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HDL continues to Ch. 5 and References
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
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