfoldment is the unifying element of narrative.
Plot is the first principle, the very soul of tragedy. Plot-making forms story into an actual tragedy, bringing potential for catharsis or purging of the emotions of fear and pity. Purging us of our emotions helps us reconcile with our fate, because we come to understand it as the universal human lot.
Catharsis or purgation can mean either the cleansing of the body (a medical term) or the cleansing of the spirit (a spiritual term). It is a movement of spirit from ignorance to insight. A complete action passes through the modes of purpose and pathos to the final perception. Both action and character are formed of our ill-defined feelings and emotions, appetites and fears, but this element of pathos is essential.
Thus, tragedy speaks to the mind, soul, and spirit. The "end" of tragedy is the purgation of passion, and the embodiment of a universal truth, analogous to the purposes of spiritual ritual. Paradoxically, tragedy gives us pleasure, even with its images of conflict, terror and suffering.
Perhaps it is the promise of catharsis, which may or may not come, in an unpredictable real life tragedy. Poetry expresses the universal, but our histories express the particular. The appeal of tragedy is, in the last analysis inexplicable, rooted as it is in our instincts and mysterious human nature.
Our instinctive editing is in fact driven by cultural considerations about disruption, as its ritualistic aspect implies. Thus, the same topics emerge over and over again in stories by those from the same cultural background. They reveal what we consider most meaningful about our lives. Do we find ourselves sympathetic or unsympathetic characters in our own story? Or, do we or others judge us as simply pathetic ? Some themes remain dominant, while others recede into the background until another chaotic disruption brings them to the fore again.
Life Themes and Memes
Themes are cultural "memes" which also help us make sense of our experiences. Our stories may be highly influenced by a complex dynamic interaction of memes (cultural "viruses"), mirror neurons (biological capacity for imitation), poetics (emergent dramatic expression), and embodiment (embodied distress or normalcy).
The theory of memes describes them as a form of information that sculpts minds and culture as they spread through imitation. Memes are likened to informational "viruses," and the DNA of human society because of their ability to propagate. Because of their ability to replicate themselves, they influence every aspect of mind, behavior and culture.
Memes are the cultural equivalent of DNA. This notion undermines some of our cherished illusions about individuality. We are neither the slaves of our genes nor rational free agents creating culture, art, science and technology for our own happiness.
Blackmore includes among memes the stories, songs, habits, skills, inventions and ways of doing thing that we copy from person to person, including medical memes. Memes are to our minds what genes are to our bodies. Perhaps memes also evolve. Our culture has generated a host of medical memes about health, illness, and treatment. Our own stories morph over time varying with the meaning they embody.
[Richard Dawkins, "father" of meme theory] described the basic principle of Darwinian evolution in terms of three general processes—when information is copied again and again, with variations and with selection of some variants over others, you must get evolution. That is, over many iterations of this cycle, the population of surviving copies will gradually acquire new properties that tend to make them better suited to succeeding in the ongoing competition to produce progeny. Although the cycle is mindless, it generates design out of chaos. (Blackmore, 2000).
Human life is permeated through and through with memes and their consequences. Everything we have learned by imitation from someone else is a meme. But we must be clear what is meant by the word 'imitation' because our whole understanding of memetics depends on it.
Dawkins said that memes jump from "brain to brain via a process which, in the broad sense, can be called imitation." If in doubt, remember that something must have been copied. Aristotle named this principle of imitation the first tenet of his description of the mimetic arts, essentially the varieties of storytelling, chiefly epic, comedy, and tragedy:
"And with regard to each of the poetic forms, I wish to consider what characteristic effect it has, how its plots should be constructed if the poet's work is to be good, and also the number and nature of the parts of which the form consists. . .Let us then follow the order of nature and begin by taking up that which is by nature first: the basic principle of imitation. " [Second comes] "differences based on the means of imitation." (Aristotle's Poetics).
This dramatic imitation takes place in narrative, action, and manner and mode of presentation. But when Aristotle speaks of imitating action, he does not mean mere physical activity but a movement-of-spirit. By imitation, he does not mean superficial copying, but the representation of countless forms which the life of the human spirit may take through the arts.
This, peripherally, is why art therapy in all media is so effective as an aid to psychophysical recovery. It helps us express what we cannot put into words. Many of the arts combine imitation with harmony and rhythm. And so do our dramatic tales of our life journeys.
Ain't It Awful?
Tragedy is an imitation of an action that is whole and compete in itself and of a certain magnitude. As a whole thing it has a beginning, middle, and end. Differences arise from the object of imitation and the manner of imitating. The most important aspect of drama is the organization of the events -- the plot. It is in action that happiness and unhappiness are found. Everything that is passed from person to person through imitation is a meme. This is also revealed in the emergent style of drama, as described holistically by Aristotle:
"Just as in the other mimetic arts an imitation is unified when it is in the imitation of a unified object, so in poetry the plot, since it is imitation of an action, must be the imitation of a unified action comprising a whole; and the events which the parts of the plot must be so organized that if any one of them is displayed or taken away, the whole will be shaken and put out of joint; for if the presence or absence of a thing makes no discernible difference, that thing is not part of the whole. . . [P]ossbility means credibility; until something happens we remain uncertain of its possibility, but what has happened obviously is possible since if impossible, it would not have happened. . .It is clear then that the poet should be a maker of plots more than a maker of verses, in that he is poet by virtue of his imitation and he imitates actions. . .It is not only an action complete in itself that tragedy represents; it also represents incidents involving pity and fear, and such incidents are most effective when they come unexpectedly and yet occur in a causal sequence in which one thing leads to another...things that actually do happen by accident seem most marvelous when they appear to be intention...It is hard to believe that such things happen without design."
Aristotle goes on to describe elements of drama that seem reminiscent of chaotic dynamics. Some plots are simple; some are complex. In simple action, changes of fortune take place without a reversal or recognition. In complex plots, the change of fortune involves a recognition or a reversal or ideally both.
The action of perceiving, passing from ignorance to knowledge, is near the heart of tragedy. Pathos or suffering is also an essential element. The recognition and reversal follow from the preceding events toward a probabilistic outcome, but with a vast difference between "following from" (emergence) and "following after" (linearity).
Complications are influential events which happen outside of the range of the story, while the denouement or unraveling is the final turn of events, for good or ill, before the end of the story. In medical treatment, for example, the reveal comes after treatment with the prognosis.
Reversal is a change from one state of affairs to its exact opposite; recognition is a change from ignorance to knowledge. The best form of recognition is that accompanied by a reversal and springing from the events themselves. The three primary elements of tragedy include reversal, recognition and suffering (pathos), reflecting critical problems and their solutions. In drama and life, tragedy is never about one isolated character:
Neuroscientists are finding that much brain function is an interpersonal phenomenon. Not only do brain structures and functions provide the means by which we connect with and make sense of one another, but through relational experience, parts of the brain, literally, grow. In fact, the brain, as we know it, is inconceivable without social relationships: “The traditional idea of the brain has been the single-skull view an organ encased inside us whose functioning is determined primarily by our inborn biology,” says Siegel, who coined the term interpersonal neurobiology to describe how advances in research have created a conceptual bridge among biology, attachment research, development psychology, brain science, and systems theory. “But we survived as a species not so much because of our physical brawn, but due to our interpersonal capacity. More and more, we’re realizing that evolution has designed our brains to be shaped by our interpersonal environment.”
Siegel posits a “multiskull view” of the brain, a way of understanding that brain processes take place through people’s interactions with one another. “The best way to define the mind is as the flow of energy and information,” says Siegel. “That flow can happen between neurons in a person’s skull, as well as between two people. Without being reductionistic, the cultural transmission of meaning ultimately comes down to a neuronal process.”
A securely attached child develops the neural pathways for resilience. Even when his or her parents are upset or impatient, his or her brain’s wiring “knows” from experience that they won’t abandon her and will reconnect after the storm has passed. Kids who don’t get this kind of back-and-forth parental attention may grow up more or less at the mercy of their emotions, unable to manage their rage and aggression, calm their anxieties, console themselves in their sadness, or tolerate high levels of pleasure and excitement.
Furthermore, they’ll be more likely to suffer social disconnection: unable to interpret others’ social cues because of deficits in their orbitofrontal cortices, they’ll have trouble joining in the rhythm of relational exchange. In short, from the beginning, relating isn’t a discretionary activity, something we can do without. As an organ, the brain must make human connections to develop a healthy, working mind, (Wylie and Simon).
Narrative is fundamental to brain function and attachment. There’s no greater example of the brain’s innate powers of self-creation than the universal human practice of constructing narratives, of drawing from the raw stuff of experience the stories with which our brain explains itself -- to itself and other brains. “Storytelling is central to every culture, and when you find that kind of universality, you know it’s not just social learning but reflects something deep-seated in our genes,” says Siegel, who believes that the neurological subplot, if you will, of the well-made story involves the integration of the brain’s left and right hemispheres.
“Coherent stories are an integration of the left hemisphere’s drive to tell a logical story about events and the right brain’s ability to grasp emotionally the mental processes of the people in those events,” he adds. Storytelling also relies on the prefrontal short- and long-term memory systems and the cerebellum—once thought to coordinate only physical movement, but now believed to coordinate different emotional and cognitive functions. Storytelling involves planning, sequencing ideas, using language coherently, shifting attention, and interacting appropriately with other people. The ability to tell a good story is a measure of mental health and a well-functioning brain.
The most striking empirical indication of storytelling’s role in mental health and development may come from a series of studies involving the Adult Attachment Interview (AAI), a research protocol that assesses the level of relational attachment. In the mid-1990s, Mary Main, the primary researcher, now at University of California, Berkeley, and then graduate student Ruth Goldwyn, found that a child’s attachment to a parent could be better predicted by listening to the how a pregnant couple related their autobiographical narrative than by measures of intellectual function, personality assessment, or socioeconomic status. A year after the initial assessment, children’s attachment to their parent could be predicted with 75 percent accuracy, based on the AAI assessment. The idea is that by measuring the “coherence” with which people describe their life story--its emotional content, plausibility, completeness, relevance, brevity, and clarity--you can determine how securely bonded their child will be. Additional research suggests that secure children will then develop the capacity for coherent narrative themselves--good narrative is, literally, something their parents can pass on.
Tell me A Story
Why is storytelling paramount? Stories link the factual to the emotional, the specific to the universal, the past to the present. A child hearing a story thinks, “There are others like me.” A storytelling parent models coping skills and provides a template for self-expression, logic, and how to prioritize.
In sharing stories, parent and child are connected at many levels of mind—which translates to many levels of the brain. Siegel speculates: “For a parent to engage in the process of telling a coherent story about his or her life reflects a fundamental capacity for that parent’s brain to integrate memory, knowledge, and feeling. It appears that this ability in the parents’ brain nurtures their children’s own neural integration.” And the process of integration then guides their capacity for self-regulation and full adult development. (Wylie and Simon)
People tell their stories in therapy. That’s how they explain themselves. But they also learn to tell stories, learn how to organize and make something whole from sometimes chaotic feelings of pain and confusion. The enterprise of therapy is itself a kind of story: there are psychoanalytic stories, cognitive-behavioral stories, family therapy stories. Different stories resonate with the brains of different patients. “Therapy evolved because language organizes the brain in some primary, fundamental way,” says Cozolino. “What we know of the brain suggests that therapy is successful to the degree to which it builds and integrates neural networks. In therapy, we teach clients that the more ways they have of interacting with others, experiencing themselves, and understanding life, the more likely they are to find new ways of approaching their problems.
Therapy is a process of helping clients rewrite the story of their lives while simultaneously building neural networks and reorganizing neural integration.”
Psychotherapy is perhaps the area where the human brain’s capacity for storytelling is most deeply engaged—not only telling old stories, but making sense of what has always seemed irrational, and making up newer, better stories, with better plotlines, stronger characters, and more promising outcomes. Even the reduction of the mind to “nothing but” the physical brain, even the way the physical brain functions, become stories we tell ourselves about ourselves, providing meaning, worldviews, and political and social agendas. Our predisposition to stories probably explains our interest in brain science.
Neuroscience researcher Jaak Panksepp of Bowling Green State University posits what he calls a “seeking system” in the brain—the inner urge to find and get, to discover and learn, to understand, to satisfy curiosity. This system underpins primitive urges, like the urge to hunt. It informs complex behaviors, like the search for knowledge, spiritual connection, love. The need to satisfy curiosity about ourselves -- where we come from, who we are, how we developed, what we’re made of -- compels the creation of the evolving story of the brain and how it grows. As John Ratey puts it, “Whatever the advances of neurobiology and our ability to relieve symptoms, I don’t think that we’ll ever undo the need for understanding people’s history.” (Wylie and Simon).
From infancy and childhood it is instinctive for human beings to mirror others, to imitate. Our brains are endowed with specialized "mirror neurons" in our frontal lobes that move us spontaneously in this direction. Researchers have identified individual “mirror neurons in monkeys,” single neurons that fire both when a monkey performs a meaningful act—such as eating a peanut—and also when a monkey sees another monkey perform an act. Scientists think that this capacity for neural mirroring helps us interpret other people’s actions and feelings, and may be the neurophysiological basis for empathy.
With knowledge of these neurons, you have the basis for understanding a host of very enigmatic aspects of the human mind: "mind reading" empathy, imitation learning, and even the evolution of language. Anytime you watch someone else doing something (or even starting to do something), the corresponding mirror neuron might fire in your brain, thereby allowing you to "read" and understand another's intentions, and thus to develop a sophisticated "theory of other minds." ... Mirror neurons can also enable you to imitate the movements of others thereby setting the stage for the complex Lamarckian or cultural inheritance that characterizes our species and liberates us from the constraints of a purely gene based evolution. . .their emergence and further development in hominids was a decisive step. The reason is that once you have a certain minimum amount of "imitation learning" and "culture" in place, this culture can, in turn, exert the selection pressure for developing those additional mental traits that make us human. And once this starts happening you have set in motion the auto-catalytic process that culminated in modern human consciousness. My suggestion that these neurons provided the initial impetus for "runaway" brain/ culture co-evolution in humans, isn't quite as bizarre as it sounds... the first great leap forward was made possible largely by imitation and emulation. (Ramachandran).
Scientists once thought the number of neurons and their interconnections was permanently fixed: the brain you were born with was physically the brain you died with. Now the rankest of neuroscience heresies—that the brain produces brand-new cells in maturity—has become generally accepted, as has the idea that the brain is changing and growing continuously throughout life, shaped as much by experience as genetic heritage.
Every passing sensation, everything we learn, every human contact we make causes millions of neurons to fire together, forming physical interconnections called neural maps or networks, the architecture of all our experiences. Some studies suggest that the process of neural growth can be startlingly fast.
The neurophysiological basis for empathy might logically be extended to include imitating the health-promoting, coping, or recovery behavior of another -- their healing arc, their healing story. It means taking elements from that story and making it one's own.
Tragedy reveals the complex dynamics of action. Dramatic tragedy is said to remove fearful emotions from the soul through compassion and terror through catharsis. Thus, our stories can also be instructive. Our painful tortures become transformative testimonials. They arouse the sympathy, empathy, even imitation of others.
Fabrega presents not only the vulnerability to disease and injury but also the need to show and communicate sickness and to seek and provide healing as innate biological traits grounded in evolution. In Fabrega's view, sickness and healing are linked facets of a unique human adaptation developed during the evolution of the hominid line and expressed culturally in relation to the changing historical contingencies of social organization and complexity. This linking in which sickness and healing are two sides of the same coin rather than separate phenomena offers a new vantage point from which to examine the institution of medicine. After setting forth the idea that a complex, integrated adaptation for sickness and healing lies at the root of medicine, Fabrega goes on to trace the characteristics of sickness and healing through the early and later stages of social evolution. He describes epidemiological patterns of disease and injury, and the associated cultural constructions of sickness and healing, for family- and village-level societies, pre-states, and states and civilizations up to and including the modern European and postmodern eras. The notion of "memes" --units of cultural information stored and used by members of any society, in this case. "Medical memes" that relate to combating the effects of disease and injury--serves Fábrega in elaborating his concepts of the evolution of medicine as a social institution. Besides offering a new conceptual structure and a methodology for analyzing medicine in evolutionary terms, Fabrega shows the relevance of this approach and its implications for the social sciences and for the formulation of medical policy. The evolutionary formulation provides a common basis for the biological, social, and cultural investigation of medicine. (Fabrega, review).
It has been said that we each have a rather small significant number of influential people, decision points, and life-changing events. These influences are the dramatis personae and plot points around which the rest of our stories revolve.
In the language of chaos theory, we might call them the "strange attractors" of our lives -- those people and events without which we would not have become who we are. Often, the hoped-for end is not yet in sight. Our story remains open ended, pregnant with human possibilities, with healing possibilities.
Plot is the unifying elements of narrative giving it holistic cohesion and well as context. The change of fortune introduces a disruption for good or ill. It is this very change of fortune that reveals character, a person's habit of moral choice.
Many of the elements of our history come about by chance, fortune or misfortune. Universally, tragedy is depicted as growing out of an initial small plot point into a sizable magnitude and influence, through a close succession of probable events. This is reflected in chaos theory where sensitivity to initial conditions amplifies small changes into ones of tremendous magnitude and scale -- even global effects.
CHAPTER 5: Character: Have Some, Don't Just Be One
"Our distinction and glory as well as our sorrow, will have lain in being something particular." --Santayana
Perhaps part of the inherent problem of the medical model is that both practitioner and patient are encouraged to divorce themselves from their characters. Professionalism means succeeding in separating the practice of science and medicine from the character of the practitioner. As patients, we are encouraged to be objective about our condition, while our self-narrative is specifically our subjective healing fiction.
Self-knowledge appears and disappears as insight along the journey of life. Character is not a function of will but of the instinctual soul. Our characters are naturally wounded by our histories. Character ties psychology to society. It is a therapeutic idea. Character polishes us into a unique image. Unlike personality, it is impersonal -- an imaginative description, a cluster of characteristics, distinct from measurable talents and abilities.
What we do and how we do it is who we are, in fact, all that we are. Originally, character was not bent to fit moral strictures, but its uniquely defining characteristics have been co-opted by moralists (Bible-thumpers, Puritans, Victorians, etc.) into cultural notions of "good" and "bad" character. Our passion or pathos is more psychological than moral, per se.
A person of character may not necessarily be a moral exemplar. A person of bad character might be so due to little insight, drifting through events, clinging to stiff virtues, without linking to uniqueness. We are compelled and constrained by what we cannot control. Character forces us to confront each event in our own particular style.
Character doesn't need moral improvement, but metaphorical insight to live more fully. Character is embodied in traits, images, qualities. The usefulness of moral virtues lies primarily in their style of enactment. Character as images is revealed in our traits. Moral virtues are only part of the contents of character. We need insight, an intuitive sense of the images at work in our lives -- in the moves we make, the words we say, marking our style.
These characterological traits are the ways we stay authentic to our own nature. We are held within our personal bounds by the qualities particular to ourselves. Rather than knowing ourselves, we discover ourselves. Shame, guilt and low self-esteem aid character formation since they eat away at naivety and innocence. Hillman (1999) says, "Self-delusion is the mask of innocence in old age, much as innocence covers itself with denial earlier on. Shame which can make the body blush and writhe, confirms character's instinctive abhorrence of innocence."
Our healing stories are about characters both because others are so fundamental to our well-being in life, and because actions, passion, and motivations emerge from character . Characters are characters because they have specific characters. Character depends on differences, individuality.
Illness, aging, woundedness, and disruption can bring us face-to-face with our own character -- its delineation, core beliefs, self-concept, and self-image which is generally preserved and defended at nearly any cost. We are also moved by feelings we hardly understand as well as by ideas or visions which can be illusory. Thus unity of action or expression can be elusive.
The changes of old age, even the debilitating ones, have purposes and values organized by the psyche. Memory for recent events may falter, offering more place for long-term recollections. A heart condition in later life brings an opportunity to remove blockages from constricted relationships, while changes in sleep patterns allow the old to experience the profound elements of nighttime that we usually overlook. As Hillman says, "aging makes metaphors of biology." We don't realize that "oldness" is an archetypal state of being that can add value and luster to things we treasure, places we revere, and people's character. (Hillman, 1999).
Aristotle tells us action springs from two "natural causes," which are character and thought. Character disposes us to act in certain ways, but actually only in response to the changing circumstances of life. Thought (or perception) shows us what to seek and what to avoid in each situation. Are we afraid to look inward? What are we naturally curious about? There we find our passion. Thought and character together make our actions.
But action (praxis) here does not mean deeds, events, or physical activity. It means the motivation from which deeds spring. It is mainly a psychic energy working outwards. The focus or movement of the psyche is toward what seems good to it at the moment -- a movement-of-spirit.
Action implies the whole working out of a motive to its end in success or failure. Medically, that can mean cure, or healing even without cure, or failure to cure leading perhaps to death. Even in the face of biological failure to heal, however, we can heal emotionally and spiritually. It all depends on how authentic we stay to our characters, how we react to chaos and disruption, and how we want to end our unique story.
Pathos and Healing
There are as many healing stories as individuals. We intuitively craft our stories in the form of folk tales, drama, poems, prose fiction or essays that record the progress of an illness towards cure or death, stories that point the way to cure, and stories that may in themselves be healing medicine. We tell them to whoever will listen, or the story is that no one but ourselves will listen. Thus, we have stories from the point of view of the caregiver, the afflicted, the sick-room visitor.
Stories about diagnosis, denial, and protracted suffering; stories of courage and fortitude; stories about quick fixes and miracle cures; stories of apparent success then relapse or additional complications; stories of near-death, and mortality. Stories of medical failure; or medical success yet emotional or spiritual failure to heal. Stories about cultural plagues, such as tuberculosis, syphilis, influenza, cancer, and AIDS.
Stories involving healing modes such as neurology, psychology, hypnotherapy, psychiatry, homeopathy, chiropractic, modern drug medicine, surgery, and, traditional native healing, to name a few. Stories about cultural wounding, family sorrows, and the healing of men and women. Stories of crime and medicine. Stories of love and medicine. Stories of writers and medicine. Stories of war and medicine. Stories of the politics of medicine. Literature reveals many universal discoveries about the process of illness and healing. But no one else takes our particular journey.
Life's pathos is the royal road to healing. But, of course we can't substitute storytelling for needed medical treatment. No one would suggest such a thing. More accurately, it is in imagining through pathos, the pathologies and tragedies of life that healing occurs.
Hillman, in Healing Fiction, asserts that the way life is imagined is the way life is lived. The matter then becomes not one of healing persons, of curing diseases and addictions, but of healing one's imagination. It is a matter of healing our relationships with our stories, with the way in which these stories are imagined.
Nietzsche, in The Birth of Tragedy, writes that tragedy gives birth to imagination. It is to this realm, through the tragic suffering of our pathos, that the daimon leads us back to the soul's purpose.
Individuals who experience suffering must not only go through pain and confusion, they must come to terms with the powerful cultural ideology of rational determinism. This emphasis on the ability of will power alone to influence normalcy colors people's attitudes toward illness, old age, blood ties, and the chaos resulting from change.
Becker makes it quite clear that the cultural shibboleth that life will be orderly and predictable is an illusion. More and more people experiencing disruption are finding fresh paths to meaning and personal transformation in these crises.
Hillman conceives and practices therapy as an imaginative art, intimately bound with poetics -- the making with words, fictioning. To heal the symptom, he argues, we must heal the person, and to heal the person we must first heal the story in which the person has imagined himself. He suggests therapy "...that is based on a respect for the creative imagery of the patient, for his real predicament in the world and his ultimate irreducibility to rote mechanism."
We have seen that as complex adaptive organisms we use certain mechanisms to create a sense of order from the chaos we live in, and this gives us a feeling of well-being. Culture and tacit paradigms or worldviews plays a big role in this process, and the metaphors we employ to foster that well-being and return to normalcy.
New Directions
We can help physical and mental healthcare students envision an integrative health system for the 21st century and help them identify the skills they may need to acquire to help them practice in such a system.
1. Examine the impact of culture, history and politics on the allopathic and complementary health practices.
2. Learn to respect a variety of healing practices.
3. Describe the mind-body healing paradigm.
4. Describe the spiritual faith paradigm.
5. Describe selected complementary practices.
6. Observe the demonstrations of the various treatment modalities.
7. Identify the major underlying philosophies of the complementary practices.
8. Show an awareness of the research resources available related to the selected complementary practices.
9. Develop a frame of reference from which they can better understand a complementary practice.
10. Distinguish between an appropriate and inappropriate use of a selected complementary therapy.
11. Explore the primary concepts of a selected complementary therapy or an allopathic therapy related to the student's own health and well being.
12. Interact with students from various allopathic disciplines in a small group setting.
13. Appreciate the importance of communication about a person's health orientation in the healing process.
14. Describe one way in which the allopathic and complementary practitioner can best collaborate to promotion of health and the prevention of disease.
Topics found to be effective, teachable and used by the public include: progressive relaxation, focused breathing, meditation, visualization, self-hypnosis, biofeedback, autogenics, nutrition, yoga, tai chi and exercise. The healing community has immense resources to assist students to "walk the talk" of physical, spiritual and emotional self-care.
Students who "explore their own capacity for self-awareness, self-care and mutual help, (who) open their minds to new approaches are far more likely to value and encourage these possibilities in their patients. If they are treated, and learn to regard one another with love and respect, they may well come to treat their patients the same way." (http://www.ahc.umn.edu/tf/cc.html).
This journeywork with narratives, however, is not the ultimate healing modality. It is meant to be the first 'baby-step' in a bottom-up look at the healing process. So, it remains quite inadequate when critiqued from a top-down viewpoint.
There are deeper processes which can be tapped, but we must consider the status and capacities of our clientele to make a quantum leap to this ideal, particularly when they are in the shock of catastrophic change. Transpersonal Psychologist, Richard Theiltsen has suggested a spectrum of healing with seven operative levels:
Just as there are levels of consciousness, of evolution, and of awareness, so are there levels of healing. This is a spectrum of possibilities. Process-work is essentially a non-cognitive process. Higher integration comes from methods of slowing or stopping cognitive processes so that the greater body-mind can in fact re-configure without the little ‘story’ mind getting too freaked out and in the way. It is the cellular level of the body and mind that does the re-configuring.
LEVEL 1
In level one healing, one has healers and clients and these clients have conditions that they would like to address. In pursuing level one healing, the healer may do something, give the client something, tell them something, or perform some type of manipulation on them. In short, the healer is the active person, and the client receives the effect of the action, and goes away either better or not, as the case may be.
Level 2
In level two healing, one has healers and clients and conditions. In level two healing, the healer acts as a source of information such that the client is educated and empowered to realize that the client has within themselves the main healing power. The healer may teach, give them resources, inspire, or even perform some action, but the main focus is on the client to come to some realization, understanding, or action to help facilitate their innate healing process. This healing process can take many forms such as the creation of meaning, a change of lifestyle, etc. This is level 2 healing.
Level 3
In level three healing, one has healers and clients and conditions. In level three healing, the interaction between healer and client goes on not on the verbal or physical level, but on the energetic level (for want of a better term). Here there is some interaction that goes on between the body, mind, or energy fields of the healer and clients. This can be conscious or unconscious for either party. In this level we find modalities such as therapeutic touch, prayer, shamanic work, etc. Simply being in the presence of a person who has a certain state of being will bring another person into resonance in certain ways. It is similar to the phenomena of induction in electricity. This is level 3 healing.
Level 4
In level four healing, one has healers and conditions, but no individual clients as such. In level four healing, one works on healing one’s own self. By working internally, one becomes more aware of and able to effect one’s state of health, thinking, feeling, or energetic body. This work may take may forms such as live style changes, cognitive changes, awareness training, and many others. The result is that by changing one’s own body, mind and energy, one has a profound effect on all those around themselves, and this is a source of level 3 healing for others.
Level 5
In level five healing, one has healers, but no more clients or conditions. At level five one works in consciousness to come to the realization that all so-called conditions are nothing but the perfect working out of cause and effect. So thus they can be seen as perfect, and not out of order. The realization and acceptance of this truth brings a great release from suffering. This release from suffering brings a great peace and change to one’s body, mind and energy field, and is thus a source of healing to all in one's presence.
Level 6
In level six healing, one has no clients, no conditions, and no healer. In this level the interior work in consciousness deepens to the point that the mental verbal stream of consciousness quiets and gently comes to an end. Since our since of self is based upon this stream of verbal consciousness, and since suffering is based on this sense of self, by quieting the verbal mind to this point, suffering ceases. This state of no self operates just as it is, moment to moment. This state of enlightenment and no mind is the state of great peace, which allows the body, mind and energy to harmoniously normalize and flow through the cycles of destruction and reconstruction. This great peace is the center from which all true healing can be shared.
Level 7
Level seven healing is difficult to distinguish from level 1. You have healers with clients and conditions performing certain appropriate actions or teachings. The difference is that the healer operating at level seven is doing all these things from the state of consciousness of level 6. So the benefits of whatever appropriate actions the healer may confer come from a place of deep quite peace, and this is transmitted at a very deep level.
Conclusions
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Notes:
[1]. Medical anthropologists study such issues as:
Health ramifications of ecological "adaptation and maladaptation"
Popular health culture and domestic health care practices
Local interpretations of bodily processes
Changing body projects and valued bodily attributes
Perceptions of risk, vulnerability and responsibility for illness and health care
Risk and protective dimensions of human behavior, cultural norms and social institutions
Preventative health and harm reduction practices
The experience of illness and the social relations of sickness
The range of factors driving health, nutrition and health care transitions
Ethnomedicine, pluralistic healing modalities, and healing processes
The social organization of clinical interactions
The cultural and historical conditions shaping medical practices and policies
Medical practices in the context of modernity, colonial, and post-colonial social formations
The use and interpretation of pharmaceuticals and forms of biotechnology
The commercialization and commodification of health and medicine
Disease distribution and health disparity
Differential use and availability of government and private health care resources
The political economy of health care provision.
The political ecology of infectious and vector borne diseases, chronic diseases and states of malnutrition, and violence
The possibilities for a critically engaged yet clinically relevant application of anthropology
[2]. In a recent survey of physicians published in the Journal of the American Board of Family Practice on attitudes toward complementary or alternative medicine, over 70% of the physicians surveyed indicated that they were interested in more training in the following modalities: diet and exercise, behavioral medicine, biofeedback, acupuncture, acupressure, hypnotherapy, massage therapy, megavitamin therapy, vegetarianism, prayer and herbal medicine. Issues to address include research, cultural awareness and sensitivity and the educational and the socialization process of becoming a healer. Complementary care is an emerging area of health care that demands academic leadership, excellence in complementary, spiritual and cross-cultural care. We need to conduct research and development of innovative, interdisciplinary models of education and patient care that reflect an integration of complementary, spiritual and culturally-appropriate approaches to healing.
The graduates of health professional programs should be 1) skilled in critical thinking and the analysis and application of research findings in complementary care; 2) cognizant of the diversity of healing systems; 3) experienced with interdisciplinary teams that include complementary practitioners; 4) educated in the importance of cultural belief systems; 5) capable of talking with patients regarding their use of complementary modalities; 6) aware of how and when to refer to a complementary care provider and 7) skilled in self-care.
Health professionals practicing today increasingly encounter patients who are using complementary therapies and have questions about them. Patients are also increasingly demanding a more collaborative relationship with their care providers, and expect providers to be aware of and sensitive to cultural, spiritual and emotional aspects of their health. Practitioners need basic competencies in complementary care, prevention/wellness care, critical thinking, cross-cultural health, self care and interpersonal relationships. The health professions are responsible for preparing future practitioners who have both the intellectual skills for evidence-based practice and the knowledge base for understanding patients' complementary care practices and initiating appropriate referrals to complementary care providers. Future providers need relationship skills to help patients make life style changes and gain greater awareness of the spiritual, emotional and physical aspects of their health.
Recommended directions: 1) Content on complementary/alternative care needs to be integrated, 2) Interdisciplinary education is necessary and desirable to help students acquire the knowledge and skills required to function as a member of a health care team. 3) The education of health professionals within the academic setting has produced graduates who are intellectually prepared for the healing profession. There has been less emphasis on developing the health professional's awareness and understanding of issues of personal health and well being as well as the transformational process critical to becoming a healer. 4) There is a need to re-evaluate pre-requisites for admission to health professional schools, to encourage applicants to explore what it means to be a healer and to strive to achieve increased diversity in the student population.
[3]. Develop a graduate-level interdisciplinary program of studies in the area of complementary/ cultural/spiritual health. Course offerings would include didactic, experiential and clinical courses in comparative health, cultural and medical anthropology, culturally-based systems of healing; alternative systems of healing such as naturopathy, homeopathy, Ayurvedic and Traditional Chinese Medicine; shamanism and spiritual healing; energy medicine; skill based courses in areas such as clinical hypnosis, imagery, meditation, and manual healing; clinical nutrition, herbal medicine, use of the arts in healing and research methods courses. Course offerings could be used to build a supporting program in an existing graduate program. As faculty are recruited and the curriculum developed, it is anticipated that this area of study would become a graduate level degree granting program.
The world views of researchers based in the biomedical model may differ from researchers and clinicians functioning in complementary/alternative care. Establish a comprehensive interdisciplinary program of research in complementary, cultural and spiritual care that focuses on the following broad areas of study: safety and efficacy of modalities, mechanism of action, elements of the therapeutic process between patient and practitioner which contribute to health and healing, role of patient's beliefs in the process of their healing, role of the healer's beliefs, strategies for clinical integration of allopathic and complementary health care and outcomes research that focuses on restoration of health and well being, symptom reduction, quality of life and impact of use of complementary care on overall utilization of health care resources.
*assess and recognize how a patient's cultural background, race/ethnicity, spiritual and religious beliefs, as well as gender and socioeconomic status contribute to proper diagnosis and treatment.
*recognize the importance of one's family and community in overall health and well-being.
*assess and recognize how one's own core beliefs and cultural, ethnic and religious background influences one's perceptions, behavior, and ability to listen, care for and recommend treatment alternatives.
*understand the underlying philosophy, therapeutic practices and research base of selected complementary modalities, systems of care and culturally-based healing traditions.
*evaluate the strengths, weaknesses and appropriate applications of a range of research methodologies.
*evaluate research as well as determine how research results impact clinical practice.
*work within an interdisciplinary health care team that includes complementary practitioners.
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File Created: 1/22/03
Last Updated: 1/29/03 ~ 1/2005
