Peter Fifield: "Coyote Medicine"

Pete,

Here in Western Colorado, cultural questions are most frequently about faith and religious practices.  For me, that is the heart of the controversy.  During my training years, I was acutely aware that my profession was frequently anti-religion.  It was not at all uncommon for training conferences to openly discuss the need to counter the effects of religion in a client's life or to suggest that the change process of therapy was a more benign form of religion's change through repentance.

This culture clash has deep roots.  Many of the founders of psychiatry were secular and skeptical of religion, as were the key proponents of behaviorism and humanism.  Anecdotally, modern mental health professions attract more liberal and secular practitioners.  Current "post-modern" models challenge notions of universal and absolute truths. And, religion has traditionally been a non-empirical practice.

In my own practice, I'm frequently introduced to clients who want to know if I'm "Christian enough" to respect and build upon their faith tradition.  I've also had difficulty engaging highly religious patients in yoga during chronic pain groups.  My colleagues and I have joked that we should change the name of the yoga session to "Christian relaxation"

I do not personally share the animosity toward religion that I believe is common among my peers.  To the contrary, I will always inquire about my clients' faith practices and their current relationship with God or a higher power.  I will often encourage church attendance as a way of engaging clients in positive relationships, will recommend prayer and Bible study to assist with anxiety treatment, and suggest that clients talk with their pastors about troubles they face.

I will not do any of these interventions with people who do not self-describe as being religious, but when they do, I believe it would be short selling my menu of interventions and their faith not to.

I unfortunately missed Dr. Mehl-Madrona's presentation but was able to read his book, Coyote Medicine. I really enjoyed his discussion about how the medical model and its need to explain the human body, can be more detrimental than healing. I also appreciated the theme of agency that had manifested from his personal experiences. His ability to let healing be defined by the patient's needs is a lens that many patients (via their physicians) can benefit from.

However, I did have some concerns with the messages that were, maybe unintentionally, sent to the book's audience. Words like 'magical,' 'mysterious,' 'legends,' and 'full-blooded,' are among many that perpetuate Native Americans as being un-human and historical in nature. In addition, as a member of the Cherokee Nation, I feel it is important that the larger audience know that for most Native Americans, religion is not shared with others because it is sacred and I hope that as health professionals we all respect the decision of our patients to practice their religion in private, if they like.

Lastly, I do not encourage those who are not familiar with the religion to try to impersonate it. It can be mistaken as being very disrepectful and even dangerous (see the following articel; http://www.msnbc.msn.com/id/33352081/ns/us_news-life/page/2/from/ET). I enjoyed the book and appreciated Dr. Mehl-Madrona's story but hope that in trying to respect our patients, we do not in turn disrespect them.

Welcome Melissa Lewis.  You make a valid point regarding the inappropriate use of influence regardless of its nature in the link you referred to.  Individuals in such influential roles should play them carefully.  I was fortunate enough to attend Dr. Mehl-Madrona's presentation on elders in the community and how they can play a positive role in domestic violence cases.  My interpretation of his position was that the overarching goal was for the practitioner to operate with in the realm they are familiar with and/or skilled in.  He actually explicitly stated that he also works with a member of the Catholic Church in ways that are spiritually similar (not procedurally) to the ways he works with Native American cultures.  This impressed upon me the idea that spirituality is what matters, not the dogmatic rules we use to define it.  I also agree with the notion of respecting spirituality and promoting the privacy around such beliefs.  Personally I would feel uncomfortable and somewhat of a hypocrite trying spiritually representing a concept I was not intimately familiar with.  On that note, I feel that with continued effort, open mindedness, exposure, humility and willingness to learn one can become familiar with such spiritual practices regardless of their original race, creed or genetic origin.

Dear Peter, Melissa, and Randall,

I'm really touched that you guys are discussing Coyote Medicine and my presentation at CHFA.  I wanted to respond to some of Melissa's comments and perhaps stimulate a discussion.  I only discovered this blog today, so perhaps I'm late in responding. My understanding of Cherokee culture (Cherokee is my mother's side, though I confess that I know more about Lakota, my father's side) is that spirituality is a personal matter but that spirituality is intimately infused in all matters. Nothing is secular. I wonder if Melissa could comment upon her understanding of this. The way I interpret this difference is that everything within Cherokee life has a spiritual element or aspect, just as every story has a spiritual level of interpretation. So I would read that as meaning that all of our work must address a spiritual element. Of course, in Cherokee country, many people are Southern Baptist now and that's an entirely different perspective than the traditional Cherokee.  I had that experience in the far north of Saskatchewan, where almost everyone was Roman Catholic.  What did remain, however, was the infusion of spirituality in all aspects of life.  Prayers began every event at the hospital -- even preceded bingo!  Involvement of the priest was very important in my clinical work there, including reduction of domestic violence.

I wanted to speak to the question of magic and thought perhaps that we could dialogue about that as well.  I think that infusing a spiritual element into all aspects of our work creates magic.  I do believe in magic very much, defining magic as the infusion of spiritual beings and supernatural power into the physical world. To believe in animism, as I do (that all aspects of nature are conscious and have ontological status) is to believe in magic as it is defined in the scientific world.  I don't know the context in which Melissa reacts to the words "mysterious", "legend", or "full-blooded", though I can say that the concept of full-blooded is objectionable to me, since it was a concept created by the U.S. Congress in 1904 and was never part of Cherokee thinking.  For example, John Ross, the Head Chief of the Cherokee in 1828 and during the Trail of Tears was by blood quanta, 7/8's Scottish, though by Cherokee thinking of the time, fully Cherokee.  We didn't have concepts of Mendelian inheritance since those came from Europe.

I do think our legends or stories are very important and contain many layers of teachings that are worthy of continued contemplation.  I also believe that much of healing is mysterious and that much of what we physicians do is as Pascal wrote, "bandaging the wound".  I can recall from my emergency department work how who lived and who died was mysterious and not scientifically predictable.  Regardless of our best efforts, healing, including living and dying, remains mysterious.

As Peter wrote, I can work with the priest because I understand Christianity and Catholicsm well enough that I can see the parallels between traditional spirituality and Catholic spirituality.  I can make the translations in my mind so that it's not hypocritical.  What I have observed among my students is that people with deep spiritual convictions and practices can readily relate to similar people of different convictions and practices. My students who cannot make this bridge are the committed materialists.  For example, I was working in the round with a psychotic client who was terrified of one particular voice whom she thought was going to kill her.  She had been afraid of being killed by this voice for the past 17 years.  Over the course of the demonstration session, we came up with a plan for her to use sage and an amulet (sacred prayer pouch) to protect her from the voice. This worked well and allowed her to go out of doors again and to sleep much better at home.  The students who had spiritual practices felt very comfortable with this plan, but the committed atheists and materialists in the group objected to it on principle.  They could bridge one spirituality to another because, for them, all spirituality was silly.

Enough for now.  I hope to have further discussion with you.

Lewis Mehl-Madrona

P.S.  I wrote Coyote Medicine in the mid-1990s. I hope my thoughts have further evolved in the succeeding books, Coyote Healing, Coyote Wisdom, and Narrative Medicine.

Thank you for responding to my comment! I would like to try to answer questions and respond to comments of Peter and Lewis so I apologize if this is a bit choppy and long.

Peter- It seems that you picked up on some of my concerns regarding scope of practice, privacy around spirituality and spiritual practices and addressed them through your experiences and your attendance of Dr. Mehl-Madrona’s presentation. I valued your comments and suggestions and believe that they were well put. I also agree with both of you that students need to have a guiding hand in the process of learning a new skill and jumping into someone else’s belief system should be handled with care.

Dr. Mehl-Madrona, I agree with your explanation of Cherokee religion, in that it is not a part of someone’s life but it is a way of living, which is different from many other religions that are secular. (I liked the bingo prayer comment!) It seems that we are discussing the difference between being, sharing and teaching (religion). The nature of interacting with someone alone affects others around them; however, formal and specific teachings of religious practices have bounds. Just as you described rules to creating a fire and holding a ceremony, there are also rules about the people who are involved in the ceremony and who is allowed to learn certain practices (native ancestry or not).

In addition, I wanted to speak to the comments regarding commonalities in different religions. I am being taught to use a biopsychosocial model in my training. This lens is a combination of a medical model and a psychological model. At one point, they operated alone. Combined, they are a completely different concept. I not only ask about disease progress and social resources, I ask how they intermingle and produce outcomes for the patient. I see some techniques you mentioned in the same way. You have brought Native American thought into Western medical practices. You even mentioned bringing Christianity into sweats. Combining resources and religions produces a whole new concept. It is not Christianity and it is not Lakota. I wonder if this is what collaboration is? Again, there seems to be benefits and risk factors to these techniques. Some people say that we all pray to the same God and others feel that Jesus Christ and the Great Spirit are very different and even opposed. Religion may be even more difficult to combine respectfully than the mind-body split.

While reading Coyote Medicine I was struck with the amazing stories that were told and the personal nature of them. From my experience, and in my community, members would not like to share those stories and experiences. I am not sure if it is because of the current misuse and distrust towards the dominant society or something completely separate. I addressed the concept of privacy in religion and religious practices as a cautionary comment given many Native Americans may not want to share these practices without a relationship with the person first (and some would not share them with non-Indians). It seems that most patients were non-Indians, while healers were. What were their reactions with having their stories shared in a book I wonder?

That is one of the reasons that I mentioned the words mysterious, magic, and legend that were used in describing Native Americans or experiences with them. I like your definition of magic and believe that many people across religions see value in faith and the supernatural. The word magic inside and outside of a Native American context have different meanings. My concern with these words is that they may contribute to stereotypes that Indians are somehow not the same as members of the dominant society or that all are shamans. This deteriorates the ability of the dominant society to see Indians as professionals and as humans. (i.e., BIA in Dept of Interior with Nat’l Park Service and Fish and Wildlife Service.) It seems that several decades ago common stereotypes of Native Americans included being drunk or dumb. I am glad to see that those comments have reduced in quantity but current comments based on stereotypes such as asking Native Americans to ‘speak Indian to them’, asking blood quantum, assuming Indians have ‘magic’ abilities and asking if they can join a sweat, can be equally as harmful.

Although I am on my political soapbox, I very much value what you have contributed to healthcare. I admire how creative and empathetic you are with your clients and see that your experiences have helped guide you in that. I agree with you that health and healing are mysterious, dynamic and unpredictable and in that, our legends, our beliefs about the world around us, are an important resource for health.  I applaud you for bringing religion and client’s spirituality into a medical environment.  I like very much how you are able to intertwine your client’s stories and your own stories into a therapeutic moment. I am excited to read your current books and look forward to learning more from you.

Melissa

I like the example of the psychotic woman who beieved a certain voice was going to kill her that Dr. Mehl-Madrona gave.  I can't help but think of my family and all of the "things" they believe in.  When I hear my family members going off on what they dreamed about, saw, sensed, and what not,  I can't help but laugh and think to myself "obviously your wrong".  Then itll hit me, I think this way because of how science has been drilled into my skull since I can remember.  For example, my family strongly believes that when they see the figure of a skull on the moon that its a sign that someone they love/know is going to die.  Years ago I heard my mom say "ughhh there is a skull on the moon..." and I automatically said to myself "mom is losing it..." sure enough a couple weeks later my uncle, her brother died.  The week following the funeral my grandmother, aunts, great aunts were all talking about the "signs" they had seen.  To us this might be weird, silly, funny, crazy, but to them its REAL (probably a little real to me now too well... open-minded I should say)...What Iv learned is to not be so judgmental of what they believe in just because i dont believe in it or have a different way of explaining what happened.  So if the psychotic lady believed in a sage and amulet and it worked for her, then that just means another person is getting help and feeling better (which is the goal afterall isnt it?)

     Maybe Collaboration is coming up with several different ways in treating a person, rather than sticking to only medicine, only therapy, only religion, etc ...