Service-Learning Changed My Life

Version 2I am forever grateful for the liberal arts education that included meaningful community-engaged service-learning. (Thank you Oberlin College!) I continue to wrestle with ways to bring the humanities and real service-learning* into my own work teaching undergraduate nursing students. The combination of a grounding in the humanities (in my case medical ethics through Biology and Religion majors) and service-learning, changed my life—and my career—for the better.

In my sophomore year at Oberlin, I took a child psychology course with Dr. Friedman that included a service-learning opportunity of working as a Big Sister or Big Brother to a child or young teenager at a children’s group home on the outskirts of town. Starting in that course and continuing until I graduated and left Ohio, I was the Big Sister for a young girl (she was 12 when I started working with her and I was just 18). I took her on weekend outings around the college town, taught her to swim in the college pool (I was a lifeguard and swim instructor), and visited the town’s Santa for a photo that I treasure. At the time I started working with my little sister I was a pre-med Biology major and thought I had my future life and career clearly charted. But that service-learning experience, accompanied by further private reading study on child abuse with Dr. Friedman, led me to medical ethics and on into a career in nursing.

It is instructive to re-read one’s college term papers. I am fortunate that my mother, who was my best proof-reader, kept all of my early writing going back to my age 7 haikus, and she gave them to me in a package before she died. (Thank you Mom!) Here is an excerpt from a term paper titled “Child Abuse: A Wider and Closer Look” that I wrote for Dr. Friedman in 1979:

“Who would contest that poverty creates the most stressful situation imaginable? If we want to truly treat child abuse, we have to face the fact that poverty is a very real influence. How can anyone possibly cure poverty? That question touches a sore spot in all of us comfortably full and well-clothed individuals. We recognize an inconsistency in our moral structure and in our social structure. The harming of children—all of the legislation, psychoanalysts, psychiatrists, and self-help groups in the world won’t cure it. The idea of changing our society is radical and frightening because we would have to risk losing what we have and feel safe with. How long will the present interest in child abuse last? Will we take the chance and try to cure child abuse, or will we continue placing Band-Aids on the sore, with our heads turned away from the real problem?”

Indeed, four decades after writing that paper I continue to ask similar questions—and to work towards finding solutions to those big, wicked problems. But it was my foundational liberal arts education combined with service-learning that is what prepared me for my life and my career.

* Real service-learning is (as defined by the University of Washington Carlson Leadership and Public Service Center):

“Service-learning is a learning experience that combines service with the community with structured preparation and reflection opportunities. Service opportunities are tied to academic coursework and address concerns that are identified and articulated by the community.

As students engage in service-learning, they learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as community members.”

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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Read Like You Give a D@#n

IMG_3959Empathy is in short supply. Anti-empathy, racism, xenophobia, misogyny and all things ugly are being modeled and stoked by too many people and institutions—including, of course, the President of the United States. Effective resistance to all of this comes in many forms. It is not enough and is self-indulgent to be simply outraged. Fire and fury is not the answer. Do something: Read like you give a d@#n.

You do not need to read or re-read Ray Bradbury’s dystopian novel Fahrenheit 451, or review the history of book-burning, book-banning, author suppression and outright killing (as by Hitler during WWII), to know that books and the mind (and empathy) expanding knowledge they contain is powerful stuff indeed.

My beloved local library system, Seattle Public Library (SPL), has a gutsy and well-read patron who posted “Sh**hole Countries: A Reading List” on their BiblioCommons site. The SPL has added a disclaimer that the post and the list of recommended books is not a publication of the SPL, but kudos to them for supporting the sharing of diverse opinions and resources. Even if you happen to find the content of the brief post either too in-your-face or borderline offensive, be sure to look at (and hopefully read) some of the amazing books on the recommended reading list.

Of course, reading real literature (non-fiction, fiction, poetry, plays) does not necessarily build empathy and equity. Mind and heart expansion require having at least a doorway or a window or a crack in the walls of mind and heart for them to open and expand. But good books and reading them like you give a d@#n do have amazing, lovely, powerful, radical effects on not just the individual reader but also the world.

For the past three summers I have posted a summer reading challenge list of books that have a social justice, global, and health humanities bent. (See “Summer Reading Challenge with a Health Humanities/Social Justice Slant” from June 2, 2015; “Summer Reading Challenge 2016” from May 28, 2016, and; “Summer Reading Challenge: Global to Local” from June 11, 2017.) You don’t need to wait until the summer or a vacation of some sort to start reading real books, radical books, world-view changing books.

Field Notes on Witnessing

IMG_9363On this sunny Sunday in Seattle, I awake and find my essay, “Witness: On Telling” published in the Field Notes section of Intima: A Journal of Narrative Medicine. This is one of my most digging deep and making it real sorts of essays I have ever written. It is the second part of a two part bookended longer essay on the complicated role of witnessing to the traumas of others and of ourselves. The second essay is titled “Witness: On Seeing” and both are part of my forthcoming book collection of essays and poems, Soul Stories: Voices from the Margins.

In this essay I explore how and why and in what forms we tell (and listen to) stories of trauma and what Arthur Frank terms “deep illness.” I parse out the typology of illness stories as presented in his landmark book, The Wounded Storyteller. I challenge health care providers to increase our capacity to listen to—and to hear—different types of illness stories, including the more distressing (and closest to the reality of trauma) chaos stories.

And I look forward to being part of the upcoming (October 20-22) Northwest Narrative Medicine Conference in Portland, Oregon. I’ll be giving a Saturday keynote address titled “Endurance: The Limits of Resilience” and a Sunday writing workshop titled “Radical Self-Care for Social Justice and Health Equity.”

Soul Stories: The Book and I

IMG_2241One midwinter’s day in Seattle in 2009, I sat at my desk at home writing a federal grant proposal for investigating ways to improve health care for homeless young people. I stopped typing midsentence and gazed out the window at the rain and wind rippling the bamboo leaves in my garden. I asked myself what I was doing with my life.

I was a tenured professor teaching community health and health policy to nursing students at a large university. I was a nurse practitioner working with homeless teens and young adults in a community clinic. I loved teaching and I loved my work as a nurse, but this type of writing was not what I longed to do. I needed to find a way to merge my work in health care with my love of writing—of real writing, not the stiff, academic, formulaic writing required by my academic job, and certainly not the cold, distant medical writing in my patient clinical chart notes. Real writing to me was expressive, creative writing—reflective writing that allowed the “I” back into the frame, as, of course, I am doing now. So, as if it were a crystal ball, I typed into my computer’s search engine the words “healthcare” and “literature.” Among the results were links to narrative medicine and to the Narrative Medicine program at Columbia University in New York City. Developed over the past several decades by physician and literary scholar Rita Charon and her colleagues, narrative medicine (as defined by Charon) “fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness.” (…)

And as for real writing within my own life? In retrospect, it was fortuitous that I submitted my last federal health care grant back in 2009, at a time of extreme funding cutbacks during our country’s Great Recession. The reviewers’ feedback was that it was a worthwhile proposal and that it would have received funding if it had come in a year or so earlier, when they had more money. Around that same time, I sat in a faculty meeting where a successful older researcher showed a PowerPoint slide with a series of rolling hills leading off into the distance and a road with National Institutes of Health (NIH) grant signs, one after the other, leading over the hills and fading into the sunset. Her point was that this was how our lives as university researchers should look: this slide represented our marching orders. I stared at the slide and then whispered to a colleague, “and then you die.”

I have nothing against NIH or the researchers who stake their careers on NIH or similar grants, but I knew that slide did not represent the life I wanted. I was forty-nine years old at that point, and my mother had died the year before; the sunset in the slide seemed very real. My husband had also recently commented that if I had used the same amount of time, effort, ink, and paper that went into my grant-writing, I would have written a book manuscript—or several—by then.

Instead of revising and resubmitting my rejected NIH grant proposal, I began to write what became my first published book, a medical memoir titled Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net. This was a book about my work with and spiral into homelessness as a young adult. Through the writing of Catching Homelessness, I did what I consider real writing. The act of researching and writing the book, a book which wove in pertinent events from my personal as well as professional lives, helped give some narrative cohesion to my own fractured and oftentimes confusing existence.

While writing a later chapter of that book, “Greyhound Therapy,” which deals with gender-based violence, I brushed up against a then mostly closed door to my own childhood traumas. I made the decision to keep that door closed: to open it within Catching Homelessness would have led away from the main purpose of the book, which was to illustrate the complexities involved with homelessness and its attendant ills. I knew that to open the new door would require a much different book, one that contextualized the effects of trauma on individuals and communities, and the ways that narrative and storytelling factor into health and healing.

That much different book became Soul Stories: Voices from the Margins. The opening of that door and the personal exploration of what was behind that door led to this book. In writing it, I allowed myself to stray from the clear objective facts of science and medicine into the murkier subjective part of what it means to be human, and what it means to find healing in the face of trauma. This book is the result of that labyrinthine journey.

Note: The above is an excerpt from the Preface of my book manuscript Soul Stories: Voices from the Margins, currently accepted for publication by an academic press, details to follow.

Northwest Narrative Medicine

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Narrative medicine, Pacific Northwest style, strikes me as something worthwhile. Frontier, boundary pushing narrative medicine. Pencils (and pens, and laptops) with golden wings! We now have (thanks to the folks in Portland, Oregon) a Northwest Narrative Medicine Collaborative.  Next month (October 20-22nd) they will hold their second annual Narrative Medicine Conference in Portland, Oregon. I am honored to be a part of it and will be giving a keynote address titled “Endurance Test: The Limits of Resilience” in which I’ll examine the unintended consequences of the often saccharine sweet resilience research and will, instead, propose the concept of endurance in our work and lives. Endurance, as described by psychiatrist and anthropologist Arthur Kleinman, makes so much more sense to me than does resilience—especially in the times we are living through. Kleinman writes:

“What helps us endure? And I mean by endure withstand, live through, put up with, and suffer. I do not mean the currently fashionable and superficially optimistic idea of ‘resilience’ as denoting a return to robust health and happiness. Those who have struggled in the darkness of their own pain or loss, or that of patients or loved ones, know that these experiences, even when left behind, leave traces that may only be remembered viscerally but shape their lives beyond.”  (Arthur Kleinman, “The art of medicine: how we endure.The Lancet. January 11, 2014. 383: 119-120.)

Skeletons in the Closet

IMG_2792.jpgOne evening this past weekend I watched the indie movie “To the Bone” (2017) which deals with the topic of eating disorders, particularly anorexia nervosa—with the highest mortality rate of any mental illness. People waste away, become skeletal like concentration camp victims, and literally starve themselves to death. Unless, that is, they are fortunate enough to be able to access effective and compassionate health care and recover from this devastating illness. As does the 20-year old lead character in “To the Bon,” Ellen, as well as the actress, Lily Collins, who plays her in the movie—and as does the writer/producer of the movie, Marti Noxon. Both Collins and Noxon have struggled with anorexia and Noxon based the screenplay on her own experience.

I had read about some of the controversy surrounding this film, including critique that it glorifies thinness and eating disorders in general, as well as that it can tigger viewers into a recurrence or worsening of their own anorexia. Although I am not in favor of the over-use of trigger warnings, I did feel that the brief written warning at the beginning of the movie was tasteful and appropriate. As I remember, it stated something like “The following movie includes content that some viewers may find difficult to watch.”

Having lived through anorexia as a teenager, and having provided primary health care to many young people struggling with eating disorders (and across the socio-economic spectrum), I can say that “To the Bone” is an honest, nuanced, and not overly-sensationalized depiction of the lived experience of eating disorders. The movie does not glamorize thinness or eating disorders. It appropriately alludes to the linkage between eating disorders and childhood trauma, including sexual abuse. The supposedly unconventional heroic physician in the film, Dr. William Beckham, played by Keanu Reeves, is borderline obnoxious in that Robin Williams ah-shucks smiley face sort of way. And the group home eating disorder treatment center where the main character Ellen goes in a last-ditch effort to find a cure, is a gorgeous and expensive-looking setting. It helps that Ellen’s elusive father (he never appears in the movie even for a family therapy session) is portrayed as having a well-paying job in order to pay for that group home inpatient therapy. Even patients with relatively comprehensive health insurance often have difficulty accessing such treatment for eating disorders.

My assessment is that “To the Bone” is a good and honest film about an important mental health issue, and it is written/produced by a woman and features mostly women in the leading roles (luckily, Reeves has relatively little screen time). I can see this film being used effectively in nursing and other health professions educational programs for many years to come.

  • A good resource for more information on eating disorders (including a toll-free, confidential help-line) is the National Eating Disorders Association.
  • And about that actual skeleton in the closet included in this post… It is a human (not plastic) skeleton enclosed in its own wooden closet on wheels and is located in the University of Washington School of Nursing’s new simulation/learning lab. I took her photograph last week and am currently trying to discover anything more about who she was.