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  1. 1. TOWARDS AN INSTITUTE FOR A LIBERATION NARRATIVE HEALTH, MEDICINE & PSYCHOLOGY PRESENTATION: Sixth Annual Conference Western Institute for Social Research Berkeley, California November 1, 2014
  2. 2. ILNHMP follows Ignacio Martin-Baro’s call (“Towards a Liberation Psychology ”) for a: • New Goal • New Epistemology • New Praxis for public health/health policy, medicine and psychology
  3. 3. Why Narrative HMP & Role of Narratives of Body, Health, Medicine, Psychology • Narratives are the Social Maps for expressing human Social Nature as our Social Reality. (Narrative is the social analogue of/key to biological DNA). • Narratives can either help produce & reproduce the Mode of Production (Marx) – by being hegemonic Narratives (Gramsci); – by being repressive narratives that discipline (Foucault); – by being narratives of ‘internalized oppression’ (Fanon, Feminism, etc.) or – narratives of ‘repressive desublimation’ (Marcuse); • Or they can change it by being narratives that are critical, compassionate, creative, constructive Liberation Narratives
  4. 4. • Health, medical & psychological narratives are created by individuals and collectivities at macro-, mid- and micro-levels of social interaction. (Diagram from Singer, Baer: Critical Medical Anthropology) • Curing/Healing occurs when provided/provider “Narratives for” are congruent with “Narratives of” reality.
  5. 5. “Liberal”(not Liberation) Narrative Medicine Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, Narrative Medicine helps physicians, nurses, social workers, mental health professionals, chaplains, social workers, academics, and all those interested in the intersection between narrative and medicine improve the effectiveness of care by developing these skills with patients and colleagues. Our research and outreach missions are conceptualizing, evaluating, and spear-heading these ideas and practices nationally and internationally.
  6. 6. • The value of narrative medicine: • In the diagnostic encounter, narratives: – Are the phenomenal form in which patients experience ill health – Encourage empathy and promote understanding between clinician and patient – Allow for the construction of meaning – May supply useful analytical clues and categories • In the therapeutic process, narratives: – Encourage a holistic approach to management – Are intrinsically therapeutic or palliative – May suggest or precipitate additional therapeutic options • In the education of patients and health professionals, narratives: – Are often memorable – Are grounded in experience – Encourage reflection • In research, narratives: – Help to set a patient centered agenda – May challenge received wisdom – May generate new hypotheses • Narrative medicine aims not only to validate the experience of the patient, but
  7. 7. CRITIQUE: Liberal Narrative Medicine seeks reform of biomedicine by adding ‘Narrative Competence’ to essential truthiness of (capitalist) scientistic biomedicine i.e. Narrative Medical Theory & Practice = biology + narratology  acceptable domination/discipline by medical practitioners & ‘medicalization/depoliticization’ of social/ecological problems. 1. Does not challenge centrality of Biomedicine 2. Does not change the dominating Power Relations between patient and provider 3. Instead the effort to create a “Cultural Construction of Clinical Reality” becomes the “Clinical Construction of Culture” 4. Does not challenge the ‘status quo’ i.e. does not advocate social change as necessary therapy i.e. Social Medicine
  8. 8. Narrative Public Health/Health Policy • Narrative, Literature and Public Health (Martin Donohoe): Use of Fiction/non-fiction to teach health/medical care providers Public Health & Social Justice. • Narrative/Literature for Health & Social Policy (Fitzhugh Mullan) literary fiction/nonfiction highlights public policy issues: exploring problems and concerns with health care delivery, roles of providers or patients, need for research, system redesign, and changes in public policy.
  9. 9. WHO/Council on the Social Determinants of Health “ Drawing together all these and other issues is the question of “story”. This is not a mere footnote to the scientific and political problems the Commission must confront, but is at the heart of the CSDH’s effort to catalyse change. What story do the members of the CSDH collectively want to tell about social conditions and human well-being? What narrative will capture the imaginations, feelings, intellect and will of political decision-makers and the broader public and inspire them to action?”
  10. 10. • Nancy Scheper Hughes Phd. on the role of the ‘clinic’: “A social space where new ways of addressing and responding to human difference, disease, pain, and misfortune could be explored. In other words, a locus of social ferment, of revolution.”
  11. 11. The INSTITUTE FOR A LIBERATION NARRATIVE HEALTH AND MEDICINE (ILNHM) is: A developing international education, research, consulting & social action group working with story and narrative as a means to: Create a Liberation Narrative of the individual (biological), psycho-socio-cultural, political-economic and spiritual Body in states of health, disease, illness, sickness towards the dual goals of ]A better Theory & Praxis of Health, Medicine & Psychology and a more Just, Sacred and Sustainable World.
  12. 12. Why “Liberation” Narrative Health and Medicine • Liberation (as in ‘freedom from’) from the dominant culture’s objectifying, reductionistic, & commodified Biomedical narratives of the body, health, disease, medicine, psychology, produced over the last 500 years as the culturally resonant, hegemonic narratives for legitimizing by ‘naturalizing’ individualism & capitalism
  13. 13. • Liberation as ‘freedom to’ study, research, create, teach and ‘activistly’ promote Liberation Narratives of HMP which support: » Committed ‘Attention’ to, » Empathic ‘Representation’ of, » Compassionate ‘Affiliation’ with (Charon) » Mutual Recognition of (Gabel) the ‘other’ to act as ‘engaged witnesses’ and activist ‘accompanimenteurs’ (Oscar Romero, Paul Farmer) for accomplishing the goals of better practices of Health, Medicine & Psychology as well as for a Just, Sacred and Sustainable World.
  14. 14. ILNHMP: A New Epistemology • The ILNHMP will be working in areas that are academic, clinical, communal, and sacred weaving a storied tapestry--like a Persian gabbeh--beyond that of biomedicine. • We will utilize narrative threads drawn from approaches that are critical, creative, compassionate, and constructive from fields that include Social Medicine, Public Health, Clinical Medical Anthropology, Psychological Anthropology, Literature and Literary Criticism, Poetics, Critical Psychology, Social Theory, Public Health, Political Economy, Cinema & Film Studies, Philosophy and Ethics, and others.
  15. 15. ILNHM: THREADS OF A NEW EPISTEMOLOGICAL TAPESTRY Arthur Kleinman: Explanatory Model’s, Semantic Illness Networks & Illness Narratives; The “Cultural Constuction of Clinical Reality” • Michael Taussig: Critique of EM’s as Reification of the Patient & “Clinical Construction of Culture” • Allan Young: Mode of Production of Medical Knowledge/Narrative; Biomedical Knowledge > Ideological Reproduction of Conventional Knowledge; Anthropology of Sickness • Foucault: Archeology of Knowledge/ “Medical Gaze’ / “Clinique’ as site of struggle of medical knowledge/narrative production • Scheper-Hughes; Lock: “Speaking Truth to Illness: Metaphor, the Sick Role & a ‘Pedagogy for Patients’”
  16. 16. • Critical Medical Anthropology: Political Economic ‘Upstream’ Medical Anthro Narrative > Social Medicine> Health Care provider as Accompanimenteur (fr. Paul Farmer via Oscar Romero) • Scheper-Hughes/Lock: Critical Interpretive Medical Anthropology > Radical center between of listening/privileging patient voices & CMA (Political Economy) • Rita Charon: Narrative Medicine: “Attention, Representation > Recognition & Affiliation” • Peter Gabel: Mutual Recognition; Overcoming Alienation/Fear of the Other & the recognizing the “Presence of Living Things” > Spiritual Activism & “Call for Spiritual Biologists {Health Providers}”
  17. 17. • Mary Watkins, Helene Shulman: Liberation Psychologies • Identity Politics, Post-Modernist and Post- colonialist perspectives: including Dubois, Fanon, MLK, Baldwin, Feminist Theory, and Queer Theory etc. • Lewis Mehl-Madrona: Narrative as ‘Social Maps’ of the social nature of humans > bio- genetic/psycho-social/spiritual reality; Narrative Medicine & Psychology; • Alistair Campbell: Narrative, Health, Medicine & Liberation Theology • Doctors for Global Health: Liberation Medicine
  18. 18. NEW PRAXIS "The purpose of education is not to make men and women into doctors, lawyers and engineers; the purpose of education is to make doctors, lawyers and engineers into men and women." - W.E.B. DuBois • SCHOLARSHIP • EDUCATION • ACTION RESEARCH • COMMUNITY SERVICE / SOCIAL ACTION
  19. 19. CONTEXTS OF PRAXIS • Pre-medical/Health Provider Curriculum Development, Teaching, Mentoring • Medical and other Health Provider Education • Continuing Medical and Health Provider Education (CME’s, CEU’s for RN’s, MFT’s, LCSW’s, MD’s etc.) • Health Provider Staff and Clinic In-service Training Programs • School-based and community health education • Patient Education programs • Community-based research, service learning and social action programs.
  20. 20. CONTEXTS OF PRAXIS ILNHMP Intellectual Think Tank Writing, Publishing Community Ac tion Teaching Advising, BA,MA,EdD. seeking students ILNHM: Teaching, Advising, Mentoring other clleges' BA, MA, Doc. students ILNHM offers CEUs for BBS (MFTs,LPCC.s, LCSW'S, ) BRN for RN's, CHE'S, CME's et al. Develop, teach BA Pre-med & Post-BAC pre-health professional curriculum LNHM Grand Rounds, Events, Films, Book Readings; Writing grroups Community Action Research to create macro-; micro; mid level narratives Development/ Incubator/Acceletor/ Alt. Sites of LNHM praxis
  21. 21. ILNHMP: PRACTICE ILNHMP Internal Study Group Seminars: – Develop LNHMP Theory – & Practices of HMP + – Community Support/Building/Resilience/Sustainability/Activism • ILNHMP as collective Public / ‘Organic’ Intellectual/Think/Action Tank: Co-Writing, Publication, Presentation – Books/Monographs – Press: OP-ED – Social Media/Blogs • Teaching: within existing degree granting curricula • Courses • Seminars • Workshops • Required Professional Continuing Ed. (in residence/home study/ on-line) for: • BBS (LMFT’s, LPCC’s, LEP’s , LCSW’s, etc.); • BRN (nurses) • CHE’s? • Acupuncturists • CME’s for MD’s • ‘Advisor’ ing/Mentoring: of BS/ MS Social Science/Human Services • Role on Doctoral Dissertation committees • Pre-med Curriculum &/or Courses • Post-BAC Pre-health/med program (inc. pre-med Sciences taught @ other institutions e.g. JC if not taught at proposed institution) • Professional School Curricula/Course offerings: MD/RN/Clin.Psych/Interdisciplinary • Community/General Public Education: ILNHM Seminars/Courses/Workshops – Independent – Extension/Adult Ed. • Social Change/Activist “Development & Accelerator” Programs (for the Alt-Academic /’Organic’ Intellectual/Intellectual Entrepreneur): to help develop Alternative Social Change Practices / Projects / Careers • Community Action Research, Education Projects – Cultivation of Ruptures in Dominant Narratives/in Habitual Thinking > ‘Conscientization’ of Consciousness via creation of Transformative Limnal Spaces – Community/Participatory Research > Create Liberation Narratives at Meta-/Mid-level/Community & Micro-Levels • Parallel Universe (if you build it they will – desert the dominant culture – come.) – Consciousness change – Healing – Creating Alternatives – Create Parallel Universe Social Movement – Inhabit/manifest Beloved Community
  22. 22. ILNHM: THE NEW GOAL Not Only Better Health and Medical Care, but A Just, Sacred and Sustainable World
  23. 23. • Just, a world in which all forms of inequality and dehumanization are overcome • Sacred, affirming the inviolate beauty and interconnectedness of all things; • Sustainable, a world in which all human activity is expressive of an ecological sensitivity that assures a just and sacred world to all of existence across the dimensions of time and space.
  24. 24. The ILNMH contributes through Education, Research and Social Action to six elements for a Just, Sacred and Sustainable world 1 Consciousness Change 2 Healing of Trauma & Manifesting Moral, Activist Courage 3 Nonviolent Resistance and Community Resilience through Spiritualized, Collectivized Social Policies 4 Alternative Systems: Create ‘pre-figurative’, Institutions, Organizations, Businesses & Communities 5 Building of a ‘Parallel Universe’ Social Movement 6 Inhabit the created more Just, Sacred & Sustainable World
  25. 25. • Consciousness Change: – FROM alienated individualism and separation from nature with the resulting fear of the ‘other’ TO mutual recognition of our oneness with other humans and the environment; – an eco-political consciousness of solidarity and affection – and ‘accompaniment’ for seeking to create ‘an option for the poor’ • Personal and Social Healing and Change: – from the physical, psycho-spiritual and social woundedness and disability acquired from living in this pathogenic society and enhance our abilities (moral & activist courage/social skills) to together create a new world; • Nonviolent Resistance and Spiritualized, Collectivized Resilience: – In the ‘dominant’ culture, resist nonviolently and create spiritualized and communalized policies, politics and practices for equitable, economical, and ecological resilience for those who must remain and survive while building a new just, sacred and sustainable ‘parallel universe’ in its place.
  26. 26. • Create Alternative Institutions, Organizations, Businesses, Systems & Communities pre-figurative of a Just, Sacred & Sustainable World: – Alternative Economic ; Sustainable Agriculture, Food Justice and Security; Complementary Medicine & Holistic Health; Ecological Design & Natural “Green” Building; Intentional Communities; Alternative Energy and biofuels; Restorative Justice; Sustainable Businesses; Cooperatives, Collectives and worker-owned businesses; etc. • Building a ‘Parallel Universe’ Social Movement: – Facilitation of processes for people with changed consciousness and healed bodies, minds and souls to non-violently move, escape, desert the dominant culture to the created just, sacred, sustainable parallel universe. • Inhabiting and Manifesting MLK’s Beloved Communities; Gandhi’s Constructive Program, etc.: – Living in and Learning from his ‘Dream’.
  27. 27. Scholar-Activists w/some Interest • Michael McAvoy MA, Medical Anthropology (Case Western Reserve University); Columbia University Program in Narrative Medicine advanced training workshop; Richmond, CA • Jan Chambers, MD (UC Davis); Psychotherapist; former Medical Director West Coast Children’s Center; ISHI faculty “The Healer’s Art’ (UCSF Medical School); Albany, CA • Paul Rueckhaus, MPH Community Health Education, MA English Composition (San Francisco State University); Berkeley, CA • Peter Gabel, J.D.(Harvard), Phd. (Psychology); Faculty: John F. Kennedy University; Author: The Bank Teller and other Essays on the Politics of Meaning; San Francisco, CA • Katherine Dorman, BA Humanities in Sustainable Communities and Political Economy. • Barbara Hrovatin, MD, TCM; Columbia University Program in Narrative Medicine training; Ljubljana, Slovienia • Mutombo Mpanya, Ph.D., Urban and Regional Planning, University of Michigan; MA Theology. • Crispin Shelley, MA, Culture, Ecology, Sustainable Community (New College of California); Phd © Clinical Psychology (Meridian University, Petaluma, CA), Oakland, CA. • Nigel Hatton, Phd. Comparative Literature (Stanford); Associate Professor, Literature, UC Merced; Harvard University 2012-13 W.E.B. Du Bois Institute Fellow; Columbia University Program in Narrative Medicine training; Health&Human Right/The Hague. SF Bay Area, CA. • Ayesha Ahmad, MA Philosophy, Phd. Medical Anthropology. London, England, Columbia University Program in Narrative Medicine training. • Mack C. Miller, BA Humanities in Poetics and Society (New College of California). Oakland, CA. • Niel Rosen, J.D., Phd. Bioethics. Faculty: New Jersey College of Medicine and Dentistry. Washington, DC Columbia University Program in Narrative Medicine training. • Gary D. Yeoman, DO; former Medical Director, Free Medical Clinic of Greater Cleveland; faculty Case Western Reserve University School of Medicine; former Regional Director, National Health Service Corps. Philadelphia, PA. • Azibuike Akaba, Oakland CA. Public Health Institute (RAMP). New College of California
  28. 28. Capitalism created/enlisted ‘Enlightenment’ support  ‘free market-based’ individualism (Hobbes, Locke, Smith); objectifying, reductionist scientism (Vesalius to  supporting ‘Truthiness’ claims of Biomedical Narrative with a machine- like body and internalizing narrative directing the ‘medical gaze’ to what matters (to use violent/warlike metaphors of medicine-Sontag); Biomedical Narrative in constant ‘legitimation crisis’ due to its empirical lack of medical efficacy  resorted to: 17th – 18C. From Witch burnings (Witches, Midwives, Nurses) to guild/professionalization seeking delegitimization of ‘alternative’ healers;
  29. 29. • 19th Century Alternative Narratives – 1840’s: • Europe: Social Medicine / Rudoph Virchow 1848 met with authoritarian/violent repression • US: Popular Health Movement (abolutionist, feminist)/Thompson, Graham, etc. contra- professionalism via diet, exercise, self-care, herbalism, etc. replaced post civil war with industrial capitalist versions • Contagionism v. miasma • Germ theory (Pasteur) v. Milieu Interior (Claude Bernard) • Homeopathy; Osteopathy; Chiropractic, etc.
  30. 30. • 20th C. Biomedical Narrative & its Discontents – (1910) Flexner Report: Rockefeller Medicine Men – The misrepresented Role of Medicine (McKewon)and the End of Medicine as we (never) knew it. – Stress (Hans Selye) – Diseases of Civilization/or Social Inequality • Heart Disease, • Cancer, • Sugar Blues (diabetes / obesity) etc.
  31. 31. • Community Health Center movement; COPC; CCHH; both access and content oriented • Critical Social Science Theory/Praxis (marxism + poststructuralist identity-based politics a la Foucault ) Medical Anthropology/Psychology/Sociology, etc. • DGH/dsf/PIH/PSR/PHR/ • Public Health/Public Policy
  32. 32. Nature of collective • Independent (T-corps) • International • Cooperative/collective • Affiliations (WISR as homebase) • Study • Education • Research • Consulting • Social Service/Social Action
  33. 33. Medicine Psychology Education Arts Etc. Economic Mode of Production Hegemony
  34. 34. “I am not interested in dry economic socialism. We are fighting against misery, but we are also fighting against alienation. Marx was preoccupied both with economic factors and with their repercussions on the spirit. If communism isn’t interested in this too, it may be a method of distributing goods, but it will never be a revolutionary way of life.” -- Che Guevara
  35. 35. • Liberal Narrative Medicine seeks reform of biomedicine by adding ‘Narrative Competence’ to essential truthiness of (capitalist) science i.e. Medical Theory & Practice = biology + narratology  acceptable domination/discipline by medical practitioners
  36. 36. Narratives of the 4 Bodies: Physical, Cultural, Political- Economic & SpiritualPhysical Body Phenomenological “lived” body Cultural Body representational; metaphorical; body reflects social disharmony or harmony Body Politic Dominated: surveillance, management, control, violence Revolutionary: bodies in action Spiritual Body “I – Thou” oneness with all humans & “the more than human”, nature/planet earth itself Disease: abnormalities of structure/function Illness: a person’s perception of a socially disvalued state, includes disease but not limited to disease. Sickness: Liberal > Sickness = Disease + Illness Radical: Sickness Socializes Disease/Illness thru Politics of Diagnosis> who & what is culpable & who/what power>can cure, heal, prevent Alienation & Fear of “Other” >Fear of Humiliation; Economic, Spiritual Poverty >Fear of Annihilation. Fear  destructive /self-destructive behaviors e.g. creation capitalism seeking freedom from fear via wealth
  37. 37. • test
  38. 38. • Utterances  semantic illness networks explanatory models of illness narratives 