Originally Published on FutureHealth
Coyote is rapidly becoming a worldwide symbol of change and transformation. She is one of the most rapidly expanding species on the planet, flexibly integrating herself into diverse environments, from the wilds of Labrador to Central Park in the middle of Manhattan. A marvelous story exists of a coyote being scooped up by the front bumper of a car, going full speed on an interstate highway and hours later walking away unscathed when released from the grill of the car. Coyote has grabbed our attention exactly because she is a survivor and with panache to boot. Coyote embodies flexibility, humor, and adaptability. This makes her the ideal symbol for our times.
Coyote has also become a symbol for those of us on the margins of the mainstream. By her nature, Coyote lives outside the box in the margins of acceptability and respectability. Of course, those who live outside the box have perspectives that are not possible from inside the box. Inside is safe and comfortable. Or is it? How many inside the comfort zone anticipated the financial collapse created by Bernie Madoff and by the mortgage crisis in the United States? I know a London financial analyst who did identify Madoff and even explained the scheme to his superiors only to be removed from the mainstream and placed outside the box. From the home office in London, he was moved to the moors of Scotland where he could do no harm. Of course, he resigned and started his own consulting company, which is a common coyote story. I am in process of leaving the community mental health center and joining a private practice in which I can have more control over how long I spend with patients. When I started with the community mental health center, I had been told that as long as I kept my productivity over 100%, I could have longer appointments, do some psychotherapy, and have more flexibility. I got my productivity to a high of 217% and that promise never came true. There were always too many patients to see to let me have any flexibility. Then there was that added concern that I was stepping outside of my bounds by wanting to do some psychotherapy. Psychiatrists write medication prescriptions and that's all they do. Therapists do therapy. Why was I trying to do their job and my job also?
Like Coyote, I believe I will eventually be proven correct -- that it is more cost effective for one person to do both the psychotherapy and the medication than it is to farm out all psychotherapy to therapists and have the psychiatrist only do brief medication management appointments. That, however, is another story that will unfold over time.
Professor Forrester at the Massachusetts Institute of Technology found that people in companies mostly all know what's wrong in a troubled enterprise and also know how to fix it. They know the leverage points at which problems can be solved and have a good idea how to do it. Nevertheless, they keep quiet and say nothing and continue to do what doesn't work and what everyone knows will not work. Forrester wrote that the comfort from inside the system dictated behaviors which everyone knew were counter-productive. Coyotes are far enough on the edge to say what will work and what will not, though rarely does anyone listen.
Every society needs its coyotes, its court jesters, its satirists, its sacred clowns. Social survival requires someone to be able to say when the Emperor is naked.
Change happens at the margins, which is also where art, fashion, music, and sometimes even science happens. Change involves doing things differently than they have always been done when they are not working.
In the community mental health center, change will not happen until we are rewarded for outcomes. The Office of Mental Health has just reviewed the place where I work, and it passed with flying colors. Our processes are perfect even if our outcomes are not. That is because everyone assumes that what we are doing works. All that matters is how we are doing what we are doing. If we had to collect outcome measures on what we are doing to determine if it is working, we would not be so congratulatory. From what I have seen, what we are doing is largely unsuccessful. People suffer and continue to suffer despite us.
Today is the first day of the Coyote Institute's Australia trip. Three of us are journeying down under. Besides me, I am accompanied by Dr. Robert Crocker, our President, and an Associate Professor at the University of Arizona's Center for Integrative Medicine. Also present is Barbara Mainguy, MA, MFA, from the Creative Arts Therapy program of Concordia University in Montreal. We are sponsored by the Gippsland and East Gippsland Aboriginal Cooperative, the Life Is". Foundation, our own Coyote Instiute for Studies of Change and Transformation, and Union Institute & University. We thank all of our sponsors.
Even as I am writing this, we are preparing to touch down in Sydney where we will transit onward to Melbourne, the closest airport to where we are going. We learned once upon a time not to bring sacred herbs into Australia -- no sage, sweetgrass, cedar, lavender. Nothing! Even our sacred pipes stems are scrutinized. We were able to mail some sage and cedar and otherwise we have learned to use the local herbs, especially the Tee tree leaf. Last time I almost got in trouble with Customs for having forgotten a small packet of hotel coffee that I had stuffed into my bag on the morning of departure. Even coffee is forbidden. Snoopy the Beagle (there are many working Australian Customs) found the coffee. That was embarrassing. Today, I am sanitized. I brought no herbs or coffee. I do have some Tabasco sauce which will have to be examined. Barbara is carrying the sacred pipes. We are limiting each of our exposure. Rocky (Robert) has the tobacco of which we are allowed a moderate amount.
We lost Ash Wednesday on this trip. Though we will get a Wednesday back on our return, it will not be Ash Wednesday, so I will not have the excuse to rub ashes on my forehead, though I'm not sure what that means anyway. However, I never want to miss out on a sacred rite, no matter whose it is.
On this trip, we'll be exploring ho indigenous people can claim, recover or re-invent their own models for health and disease and for helping people who suffer and are in pain. In preparing for this trip, I am reminded of Hong Kong psychiatrist, Dr. Sing Lee, who was one of the first writers about the Americanization of mental health. Dr. Lee was featured in Ethan Watters' 2010 book, Crazy Like Us, in which, in Chapter 1, he describes the process by which anorexia nervosa exploded into prominence in Hong Kong within the space of one year, having not been encountered there before. Dr. Lee said, "Psychiatric theory cannot deny its participation in the social trajectory of the anorectic discourse which articulates personal miseries much as it does public concerns. " This was an example in which a chance encounter of the media with a young woman who collapsed from starvation and eventually died, but in no other manner resembled North American or European women with anorexia nervosa, launched a media frenzy leading to the importation of the American story about how to be anorexic with many young women falling in line. Anorexia had come to Hong Kong!
How does this work? Toronto medical historian Edmund Shorter wrote about this process by which suffering that cannot be articulated gets channeled into pre-existing social templates for the expression of pain and misery. Anorexia is one of those templates and doesn't actually exist as an internal, intrinsic, essential biological illness. Shorter wrote, "The pronouncement of famous doctors could have a powerful, though unconscious, effect on people. History is full of ever-changing psychosomatic symptoms shaped in large part by the expectation and beliefs of the current medical establishment."
My point is that European cultures have imposed their templates for the expression of pain and suffering onto aboriginal people and demanded correct performances in order for these people to be deserving of treatment. Aboriginal people have rebelled by sabotaging treatment, by being "non-adherent" to treatment regimens, and by generally being problematic for European style doctors.
Our goal in Australia is to participate in a process of discovering the unique templates for Gippsland, the area we will be visiting. We will ask how did local people communicate their unbearable or inarticulate suffering and pain before Europeans arrived and about what did they suffer? Answering these questions goes far toward unearthing uniquely local theories of health and disease and applying local culture and practices to those who do suffer. Can we overthrow the European-based models and rediscover those that are indigenous to the area?
We are at the margins, at home and in Australia, asking if other stories will work better and if we can recover and re-examine those pre-conquest stories.