Category: Ethics

Students Rock

IMG_4490This 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).

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Trauma Mastery

IMG_0253Note: This is an excerpt from my essay “The Body Remembers” in my book Soul Stories: Voices from the Margins (San Francisco: University of California Medical Humanities Press, 2018).

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)

 

Sources:

1 and 2, Laura van Dernoot Lipsky with Connie Burk, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (San Francisco: Berrett-Koehler Publishers, 2009), page 159.

3, Eve Ensler, In the Body of the World (New York: Metropolitan Books, 2013).

 

Dear Angry White Man

IMG_5142Dear Angry White Man,

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.

 

Homelessness: A Very Wicked Problem

IMG_4766Wicked problem: a term coined by two UC Berkeley professors of urban planning, Horst W.J. Rittel and Melvin M. Webber, to describe difficult social policy issues such as poverty, crime, and homelessness. This is included in their still surprisingly relevant journal article “Dilemmas in a General Theory of Planning” Policy Sciences (4), 1973, pp. 155-169. Rittel and Webber write, “As distinguished from problems in the natural sciences, which are definable and separable and may have solutions that are findable, the problems of governmental planning–and especially those of social or policy planning–are ill-defined; and they rely upon elusive political judgment for resolution. (Not ‘solution.’ Social problems are never solved. At best they are only re-solved–over and over again.)” (p. 160)

That last parenthetical comment is worth repeating until it sinks in. Homelessness as a prime example of a wicked problem will never be solved. The most we can hope for is that it will be re-solved. Our U.S. healthcare system is another example of a wicked problem. Therefore, unless my basic math fails me, health care for the homeless is a wicked problem squared. That does not equate with a reason to give up and not even try to address the wicked problems of homelessness and health care. It means that all of us are called upon to have the resolve to figure this out together.

Having a seemingly never-ending assortment of expert panels and reviews of evidence-based practice aimed at finding solutions for the crisis of homelessness may be necessary, but it will never be sufficient. Having a place-based, grass-roots approach and one that is supportive of critical reflection has greater potential for being more broadly effective. And this isn’t mere consumer or community-member token representation on policy committees as is so often practiced.

“Place oriented inquiry and practice emphasizes bottom-up strategies for the adaptive,
sustainable governance of complex dynamic landscapes. Adopting a spatial or place-based perspective helps with recognition that most knowledge is, to a significant degree, local or context-dependent, as all knowledge-holders occupy—by virtue of their biography, training, and geographic experiences—some particular, delimited position from which to observe the world. Wicked-problem conditions, the argument goes, require the cultivation, transmission, and application of existing bottom-up knowledge held by embedded actors in the landscape.” pp. 18-19.

Source: Weber, P. & Lach, Denise & Steel, S.. New Strategies for Wicked Problems: Science and Solutions in the 21st Century. Corvallis: Oregon State University Press, 2017.

 

Homelessness: Native Seattle

E23611D1-BEFE-4A2D-AC70-C0BD4D09CA1EI offer these images of Seattle Pioneer Square from my Skid Road street hauntings, alongside powerful quotes from Coll Thrush’s important book Native Seattle: Histories from the Crossing Over Place, second edition (Seattle: University of Washington Press, 2007). Even though it is not specifically about homelessness, it is essential reading for a deeper understanding of homelessness in Seattle.

“In 1991, The Seattle Arts Commission launched an ambitious program called In Public, a citywide set of installations designed to inspire dialogue about the role of art in everyday life. (…) In Public was edgy and controversial. One of the most confrontational pieces, by Cheyenne-Arapaho artist Hachivi Edgar Heap of Birds, was installed in Pioneer Place Park alongside the Chief-of-All-Women pole and a bronze bust of Chief Seattle. Called Day/Night, it consisted of two ceramic panels inscribed with dollar signs, crosses, and text in Whulshootseed and English that read ‘Chief Seattle now the streets are your (sic) home. Far away brothers and sisters still remember you.’ Dedicated to the city’s homeless Indians, Day/Night challenged Seattle’s other place-stories.” pp. 173-4.

Note that the images included above are two photographs, a juxtaposition of a “modern” street art image of Chief Seattle from a Pioneer Square alleyway, as well as one panel of Day/Night in English and reads “Chief Seattle now the streets are our home.” The day I took this photograph the second ceramic panel of the Day/Night art installation was not there. Vandalized? Being repaired?

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The second image and quote from Thrush’s Native Seattle have to do with the earliest days of the white American settlers/Pioneers who staked land claims on what is now Seattle’s Pioneer Square—an area that was known as the Little Crossing-Over Place by Chief Seeathl (Seattle). The Little Crossing-Over Place had a source of fresh water and had been an old Indian fishing village. The photograph above is of a Pioneer Square saloon alleyway doorstep (and nighttime sleeping place) located near the Chief Seattle Club, a terrific multi-service agency “providing a sacred space to nurture, affirm and renew the spirit of urban Native people.”

“Indeed, well before the day when Bell, Boren, and Denny decided that Little Crossing-Over Place would be their new home, the indigenous world of the Duwamish, Lakes, and Shilsholes had been irrevocably transformed. The ruined longhouse at Little Crossing-Over Place, overgrown with wild roses (and, according to oral tradition, only one of several that had once stood there), spoke to the abandonment of towns in the wake of epidemics and slave raids. In Whulshootseed, similar words described both houses and human bodies: house posts were limbs, roof beams were spines, walls were skin. Just as sweeping a house and healing a body could be expressed with the same verb, related words spoke of illness and the falling down of a home, and so the ruins were testaments of loss.” p. 38

Below, is a photograph of the native plant, the Nootka Rose, mentioned in the quote above. I took this photograph recently while walking through the University of Washington Botanic Garden’s Union Bay Natural Area— which is built on top of a large Seattle landfill that long ago had been an important Native American fishing village. Thrush concludes his book with these words:

“… in every college diploma earned by an Indian, in the restoration of urban nature and in the willingness to challenge narratives of progress, there is hope that Seattle’s Native past—or, more accurately, its many Native pasts—can be unearthed. These place-stories, linked to urban and Indian presents and futures, will not simply be cautionary tale, smug jokes, or nostalgic fantasies but will be dialogues about the transformations of landscape and power in the city and about strategies for living together humanely in this place.” p. 207

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Homelessness Visible

IMG_4667Our latest point-in-time count of people experiencing “absolute” homelessness in King County tallied 12,112 homeless individuals on January 26th, 2018 (see the All Home King County‘s 2018 report “Count Us In”). By the term “absolute” I refer to the fact that they use the strict HUD definition of homelessness, which excludes the considerable number of people (especially teens and young adults) who are couch-surfing, doubled-up with friends or extended family members and who do not have a safe, stable, affordable place to live. In this respect the HUD definition differs from the official definition of homelessness for healthcare services funded through the U.S. Department of Health and Human Services (see the various definitions compared here by the National Health Care for the Homeless Council).

The 12,112 homeless individuals counted for 2018 represent a 4% increase over the 2017 homeless count (which represented a 19% increase from the 2016 count). Some politicians claim that the slowing percentage increase in people experiencing homelessness can be counted as progress—although as a reality check, the 4% increase in homelessness is much larger than the total population growth for King County. The most recent published statistics show a 2.3% population growth for King County for 2016-17 (source: Washington State Office of Financial Management). As another significant reality check, the homeless count survey methodology changed considerably for 2017 such that comparisons with 2016 numbers should not be made.

Significantly, the 2018 homeless count found that over half (52%) of homeless people were unsheltered the night of the count, with many people living outside in tents and in vehicles. Having participated in the survey this year, I can attest to the difficulty of finding and assessing whether or not parked vehicles are being lived in between the 2-5 a.m. timeframe the day of the count. It is much easier to count the number of people staying overnight at an emergency shelter. And homeless people living in tents tend to find thickly wooded areas in which to live—and not, as in the photograph above, more visibly along well-lit streets and bike paths. But for all of us who live, work, study, and play in Seattle and throughout the rest of King County, we didn’t need the official homeless count to tell us we have a growing problem. We have homelessness, abject poverty and despair, quite visible.

Note: In a series of subsequent posts I will address intriguing, intelligent, and excellent questions which I have received lately about our homelessness crisis. They were too numerous and complex to address in one post.

 

 

Dear Flo: What Nurses Week Means to Me

IMG_4737Happy National Nurses Week to all you dedicated, compassionate, hard-working nurses out there! While you’re enjoying your free cinnamon bun and coffee, I hope you will pause to reflect on your work and on what truly fuels your continued passion for nursing (or where the heck that passion has gotten to if you have lost it).

And if you have time to read more than patients’ chart notes or community outreach notes, I hope you will pick up and read a “real” book written by nurse authors. We may be a small group compared with the vast number of physician authors, but we are growing in strength. I am proud to be a nurse and I am proud to be a nurse author in the company of some amazing, inspiring people.

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As far as living nurses go, there are many who inspire, innovate, and influence me. One of these is Ruth Watson Lubic, the nurse-midwife, MacArthur “genius” award winner, and founder of the Family Health and Birth Center, located in one of the poorest neighborhoods in Washington, DC. She walks the talk of what nursing can and should do well, to “treat everyone like a human being,” to create a community-based health center where “everyone who walks in that door feels love.” Plus, she has combined direct nursing service with upstream policy work as succinctly depicted in this brief video. (And she is a way cool elder who has her own Hip Hop Saves Lives song and video!)

The American Nurses Association Ethics and Human Rights Statement of 2017 states that “Nursing is committed to both the welfare of the sick, injured, and vulnerable in society and to social justice.” It goes on to proclaim that “Nurses must always stress human rights protections with particular attention to preserving the human rights of vulnerable groups, such as the poor, the homeless, the elderly, the mentally ill, prisoners, refugees, women, children, and socially stigmatized groups.”

I am a proud nurse educator and (most days) count among my blessings, the opportunity to work with the amazing, smart, creative, and compassionate future nurses. Like the students yesterday at the Nurses Week event at Shoreline Community College. And like these University of Washington School of Nursing students at our Doorway Project pop-up community cafe who spent a sunny Sunday afternoon washing the feet of homeless young people. Dear Florence Nightingale, happy birthday and happy Nurses Week! As Florence Nightingale nurse scholar Tony Paterniti, PhD, RN states, Nightingale wasn’t only the lady with the lamp, she was also a “woman with a mission.” (Check out Dr. Paterniti’s fascinating digital archive collection on Florence Nightingale through Texas Woman’s University.)

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Life in the Swamp: Float, Don’t Flail

P1020499Community-engaged scholarship is mucky business. It takes a high tolerance for—and even delight in—ambiguity, lack of clear paths, no solid ground, simultaneous decay and incubation, annoyingly loud squawking ducks, tail-thwacking beavers stirring the mud, and skunk cabbage. Oh yes, the putrid smell of skunk cabbage. Skunk cabbage reminds me of the people who seriously pluck my nerves, who irritate me, yet somehow must serve a useful purpose (for instance, as food for bears coming out of hibernation in the case of skunk cabbage).

Community-engaged scholarship is not for the faint of heart or the fastidious or the unprepared. I’ve learned and re-learned these lessons many times over my thirty-plus years of such work. There always comes a point of crisis, with the inevitable interpersonal and inter-agency power plays coming to a head. In these times, (which I am in the midst of currently with the particularly complicated Doorway Project) when my default mode is to fight back against the stealthy, submerged weeds of the swampland territory of this work.

But then I remember my Red Cross swimming safety instruction as a teenager. When swimming in swampy rivers and the underwater fingers of submerged plants begin to grasp your limbs, threatening to pull you under—instead of fighting them (thus tightening their hold), you are instructed to relax and float. The threatening underwater plants will then release you to the surface where you can gently scull your way back to the safety of shore. Float, don’t flail.

It is useful to have wetlands and swampy areas near at hand to visit and remember these sorts of lessons for life and for community work. (Not to mention, of course, the myriad positive environmental aspects of wetlands.)  I’m fortunate to have Yesler Creek in my (literal) backyard and Yesler Swamp (where the creek empties into Lake Washington) only a mile from my home. Yesler Swamp has undergone a restoration process (ongoing) spearheaded by a campus-community group (Friends of Yesler Swamp and University of Washington Botanic Gardens) and is now a refuge for wildlife—and for humans who need a respite from the bustle and hassle and skunk smells of academic and city life.

Swamps are terrific metaphors for community-engaged scholarship, especially scholarship that deals with wicked problems such as homelessness. I return time and time again to the wise words of Donald Schon, author of The Reflective Practitioner: How Professionals Think in Action (Basic Books, 1984) among many other important works:

….The research university is an institution built around a particular view of knowledge, as the following dilemma helps to make clear:

The dilemma of rigor or relevance.  In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution.  The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.  The practitioner is confronted with a choice. Shall he remain on the high ground where he can solve relatively unimportant problems according to his standards of rigor, or shall he descend to the swamp of important problems where he cannot be rigorous in any way he knows how to describe.

Nearly all professional practitioners experience a version of the dilemma of rigor or relevance, and they respond to it in one of several ways. Some of them choose the swampy lowland, deliberately immersing themselves in confusing but critically important situations. When they are asked to describe their methods of inquiry, they speak of experience, trial and error, intuition, or muddling through. When teachers, social workers, or planners operate in this vein, they tend to be afflicted with a nagging sense of inferiority in relation to those who present themselves as models of technical rigor.  When physicists or engineers do so, they tend to be troubled by the discrepancy between the technical rigor of the “hard” zones of their practice and the apparent sloppiness of the “soft” ones.

People tend to feel the dilemma  of rigor or relevance with particular intensity when they reach the age of about 45. At this point, they ask themselves, “Am I going to continue to do the thing I was trained for, on which I base my claims to technical rigor and academic respectability? Or am I going to work on the problems — ill formed, vague, and messy — that I have discovered to be real around here?”  And depending on how people make this choice, their lives unfold differently. (Donald Schon, “Knowing-in-action: The new scholarship requires a new epistemology,” 1995, Change, November/December, 27-34.)

Here is to all of the swamplands and swamp workers of the world. Let’s keep mucking around together and remember: when things get particularly tough—float, don’t flail.

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Listening to Skid Road

IMG_4007Listening to Skid Road: Join us for a lunchtime panel discussion on the intersections of health, homelessness, and racism in King County, as well as explorations of the moral responsibilities of the University of Washington in addressing these issues. Hear from panelists who participated in the oral history collection for the Skid Road project, currently on display in the University of Washington Odegaard Library. Panelists include Krystal Koop, MSW; Nancy Amidei, MSW; Sinan Demirel, PhD; Rebekah Demirel (author of the memoir Nothing’s for Nothing: Transformation through Trauma) and Eric Seitz, RN; with Josephine Ensign (PI of the Skid Road project) as moderator.

Date: Tuesday February 6, 2018
Time: 11:30am-1:30pm
Place: University of Washington Odegaard Library, Room 220
Light lunch and beverages provided
Open to the Public

4culture_colorSpecial thanks to public historian Lorraine McConaghy, PhD for her support and mentorship throughout this project.

This project was supported, in part, by an award from 4Culture. Additional support for the audio portion of the DS videos comes from Jack Straw Cultural Center. My Skid Road project was also funded, in part, by the University of Washington Simpson Center for the Humanities, the University of Washington College of Arts and Sciences, the National Endowment for the Humanities, and Humanities Washington.

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Solastalgia: Homesickness and Climate Change

BC642845-1D42-466F-870C-CC1456A62A08Population health effects from climate change are established scientific facts. Like anti-vaxxers (anti-vaccinators), climate change deniers are not only wrong-headed, they are dangerous to everyone’s health (and to planetary health). Case in point: beware of the pets of anti-vaxxers since many seem to be refusing rabies vaccinations for their cats and dogs/ see “Anti-vaxxers now refuse to vaccinate pets” by Nick Thieme, Slate, August 3, 2017; at the same time, global warming is increasing the spread of rabies among animal hosts such as foxes in Alaska/ see “Ecological niche modeling of rabies in the changing Arctic of Alaska” by Huettman, Magnuson, and Hueffer, Acta Veterinaria Scandinavica, March 20, 2017. And as a reminder, rabies in humans is almost 100% fatal (source: CDC).

The Centers for Disease Control has developed an excellent graphic depiction of the impact of climate change on human health, shown here:

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Of special note in this graphic is the fact that mental health impacts are shown twice, associated with both severe weather and with environmental degradation.

A recent (November 25, 2017) NYT article illustrates the mental health effects from climate change for people who live in Rigolet, Labrador. As Livia Albeck-Ripka states in the article “Why Lost Ice Means Lost Hope for an Inuit Village” there are increases in depression, substance abuse, domestic violence, and suicide related to the disorienting environmental changes and increased isolation for villagers. “An unpredictable environment means disempowerment,” she writes and links this with the stirring up of the intergenerational trauma of colonization for indigenous people. But she also points out that mental health effects from climate change and environmental degradation affect us all. She quotes Australian philosopher Glenn Albrecht as stating, “We weren’t around when the asteroid wiped out dinosaurs, but now we have humans in the 21st century who are trying to deal with a change to the world which is unprecedented.” Albrecht coined the term Solastalgia: “a form of homesickness one experiences when one is still at home.”

But what can we individually and collectively do about climate change and about the health effects of climate change? Perhaps the most important action is to become better informed and more civically engaged in respect to these topics. The Lancet has a good website: Tracking the Connections Between Public Health and Climate Change which includes a synthesis of scientific evidence in The 2017 Report of The Lancet Countdown. In the US reliable sources of information include the CDC (resources linked above) and the American Public Health Association (APHA). The APHA graphic “How Climate Change Affects Your Health” (included below) is a bit overly-busy and heavy on the gloom and doom (and curiously does not include mental health), yet could spur helpful discussion in certain settings:

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Another great resource that is geared towards a young adult audience is the Seattle-based environmental news site Grist, with the vision of working for “a planet that doesn’t burn and a future that doesn’t suck.” Their funny and informative (a good combination) “Ask Umbra” eco-advice column is worth following. Take a look at Umbra’s “21-day Apathy Detox” for great ideas on brushing up on civic engagement related to environmental justice and climate change. My two favorites are “Day 5: Read More Than Dead White Men” and “Day 20: Art Brings Life to Social Movements.” 

Get involved. Do what you can to beautify and “green” the places where you work, live, and play. Work upstream for social and environmental justice. Bloom where you are planted. Those are some of the thoughts I’ve had this fall as I’ve been involved with this year’s University of Washington Health Sciences Common Book Changing Climate, Changing Health: How the Climate Crisis Threatens Our Health and What We Can Do about It by Paul R. Epstein and Dan Ferber (University of California Press, 2011).

In order to emphasize the what we can do about it, I’ve been part of a team attempting to green the ugly weed-filled concrete planters in the main courtyard at the University of Washington Health Sciences—a courtyard with entrances to the Schools of Nursing, Medicine, Dentistry, the UW Health Sciences Library, as well as the UW Medical Center. The photos at the beginning of this post show the planters in their current (dismal, depressing) state, along with my tiny (art project!) protest sign next to a fake flower “blooming” in a pot. Our team wanted to plant spring bulbs and a healing garden full of water-wise herbs like rosemary and lavender, as well as indigenous healing herbs and native wildflowers. We have had a seemingly endless series of meetings with people from the medical center, the health sciences schools, the building and grounds folks, and the UW Sustainability group. Something that would appear to be easy to do is not. As I understand it, the (ugly concrete/example of Brutalist “raw concrete” architecture) Health Sciences building where this courtyard is located, is crumbling and leaking inside, including in the rare books collection of the library. We have been told that we can’t plant anything until the courtyard infrastructure and water membranes are replaced, which would cost millions of dollars ($7.5 million to quote one reliable estimate).

This is a somewhat trivial problem when compared with other environmental issues affecting our most vulnerable populations, but it is a daily reminder of the negative mental health effects of environmental degradation—including from poor choices for our built environment and health institutions.