Nurses in the United States: Please do not sit this election out. Do your duty as an American citizen and as a nurse. Make informed decisions about candidates and issues and cast your ballot (just once, that is—don’t listen to our current president, silly man that he is, only vote once, whether it is by mail or in person or via e-mail for oversees folks). Voting is always important and is a sacred civic duty. This year, it is especially crucial for the health and future of our country. And do whatever you can to encourage and enable other people to vote, including your patients and your community members.
If you happen to be a nurse educator as I am, remember that you can and should provide course content on the importance of political knowledge and advocacy for nursing. It seems to be a common misperception among nurse educators that political content is somehow a no-no and that it can get them in trouble with their employers. Providing non-partisan information on being an informed voter is never a no-no. And, our nursing students need to be exposed to nursing faculty and other mentors who are politically engaged—including nurses who run for political office at the local, state, and national levels. A great non-partisan resource is the All In Campus Democracy Challenge. Check to see if your college/university has signed on to this challenge and what resources and activities you can tap into.
In just a few weeks, I will cast my ballot here in Seattle, King County, Washington. I am proud of our state and county for ensuring that our elections are safe and open to every eligible voter, no matter their race/ethnicity, country of origin, language, able-ness, and political affiliation. I am proud to be part of the grassroots Nurses for Biden-Harris group, working to promote information on the reasons why nurses should strongly consider voting for the Biden-Harris ticket: compassion, faith, resilience, empathy, kindness, humility, joy, respect, inclusion, and dignity. Those are the core values of Joe Biden and Kamala Harris. They also happen to be core values and part of the Nursing Code of Ethics of the American Nursing Association.
Ibram Kendi writes, “We are surrounded by racial inequity, as visible as the law, as hidden as our private thoughts. The question for each of us is: What side of history will we stand on?” (How to Be an Antiracist, p. 22).
In preparing to teach population health nursing and health policy and politics again this coming academic year, I am working with the good folks at StoryCenter to develop media literacy content utilizing digital storytelling videos. And, since our University of Washington Health Sciences Common book will be Kendi’s How to Be and Antiracist (not to mention the current moment in terms of racism in our country), I plan to use digital storytelling focusing on racism and bias in nursing and health care.
Nurstory, working with StoryCenter, has some excellent digital storytelling videos by nurses across the country, including nurses with the Nurse Family Partnership. Dr. Raeanne Leblanc and her colleagues at University of Massachusetts, Amherst, completed a Nurstory project on social justice. My plan is to work with our students on the use and making of digital stories related to racism and bias. Since I believe that I should practice what I preach (or teach in this case), I recently made a digital storytelling video on my experience of racism in various aspects of nursing, including nurse education. Titled “Relics,” here it is:
In this time of justifiable anger, protest, and civil unrest, let us not forget other ways that the rights of persons of color are being undermined in our country. DACA: Deferred Action for Childhood Arrivals is an Obama-era program that gives temporary legal status and work permits to undocumented immigrants who came to our country as children. The vast majority of DACA recipients are young people of color and many of them work as nurses and other essential workers. (see “Washington’s DACA recipients on the coronavirus frontline await Supreme Court ruling” Nina Shapiro, The Seattle Times, May 31, 2020)
The Trump administration, big on building walls and racial/ethnic/political divisions in our country, has been trying to dismantle DACA. The NAACP is a staunch supporter of DACA. The Supreme Court is set to rule on a major DACA case any day now. In fact, they were expected to release their ruling today but likely delayed it in case their ruling fuels further protests.
Dorothea Dix was a leading US and international mental health reformer. She knew how to wield her quill pen and do her own reporting to advocate for positive changes. We still have a lot to learn from her.
Starting in 1830 with her investigative reporting on the deplorable conditions of inmates at a Cambridge, Massachusetts jail, Dorothea Dix quickly spread her mental health advocacy efforts with inspections of prisons and insane asylums throughout Massachusetts and other states, then internationally to England and Scotland (petitioning Queen Victoria for reforms), France, Italy (petitioning Pope Pius IX), and Turkey (trying unsuccessfully to meet with and petition Florence Nightingale at the end of the Crimean War).
After Dix’s controversial stint as Superintendent of Women Nurses for the Union Army during the American Civil War, she again took up her mental health reform efforts extending them to the Far West, visiting California, up through Oregon, to Washington Territory. Remarking on the natural beauty of Washington, including snow-capped Mt. Rainier, she described in a letter to her British Quaker reform friends, the Rathbones of Liverpool, that she was favorably impressed by the Pacific Northwest’s “humane and liberal” prisons and insane asylums. She attributed their excellence to how newly settled the area was, a newness that allowed for more progressive thinking than in either European or the American East Coast cities.
Dix was involved with political debates raging in England and Scotland where local parishes used the contract system, paying for their insane poor to live and work in private, for-profit insane asylums. Many of the asylum proprietors cut costs and increased their profits by shackling patients inside unheated rooms and depriving them of food and medical care. Known as the “trade in lunacy,” once the truths of the trade were uncovered, the practice was a source of widespread moral outrage and calls for reform.
In America, there were claims that treatment of insane incurable paupers in state-run insane asylums was a more humane approach. Proponents claimed it would save money in the long run, given economies of scale and since patients could avoid being sent to higher-cost jails and prisons. Early reports from institutions such as the Worcester Insane Asylum claimed high success rates of “curing” patients of their insanity, by citing high patient discharge rates. What they failed to mention were the equally high rates of readmission of these patients to the same or similar institutions within short periods of time. Once forced to face these statistics, proponents of insane asylums, including Dorothea Dix, began to point to “seasonable care,” meaning that successful treatment and cure rates occurred when patients were identified early in their illness and were provided with appropriate treatment at insane asylums. Early in their illness was typically defined as treatment within the first year of onset of their symptoms.
Public and private debates in America were raging as to whether paupers–insane or not–brought on their own plights through immoral acts such as intemperance, specifically in terms of alcohol consumption, and the duty of the state to care for such people. Calvinist work ethics and conceptions of sin and salvation colored these debates. Women with children “out of wedlock” and prostitutes were labeled as sinners and as undeserving poor. Leading reformers such as Dorothea Dix declared that the duty of society was the same whether insanity or destitution resulted from “a life of sin or pure misfortune.”
Dorothea Lynde Dix, Asylum, Prison, and Poorhouse: The Writings and Reform Work of Dorothea Dix in Illinois (Carbondale, Ill.: Southern Illinois University Press, 1999).
Thomas J. Brown, Dorothea Dix: New England Reformer, Harvard Historical Studies ; v. 127 (Cambridge, Mass.: Harvard University Press, 1998). Dix, Asylum, Prison, and Poorhouse.
Legislative Assembly of the Territory of Washington, “An Act Relating to the Support of the Poor.”
Tamonud Modak, Siddharth Sarkar, and Rajesh Sagar, “Dorothea Dix: A Proponent of Humane Treatment of Mentally Ill,” Journal of Mental Health and Human Behaviour 21, no. 1 (2016): 69, https://doi.org/10.4103/0971-8990.182088.
Dorothea Dix, “‘I Tell What I Have Seen’—The Reports of Asylum Reformer Dorothea Dix,” American Journal of Public Health 96, no. 4 (April 1, 2006): 622–24, https://doi.org/10.2105/AJPH.96.4.622.
Dorothea Lynde Dix, The Lady and the President: The Letters of Dorothea Dix & Millard Fillmore (Lexington: University Press of Kentucky, 1975).
“I want people to think of me as being this thirteen-year-old little girl that raised myself on the streets and survived through a lot of stuff like the Green River Killer, and other people that were crazy and through me shootin’ dope and never died. Cleaning up my life and having my kids and doing the best I can do.” Erin Blackwell, street name “Tiny” in a 2014 interview with the late master photographer Mary Ellen Mark (1940-2015)
I am revisiting the story of Erin Blackwell, a Seattle woman who, as a then thirteen-year-old prostituted teen in downtown Seattle, was the focus of an influential documentary and accompanying book on the “street kid” phenomenon of the 1980’s: Streetwise(1984) by Martin Bell (documentary) and Mary Ellen Mark (book). I also am revisiting and extending my thinking about the complex ethics involved in storytelling, whether that is through photography, film, or—in my case—writing.
Specifically, I am wrestling with the ethical issues involved in my research and writing of my current Skid Roadbook project’s chapter, tentatively titled “Streetwise” (now retitled “Threshold”) and based on the story of Tiny. Since my book project is a narrative history of homelessness and health in Seattle, all of my previous chapters have focused on the story of a ‘real life’ Seattleite who lived and/or worked at the intersection of health and homelessness. But all my my main characters up until “Streetwise” are now dead. The fact that they are dead obviously does not let me off the hook from being respectful of who they were as people—respectful of their memories and their legacies, including living relatives.
But Tiny—Erin Blackwell, who is very much alive and still living in the Seattle area. How do I go about ‘using’ her story as the basis of exploring the complexities of the homelessness crisis—particularly the youth homelessness crisis— in our nation and in Seattle in the 1980’s and 1990’s?
Since I moved to and began my work with Seattle homeless youth in 1994, I have come to know a fair number of the homeless youth depicted in Streetwise. I’ve also worked with social workers and other care providers who were involved in one way or another with Streetwise. Thus, I am privy to insider information, much of which is not in the public domain. That, I know, will not make its way directly into my book but it will end up in it at least indirectly. I have completed ‘official’ oral history interviews with the health and social care providers. I’m still wondering whether or not I want to try to interview Erin for this chapter. Somehow it does not feel right to ask her to expose herself more than she already has.
More information on Streetwise and “Streetwise Revisited: A 30-year Journey” exhibition in fall 2016 at the Seattle Public Library can be found at Seattle University’s excellent Project on Family Homelessness website.
A powerful and classic (yet too little known) social justice writing by George Orwell is his autobiographical essay “How the Poor Die.” It should be required reading for all nursing and other health science students as it eloquently describes the experience of death and dying for poor and homeless people. Although the essay is based on his experiences, first as a poor patient on a public ward of a Paris hospital in 1929, and then back in England and Scotland (Glasgow) towards the end of WWII, there are echoes of truths in his observations that are relevant today.
One of the most poignant parts of the essay describes “old numero 57” (patients were numbered, not named) lying—and dying—on a cot in the open ward next to Orwell. He writes, “They are treated like animals. They die alone, their organs already marked for a bottle in the museum, their bodies designated for dissection.”
Orwell’s essay came back to me yesterday as I went in search of pauper’s grave sites in Edinburgh. From my research, it seems that there are thousands upon thousands of pauper’s graves in many of the town’s oldest remaining church cemeteries—such as St Cuthbert’s just below the Edinburgh Castle. They are buried in communal ( or, rather “mass”?) graves that are, of course, unmarked, and typically located in the now grassy central parts of the cemetery as shown in this photograph I took yesterday. There are older laws banning the grazing of sheep or cattle on these churchyard fields; current laws are posted banning all animals, including dogs (except for certified service animals).
Edinburgh is infamous for its early to mid nineteenth century grave robbers, body snatchers, or “resurrection men” who dug up recently buried bodies of people and sold them to surgeons of the University of Edinburgh Medical School for their anatomy dissection. And then there were the body snatchers (and complicit surgeons) who took it even further, murdering poor and homeless men and women on the streets and in flophouses. People who died in poor/workhouses and public insane asylums and whose families did not claim (and pay for) their bodies were sold by the Overseers of the Poor to the medical schools for dissection. Is it any wonder that poor and homeless people have a well-founded fear of public hospitals and related institutions?
Telling the story of trauma—of survival—may have the capacity to at least aid in healing at the individual level, but then there is the added danger, once the story is shared, of it being appropriated and misused by more powerful political or fundraising causes. Stories can be stolen. Arthur Frank calls these “hijacked narratives—”Telling one’s own story is good, but it is never inherently good, and the story is never entirely one’s own.” (1)
An intriguing example of a stolen story is the one explored in Rebecca Skloot’s narrative nonfiction book The Immortal Life of Henrietta Lacks, a book that tells the story of the cervical cancer cells “stolen” from an impoverished and poorly educated black woman in Baltimore in the 1950s. Scientists at Johns Hopkins Hospital subsequently profited from culturing and selling these HeLa cells—cells which killed Henrietta Lacks, cells which neither she nor her family members consented to anyone using or profiting from. Skloot, a highly educated white woman, has also now profited from the use of the Lacks’ family story, although she has set up a scholarship fund for the Lacks family members.
I am reminded of the proverb that Vanessa Northington Gamble shares in her moving essay, “Subcutaneous Scars,” written about her experience of racism as a black physician. Dr. Gamble’s grandmother, a poor black woman in Philadelphia, used to admonish her, “The three most important things you own in this world are your name, your word, and your story. Be careful who you tell your story to.” (2)
**The above is an excerpt from my chapter/essay “The Body Remembers” from my book Soul Stories: Voices from the Margins (San Francisco: The University of California Medical Humanities Press, 2018) page 81.
Arthur W. Frank “Tricksters and Truth Tellers: Narrating Illness in the Age of Authenticity and Appropriation,” Literature and Medicine 28 no. 2 (Fall 2009): 185-99, page 196.
This is why I continue to love my academic work: smart, creative, compassionate students who see what is needed in our world and find ways to ‘just do it.’ They ask the hard questions, like “well, why not?” and they help keep us honest about what we are supposed to be focused on within higher education—and especially at public institutions in our country. As the University of Washington Vision and Values statement puts it, we educate a diverse student body “to become responsible global citizens and future leaders,” and “we discover timely solutions to the world’s most complex problems and enrich the lives of people throughout our community, the state of Washington, the nation and the world.”
This past academic year I’ve had the pleasure (most days) of directing the Doorway Project, with the aim of creating an innovative community cafe/navigation hub for young people (including, unfortunately, many of our own students) who are homeless and/or experiencing food insecurity in the University District of Seattle. It has not been without its many challenges, but also satisfactions and delightful surprises. It is swamp work, as in real work on real-world problems. (see my previous blog post “Life in the Swamp: Float, Don’t Flail” from April 28, 2018 for an explanation of the swamp work reference.)
What gives me hope in terms of the real-world wicked problems like homelessness? I was asked a version of that question recently in a Seattle Growth Podcast with UW professor of business Jeff Schulman. “Our students and young people,” was part of my response.
Here is a hot-off-the-press news article “Student volunteers help expand UW’s outreach to homeless youth” by Kim Eckart (UW News, August 20, 2018). Enjoy a ray of (smoky here) sunshine and hope for the future. And here is the latest new and improved design for the Doorway Cafe (design credits: Hope Freije and Delphine Zhu).
Early in my career as a nurse, I worked for a year in a “safe house” emergency shelter for women who were escaping intimate partner violence. Before my work there, I did not understand the concept of trauma mastery and how this plays out in the lives of women caught up in the cycle of abuse. I sided with the common misperception that the reason so many women return to their abusive partners is because the women are psychologically damaged and weak.
I learned that there is the not-insignificant role of addiction to the thrill of trauma and danger—to the effects of the very activating yet numbing fight-or-flight neurochemicals—which can bring at least temporary relief to the bouts of fatiguing depression that often accompany trauma. And there are also unconscious attempts to return to the previous trauma to “get it right this time”—to do what we wish we could have done the first time, to master our trauma.
Seattle social worker Laura van Dernoot Lipsky points out that these unconscious attempts to master our traumas often backfire and simply reinforce our old traumas. She says that many of us in health care and other helping professions are often using our work as a form of trauma mastery, and that by doing so, we may set expectations for ourselves and others that are “untenable and destructive.” (1) She advocates ongoing efforts aimed at self-discovery and self-empathy, and points to the many positive examples of “people who have been effective in repairing the world while still in the process of repairing their own hearts.” (2) Eve Ensler, with the combination of personal work and “world repair” work that she describes in her powerful book In the Body of the World, is one of my favorite examples of this sort of balanced approach. (3)
You do not get to have the last word. Even though another white male leader (of an ostensibly social justice-minded weeklong activist writing retreat) handed you the microphone on the last day so you could defend all generic white men from the “trigger words” (your term) of white male privilege. I do realize that you live in the whitest state in our country and in one of the remotest areas of that state (Oregon, in case people don’t know). I do realize that you have a fragile white male ego and that it would be devastating for you to admit that you have in the past and continue to benefit from nothing more than the (socially constructed) pale color of your skin and the fact that you are male. Devastating, because to admit that would be what? Humiliating? Humbling?
You do not get to have the last word. Do you realize how creepy and inappropriate it is to tell us (an otherwise all-female small writing workshop group) that you have “been closely observing us all week”? Especially when there were a significant number of young women emerging writers in our group? I chose to turn my back to you and to literally walk away at both of these times. For me, that was the appropriate choice given the circumstances. I do not regret that choice. What I do regret is ever having participated in praising your bravery in being in an otherwise all-female writing workshop and for (your words) being there “to work on my white male privilege.” I realize now that was a ruse. I regret that I fell for it early on. I do not fall for it now. You were not there to work on it; you were there to assert it even more.
Dear ostensibly social justice-minded activist writing retreat leaders wherever you are:
Please be mindful of who you hand the microphone to. Please be mindful of who walks away (and why). Please be more careful. Please be more skillful and educated in how to facilitate productive and respectful difficult conversations. Our world, and especially our very broken country, needs you to be more mindful, more careful.