Vulnerability, Courage and Healing

A few years ago a friend rang me in a state of turmoil.

‘My secretary, Debbie has been off sick for two weeks with probable Leukaemia. I am fond of her and wish to know how she is. But if I ring up it will look as if l am trying to find out when she is going to return. I have no wish to pressurise her. But if l don’t ring, she’ll feel I don’t care . . .’

I responded directly: ‘Dave, are you really fond of her‘?’

‘Yes’ he replied in a voice that was breaking.

‘Then immediately put the phone down and ring her.’

Vulnerability is not necessarily a weakness, as the Tao Te Ching reminds us of the strength and wisdom of vulnerability. ‘That the weak overcomes the strong’. However as we’ve seen, we are constantly exhorted to be more competent in caring and less vulnerable. We strive to learn much more and to become muscular in physical, psychological and spiritual senses. This approach contrasts greatly to Shamanism — healing through wounds. How can we learn to accept these immense treasures inside us and use them for the benefit of all? What sort of training would be necessary?

The over-valuing of competence can mean hiding the ‘unacceptable’ bits from ourselves and others. Kay Jamison, a professor of psychiatry and a psychiatric patient writes:

I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I have something to hide. One is what one is, and the dishonesty of hiding behind a degree, or a title, or any manner and collection of words, is still exactly that: dishonest. Necessary, perhaps but dishonest. I continue to have concerns about my decision to be public about my illness, but one of the advantages of having had manic-depressive illness for more than thirty years is that very little seems insurmountably difficult. (Jamison, 1995b, pp. 7-8)

We can use these experiences of distress and isolation to enter other worlds. They can help narrow the boundaries between different sorts of reality, enlarging our experience and bringing us into more intimate and direct contact with loving others. A healing that means melting the boundaries, being less partial to ourselves and creatively including others in more intimate and wholesome ways. Our broken hearts can make us more available to others.

Direct experience becomes gradually devalued and even rejected. The suffering and poverty of the vast majority turns into yet another service industry. Anti-discrimination strategies become ends in themselves, just mantras for use in college student assignments, separated from any genuine struggle against racism or sexism. We lose sight of the overall struggle for liberation. Walsh (199o, p.16o) comments:

The helping tradition no longer focuses on or even appreciates direct experience of the transcendent. Then what is left is an institution largely devoid of direct experience of the sacred techniques for inducing altered states then give way to mere symbolic rituals, direct experience is replaced by belief and living doctrine fossilizes into dogma. What remains is simply a series of empty rituals.

These suffocating trends have enormous consequences for health and social services in stimulating a culture of fear and competition. Diverse professions compete aggressively with each other, to achieve dominance — nursing versus social work, psychology versus psychiatry. Their very survival seems to depend on the destruction or at the very least the diminution of the other, rather than in making vital connections to expand common knowledge.

Reports about scandal after scandal make important points about the failure of the mental health services to cooperate fully, to save the life of a child or prevent patients from killing themselves.

One disturbing tendency is to industrialise human helping. As we saw with DSM labelling, differentness can easily become understood as deficiency. Human needs father a business more closely linked to professional ambitions than any needs of the distressed service users. People are encouraged to become the passive recipients of quasi-monopolistic services; to be a cash crop for exploitation. Vast tensions in socioeconomic structures are reframed as in some way the fault of individual consumers.

Ironically, major socioeconomic changes select ever more groups for social exclusion and then have to provide the relevant professionals to herd them, be it social workers, nurses, occupational therapists.

Wilkinson (1996) writes of the unrelenting processes of social differentiation which reflects and amplify social hierarchy. It is these processes which create social exclusion, which stigmatise the most deprived and establish social distances throughout society? Such devalued individuals pay extremely high costs.

These powerful trends are an essential ingredient of the ‘consumer’ revolution. We gradually leave behind ways of living, understood as a series of actions for yet another that is simply a collection of experiences more passive than active from being heroic to sunbathing on a sandy beach.

Tourists, holidaymakers, and others are not doing anything very much: they are simply purchasing and laying clown stocks of pleasant memories to be replayed and enjoyed in later years. People are not agents any longer; they are the consumers and the recorders of their own experience. They are their own video-librarians, collecting and arranging shelves of happy memories. Actions are replaced by holiday scrapbooks.

Consumers demand services that are easier to access. Everything from education upwards and downwards must be glycerined. Kenyon (1997, p.25) writes:

The fact is that Brahms needs effort, not just on the part of the performer but from the listener. And we underestimate that at our peril. The big classical works — not just the huge symphonies of Bruckner and Mahler and the operas of Wagner, but also Handel operas, Bach cantatas — make demands on the listener just as do a great book or a great picture.

This sort of challenge lies uneasily with the wishes of consumers for smooth products that ask for little effort.

It was many years ago but it remains fresh in my memory. I wanted to train for nursing profession so attended a selection interview for the course at Cambridge University. I’d been an Elderly Care officer for several years. I was asked to write the required essay on my personal background. I included that I had suffered physical and emotional abuse as a child. I endure regular physical battering by my teachers and that these had left scars that made me want to run away from school. I concluded that the health care field was a process to heal myself and possibly others.

The academic tutor was an earnest intellectual with a degree of studied, ‘objective’ distance that I found disconcerting. He was not at all empathic, rather grim. The hour-long interview felt like an incessant prodding by a long pole. Right at the end he leaned over and remarked languidly: ‘Of course with your background, if we accepted you, we would insist on psychiatric treatment. How would you feel about that?’

‘Psychiatric treatment …. ’ Struggling to answer I felt battered again.

Instantly I was demoted from senior lunatic catcher to junior lunatic. The insistence on psychiatric treatment was made with rubber gloves. I gathered myself together, or rather made a pale imitation of it and muttered ‘OK’. It was far from convincing. I’d received a valuable lesson. Until that moment it had never occurred to me that my childhood was a ‘problem’. But the Pandora’s Box was opened, never to be closed again.

The damaged and wounded side of me has seemed, for the most part, unacceptable to my chosen profession. I’ve written widely about being battered; appeared on prime—time TV shows to talk about the beatings; even made training films on violence. Professionally the response has been largely hostile. Modern social workers are not supposed to be ‘damaged goods’.

Now we’re all managers and technicians, not teachers or healers. Few articles in the journals acknowledge the hidden reasons why many people come to the helping professions. These have much to do with expiation, guilt, seeking forgiveness, experiencing loneliness. This profession was founded on the wounds and scars of people with experiences like mine. We have grown fat and influential on the suffering of neglected and damaged children. We have created a whole new industry out of their pain.

Olshansky (1972) writes:

First, professionals, by training, are committed to treating pathology and abnormality even where none exists …. Second, professionals too often develop a sense of superiority to the people they help. Enjoying feelings of superiority, they somehow lose interest and faith in the capacity of their ‘inferiors’ to change, to grow. Moreover; they expect less from these ‘inferior’ persons. Third, professionals tend to see . . . only the ‘inner space ’, the intra-psychic  professionals tend to place low value on experience. The only experiences they value are the clinical ones, where they are in control and their contacts are brief. The experiences outside the clinic seem to them to be of little value . Fourth, professionals are imprisoned by habits. They prefer to do what they have done. It is easier and more comfortable to treat pathology as they have been doing and as they have been trained to do.

The other side of this issue is the pressure from patients and clients for us to become gods. We demand that doctors don’t make mistakes, always get it right. The British Medical Journal has described doctors as ‘the second victim of medical error’, often paying for a mistake with their mental health, marriages and livelihood.

‘The easy, understandable and completely wrong answer is to blame those who made the mistake.’ (Rice, 2000, p. 25)

So the next time some medic saws the wrong leg off, meditate on their structural problems! The British Medical Journal has understandably come up with the completely wrong answer — to erase large zones of personal and professional responsibility.

Much of this adds up to a flight from pain, a protection against getting too close to emotional and psychological distress, the development of yet more rituals. When doing community nursing I had a patient allocated to me. Her file contained a query about the possible battering of an old lady by a relative. Seven social workers had visited over a number of years. Periodically at a local day centre, the old lady was seen to have bruises on her legs and upper arms. On a number of occasions this was referred to the social work team and investigated. Nothing was discovered about these bruises.

I visited on two occasions. On the second occasion the male relative broke down in floods of tears and ‘confessed’ to ill-treating his elderly relative. He had in his own words been ‘wanting to clear things up for some time’. He felt that the various professionals concerned ‘didn’t wish to hear about the violence’. They were looking at him ‘through plate glass’.

These sorts of defensive strategies serve as a barrier. It often seems to us as professionals that accidents and illness, dying and death, divorce and sorrow are processes happening to others — not to us. Working with others can be a sort of voyeurism, spectator therapy. I recall seeing a patient who was also a social worker, specialising in marital breakdown. A few months earlier her husband had left her for a young woman. She couldn’t understand why it was such a dire struggle. ‘I’ve been through so many breakdowns.’ But this time it was a direct experience, not one to be listened to and watched.

At another level, sickness, especially that with a high psychological component, becomes a fresh sort of immorality, involving the unforgivable burdens placed on others. My friend Jane got cancer a few years ago and nowadays avoids reading anything about it. Most writings make her feel guilty. She feels blamed by much of the sensational output from radio, TV and in magazines and newspapers. If only she’d ridden twenty miles a day on a monocycle, eaten two kilograms of raw rhubarb weekly, washed it down with a quart of pure halibut oil whilst listening to relaxation tapes. The more guilty she feels, the more stress and that is linked with cancer. Never mind the ‘big girls don’t cry’ crap, this one does and openly.

Jane told me how she searched for healers. They had rituals and white coats, leather couches, usually freezing hands; communicated solemnly amid the frequent purification of hand washings. Mostly they subtly deprecated the last professional she’d attended.

When she described the previous interventions there was a slight lifting of eyebrows and increased tension round the mouth. The implication was usually that she was an idiot who’d entirely neglected herself and had put herself foolishly in the cold hands of other barely qualified idiots.

They were talented at communicating disapproval. She was somehow to blame. Diamond describes a particular cul-de-sac when writing about surviving cancer:

It seems that there is a small space where new age philosophy meets sharp—heeled Thatcherism and it is in the idea that we are all entirely responsible for our individual physical states. In a way, of course, that is true enough: my choice to smoke for all those years, to live in the centre of our smokiest city, to eat full English breakfasts in bad provincial hotels must certainly have taken its toll on heart and artery and bronchial tube. And yes, I still smoked and carried on doing so through the treatment I would accept that I may bear the responsibility for the cure not working. It’s the idea of taking spiritual responsibility for a disease once it’s been diagnosed which annoys me. For it leads to the idea of the survivor as personal hero — that only those who want to survive enough get through to the end, and the implied corollary that those who die are somehow lacking in moral fibre and the will to live. I accept that some can grit their teeth, and get through the treatments more happily than others, and even that there are various calming regimes which make the treatment slightly more bearable. In terms of responsibility, though, as far as I’m concerned I will be cured only of the surgeons have cut out the right bits of my neck and the radiologists and radiographers have chosen the right bits of my throat to point their machine at. (Diamond, 1998, p. l96-7)

This sharply observed position is underpinned by an acute lack of humility on the part of New Age healers, a tendency not unknown in mainstream medicine. This is a fresh sort of fascism.

Jane’s experiences were that psychotherapy didn’t help much, neither did crystal swinging or the laying on of hands. What helped her the most was swimming and taking responsibility, not culpability, for the distress. For 18 months she was the first person to arrive each morning at 7 am at Huddersfield swimming baths. At the end she still disliked swimming but her health was much stronger. Jane has long since given up playing at tough girl, well for most of the time.

Kevin is another friend, who has physical disabilities, visual impairment and happens to be a very effective spiritual teacher. It’s lunchtime, but as I’m on this draconian diet to shift a sagging stomach my plate is empty. I’m making a meal at very short notice for Kevin as one of his personal assistants dropped out at short notice for sketchy reasons. I am struggling to heat a freshly prepared dish of vegetarian pasta which, as I am a meat eater, is a considerable difficult skill for me to master.

Kevin is fuming inside and keeps asking: ‘Who was supposed to do my lunch’? Who has dropped out? I am unhappy about this’.

He’s unhappy! What about me? Dragged away at five minutes’ notice from my office and struggling with a dumb microwave. I take his lunch to the tray on the wheelchair for the third time.

‘It’s still cold’ he grimaces. Whatever my limited skills as a nurse, I’m useless as a cook. These banal practicalities are the real test, not the ability to write an essay or research breakthroughs in nursing science.

For the seventh time: ‘Who should be doing my lunch?’

I don’t know or care one bit. Anyone except me. He tells me once more that he’s unhappy. I know he’s unhappy. I struggle again with the microwave, having just failed to find any potatoes. Kevin has a marvellously subtle way of requesting something and when you can’t comply he responds with an implication of incompetence, honed over many years in residential care. The potatoes must be there, it’s just that I’m too stupid to see them. I’m now chock full of rage. I’m so angry with him because he asks the same question over and over again to which I don’t know the answer. I know about memory loss due to the head injury. I’m beginning to feel that I should know who dropped out. My anger rattles around the cutlery drawer. Now I can’t find anything even the napkins. Kevin asks very pointedly how I became a nurse. He seems bemused rather than fascinated. It obviously didn’t include microwave oven or potato tests as I take his meal out once more and simultaneously explain about the obligatory oral exam — for the nursing, not the cooking.

He’s deeply angry.  Too stuck in that bloody wheelchair while the real world goes by. From the promise of a young soldier, playing prop forward for the local rugby union team to life in a wheelchair, seldom going out. Planned routines, an important aspect of his everyday life, are disregarded by thoughtless others. Waiting all day for assistance, who never comes because she’s too busy. Sacred staffing rotas are ignored and unexpected stand ins are dumped on you, and even the microwave mounts a dumb resistance.

I know a thousand clever tricks from counselling training and nursing to process and juggle this anger. I can envision pink flamingos flying over the African plains; hear light waltz music to relax tense tissues; do Yoga Asanas on my neck; whip myself with an ideological birch for falling short of the lunch preparation competencies — from empathy to communication skills.

I choose none of the above. The immense anger surges up my body almost to choking point. After a brief period of this surge, I can feel Kevin’s frustration every time he speaks, both in overtones and in undertones. Some comes from immense disappointment about life in a wheelchair, having to depend on frequently unreliable people making your lunch, whilst mine comes from childhood beatings.

‘Would you like some peas?’ I ask. I can find a packet of peas but no potatoes.

‘Yes’ he responds like a demented parrot, ‘But who was supposed to do my lunch? Where are they? I’m unhappy.’

For the umpteenth time I respond that I don’t know. I wish I did know. It’s an extremely large part of the human condition to be unhappy. It arises out of the great disappointment that life isn’t the way it ought to be, but is the way it is. The person supposed to prepare the lunch didn’t show up; didn’t care enough; didn’t follow the script of the rota.

Kevin and I share that disappointment in spades, except that my begrudging generosity is to be punished, instead of the bastard who sloped off somewhere.

It’s the story of my life. Who are we and who is unhappy? When I’ve finished all these ideological ramblings, simply a major distraction, there’s still lunch to get. The damned microwave is infuriating. None of the buttons work. Why do machines always make me feel stupid? He’s hungry and so am I. Spin-dryer mind whirls round and round again. Anger; healthy eating or rather not eating; accumulating lots of brownie points; unhappiness; should be somewhere else; deep disappointment about not being a good enough person; should feel warm compassion for Kevin but don’t at present; return reluctantly to the discipline of mindful practice; come back to the kitchen and attend to the lunch. This time the veggie dish meets the Kevin test, but only just.

‘Can I have some more coffee?’

I make the coffee ungraciously, and then there’s all the washing up.

I sat down and took a deep breath, ‘Kevin, I’m sorry about lunch, and for not listening earlier. I share some of your frustration and disappointment’

Kevin reached across the table and felt for my hand. He rested his on top of mine.

‘It’s OK, thank you for lunch. I know you’re not a vegetarian’

We both laughed.

Kevin took a deep breath ‘I miss my mum you know,’ and began to sob.

Kevin had lost his mother 12 years ago to breast cancer. We talked about his happy memories of the time they had together. We talked too of the last few days in the hospice where she was made comfortable before dying. There we were at the table, two men in their forties, holding hands and both of us filled with tears.

The book Wounded Healers (Rippere and Williams, 1985) contains accounts by professionals who have suffered from depression, including psychiatrists, nurses and social workers. After their breakdowns they encountered three kinds of reaction from colleagues: active support, accepting them, assuring them that their job was safe: ‘You’re O.K. We still want to know you’; apparent indifference — not noticing their distress or depression, making no comment: overt hostility — employers trying to get rid of them and hostile receptions from colleagues.

In recovery, most felt their skills and empathy had been improved by the experience. A ‘fallen’ social worker wrote:

‘Looking back on my period of depression, I feel it was a turning point in my life. It threw me back on my own resources, and although this was enormously painful at the time, it was the beginning of a long process during which I began to discover what I wanted for myself as an individual rather than as a wife’

That is in stark contrast with this vision of practice in a best-selling social work textbook:

For most people, most of the time, the human way of life ensures self-maintenance; but for a minority, either because of defects of birth, deprivation during childhood, the onset of sickness and old age, they experience of an accident, the shock of bereavement or job loss, or the ill-effects of political , economic or social planning or discrimination, self-sufficiency runs out, and the need for a maintenance mechanic becomes apparent. This need pinpoints the heart of the social worker’s role. (Davies, 1985)

The essential tools are spanners and a handbook — not much space for the healing potential of wounds! All of us are damaged and wounded. The challenge is to use these wounds in the compassionate service of others. Our so—called defects are an important way to serve others. There is an old story of a middle—aged Japanese woman, as sharp as a lemon. She had brought up her only son after her husband died suddenly of a heart attack. She had become embittered; felt that life had dealt unfairly with her. She worked hard, cleaning and washing for a living for little reward.

When the son was nearly 18, the headmaster called to see her. He was highly respected as a teacher but nationally known as a calligrapher.

‘Your son is very talented. He should go to university and enter a profession. I know you have little money but, with your permission, I could write a letter of introduction to the Dean of the faculty at Kyoto University, whom I know from university days. He might decide to take him and find a bursary.’

The mother accepted and watched the headmaster take out a piece of paper and write the letter with a blunt pencil borrowed from her. She was puzzled that he didn’t use his brushes and pens and inks. A few weeks later she travelled with her son to the university.

After handing in the letter to the Dean’s secretary, they waited in the corridor. The Dean came to collect them and was very friendly. He explained that his respect for his old colleague — the headmaster, was so great that he was willing to take the son.

‘Over the next few days, I will try to find a bursary and a place for your son to live. I have just one request. Is it possible that I can have this letter because it’s a work of art and I should like to frame it?’

She explained that the letter belonged to him and then travelled back home alone. Over the next few days she was both sad and joyful. She reflected on the blunt pencil. It made no real sense when he had such excellent pens and brushes. Then she awakened. She was herself a blunt pencil self-pitying, nothing special, but in the hands of a master, giving herself over to the Buddha she could be a vehicle for the creation of a work of art.

Most of us are blunt pencils, some like me perhaps much too blunt for this increasingly sophisticated world. In the right hands, gradually giving up our demands and bitterness, we can be used to create masterpieces, worthy of framing.

Wordsworth’s writing often echoed a wholesome wonder, a respect and worship, detecting an underlying presence:

And I have felt
A presence that disturbs me with the joy
Of elevated thoughts; a sense sublime
Of something far more deeply interfused,
Whose dwelling is the light of setting suns,
And the round ocean and the living rain
And the blue sky, and in the mind of man:
A motion and a spirit that impels
All thinking things, all objects of all thought,
And rolls through all things.

(Wordsworth, Lines written on Yintern Abbey, 1798).

We can gradually lose contact with that, become alienated even from ourselves, seduced into an excessively technological universe with plastic toys and mobile phones. None of that is ‘wrong’ unless we lose a sense of proportion and see it as important.

Wilber (1979, preface) comments:

we create a persistent alienation from ourselves, from others, and from the world by fracturing our present experience into different parts, separated by boundaries. We artificially split our awareness into compartments such as subject vs. object, life vs. death, inside vs. outside, reason vs. instinct, a divorce settlement that sets experience cutting into experience and delighting with life. The result of such violence, although known by many other names, is simply unhappiness. Life becomes suffering, full of battles.

This is a struggle with perceived splits, looking through a glass very darkly. The desire to control is the opposite of a genuine spiritual pathway. Any perception of the world as a series of technical difficulties risks losing the real sense of wonder and marvelling that Wordsworth communicates so well. We are already deep into this sort of society, relying on various forms of social engineering, failing to understand the essentially organic and intimately connected nature of our world.

Everything we do can become calculated, no longer trusting our true nature. It is necessary to reflect before we even walk or crawl.

Merton (1965, p.23) comments on the essential dangers of the excesses of introspection:

The more ‘the good ’ is objectively analyzed, the more it is treated as something to be attained by special virtuous techniques, the less real it becomes. As it becomes less real, it recedes further into the distance of abstraction, futility and unattainability. The more, therefore, one concentrates on the means to be used to attain it. And as the end becomes more remote and more difficult, the means become more elaborate and complex, until finally, the mere study of the means becomes so demanding that all one s effort must be concentrated on this, and the end is forgotten.

I increasingly noticed that our university postgraduate students did work that was more and more distant from the frontlines in nursing and social work. Twenty five years ago we researched issues that had some direct relevance to services; nowadays they produce acres of literature courtesy of the internet and tons of stuff about research methods, but precious little that might improve the services next week or even next year. Reflection can become obsessive.

In mental health, we have already built a high brick wall to protect against a necessary madness, a chaotic and potentially creative disorder. Occidental ideologies are kept distant from Western ideas and practice. Japanese approaches to personal growth, such as Morita and Naikan therapy, remain virtually unknown, in contrast to the great import of the martial arts such as judo and karate. (Reynolds, 1980).

These particular therapeutic systems pose difficulties for the West because they are based on ‘being’ rather than on `having’, on quietness and even silence rather than talking. Mental illness has become a sickness to be managed and sometimes ‘cured’. In contrast, Jamison sees her own manic depression in more complex ways, comprising both yin and yang.

The ominous, dark, and deathful quality I felt as a young child watching the high clear skies fill with smoke and flames, is always there, somehow laced into the beauty and vitality of life. That darkness is an integral part of who I am, and it takes no effort of imagination on my part to remember the months of relentless blackness and exhaustion, or the terrible efforts it took in order to teach, read, write, see patients, and keep relationships alive. (Jamison, 1995b, p. 210).

Transcendent experiences are more usually psychiatrised nowadays. Seeing visions and hearing voices are categorised as psychotic in DSM IV. Hallucinations result in yet more pills. Socrates commented rather more wisely out of his own experience of hearing demons’ voices: ‘our greatest blessings come to us by way of madness, provided the madness is given us by divine gift’ (quoted in Walsh, 199o, p. 9o).

Thankfully, we have the beginnings of a more gracious and delicate psychiatric understanding. Whilst mainstream psychiatry still favours drugs to treat ‘voices’ some dissidents see that as dangerous. Taylor, a Bradford psychiatrist, comments:

‘I don’t think voices are necessarily signs of mental illness. For some people, the experience is brought about by intense distress, and that tends to get them into contact with mental health services} (Moore, 2000, p. 46).

We have a slow move towards some levels of healthy diversity and humility. The shamans have an extremely long tradition. They were the healers in the ancient tribes, still relevant in some parts of the so called undeveloped world.

He or she is in touch with both the extreme pain and the joys of living, described by Jamison above. This sort of journey is fraught with dangers and through it the wounded healer develops a particular relationship with the essential nature of sorrow and suffering. Through his or her gifts, knowledge of alternative ways of living, the overall possibilities of the whole community for survival can be increased.

Kalweit (1992, p. 248) looks at the basis of shamanic healing:

So what is healing, where does it begin, where does it end? Are we really only trying to get rid of physical ailments and to balance psychological deficiencies? Or are we looking for more? Is it really the case that all that needs to be healed is what is labeled illness in the hospital and the psychiatrists office? Certainly the first stage of healing is the healing of body and mind. But the second stage is healing the ‘ego condition. ’

Here we open ourselves to a level where healing is an expansion of perception and of communication.

Many years ago I interviewed a nursing student who wanted a placement with me. She was struggling with her social work / nursing combined course and life as a single parent. Her marriage had just ended in divorce. Towards the end of our encounter she broke down in tears.

She sobbed: ‘I suppose you won’t take me now, I’ve broken down.’ I responded, recalling my own experience at Cambridge, ‘We will take you because you are crying.’

It was sad that she was learning to think that strength meant becoming like a rock rather than a reed. I explained that her suffering could become the start of an important journey.

There was a Zen master who returned home after a long journey to find the funeral taking place of a favourite daughter of friends and neighbours. A man found him in a corner weeping. ‘How can you help your friends in their hour of need, if you’re overwhelmed by tears?’ The master responded: ‘On the contrary, I can help best through my tears.’ Of course he could. His contribution was to feel the full sorrow and tragedy of the event rather than to sit meditating in some corner.

The Zen teacher, Bernard Glassman (1998, p.34) writes of religious retreats in Auschwitz, the former concentration camp:

There are many ways to express a broken heart: tears, laughter, silence, dance, and even German lullabies. You don’t find wholeness till you’re ready to be broken. Evening after evening we found new ways to express our brokenness. Each time we did this, a healing arose. And in the mornings we always went back to Birkenau. It was an endless continuous practice.

Ordinarily our wounds are hidden, protected from others. In this dreadful place it was impossible. Faced with this horror, people’s wounds were opened wide and healing began.

The Norwegian painter Munch wrote of the ways in which creativity exists alongside profound anxieties:

My whole life has been spent walking by the side of a bottomless chasm, jumping from stone to stone. Sometimes I try to leave my narrow path and join the swirling mainstream of life, but I always find myself drawn inexorably back towards the chasms edge, and there I shall walk until the day finally fall into the abyss. For as long as I can remember I have suffered from a deep feeling of anxiety which I have tried to express in my art. Without anxiety and illness I should have been like a ship without a rudder.

The artist lives with an acute sense of impermanence; his painting, writing, music constantly reflecting an acute sense of the ephemeral — the light is fading, the sounds dying away. Munch lived on the edge of a despairing chasm, threatening to pull him in — never to return.

Grof linked some transpersonal crises with these shamanic traditions:

In the experiences of individuals whose transpersonal crises have strong shamanic features, there is a great emphasis on physical suffering and encounter with death followed by rebirth and elements of ascent or magical flight. They also typically sense a special connection with the elements of nature and experience communication with animals or animal spirits. It is also not unusual to feel an upsurge of extraordinary powers and impulses to heal (Grof and Grof, 1986, p. 7—20).

Traditionally the roles of client and professional existed in one person. Injury and vulnerability might also be deliberate.

‘Genuine healers can injure themselves without a second thought; if they are holy, then their wounds heal by themselves. In this way they test their capabilities and provide proof of their healing ability’ (Kalweit, 1992, p. 36)

This seems a bit ostentatious to me and a very long way from practical Zen. My own practice is based on my personal experience of being battered as a child. This forged a strong desire to work with the socially excluded and marginalised. Nursing has been a quest for meaning through clumsy attempts to serve others. I’ve always felt that wounds become our source of compassion.

‘Our suffering is a sacrifice, but often what we suffer from can be a gift of strength, like the shaman’s wound becomes the source of his or her compassion.’ (Halifax, 1994,p. 15).

This is the core of Glassman’s broken heart – a form of awakening:

At some stage the hero’s conventional slumber is challenged by a crisis of life—shattering proportions, an existential confrontation that calls all previously held beliefs into question. It may he personal sickness, as with the shaman; it may be confrontation with sickness in others, as with the Buddha. It may be a sudden confrontation with death.

My past experience of violence still affects me, but sometimes enables me to have more direct communication with those who are battered, and abused. I understand when the abused tell me they freeze when recalling the experience. In my case I disconnected psychologically away from the abuser’s hand and entered a dream state. Sometimes walking in an imagined field, where nothing could hurt me. We know the mind as a self-protective mechanism when under some form of assault.

But eventually the abuse catched up with you. My initial breakdown occurred at the point of my first episode of depression. I know now I was reaping the whirlwind of past violence. There other factors involved to, like brain enzymes not processing properly; perhaps genetics, I rule out none but added another — a spiritual crisis.

What does that really mean’? My ordinary ways of living in the world, frameworks of meaning, weren’t working. I was pitch forked into despair. During this crisis I felt completely separated from the universe and other human beings; precariously perched on the edge of the unknown world. In the depth of depression i felt overwhelmed, alone and misunderstood, mixed in with strong suicidal feelings.

My everyday life was totally wrecked. Everything was worthless, disintegrated into dust. It had been a substantial illusion but nothing more. There was nothing to hold on to, everything shifting in all directions. Those dark uncertainties were filled with great anxiety and gloom. I lived on the edge of nothingness for several months at a time, sometimes even years.

Monthly I travelled by train to visit my Zen teacher at Throssel Hall, where I described living on the edge of oblivion. She congratulated me vigorously. ‘Wonderful Lee. It’s going really well.’ Whatever was going really well wasn’t me.

I couldn’t concentrate on what was happening around me. My scattered energy was fixed on so many negative things from the past and anxiety about the future. I wasn’t engaged with others usually close to me . They seemed distant. I didn’t feel their love. I was frozen, nobody could possibly understand what I was going through.

At infrequent times I emerged into the bright light once more. I blinked to see the immense wonders all around and the shadows melted away. Sometimes, coming from the shadows, I felt light and joyful, like brightly coloured balloons floating upwards. The suffering self was lost for a few hours or days and the way clearly marked, and then the darkness returned.

I am still engaged in that daily struggle that brings so much beauty and sorrow. Most days and weeks I still feel much that way. The only difference now-a-days is I use my direct experience – it has become a form of Shamanic training.

Shamanism is the exploration of personal vulnerability, a continuous contact with the damaged side — wounds stemming from isolation, lack of love and developing ways of using these to reach out lovingly to others. Professional training usually strives to conceal such wounds. Nursing text books mostly discourage self-revelation whilst, in contrast, Shamans use ‘wounds’ overtly as a primary source of healing. This vulnerability involves ‘the dissolution of the boundary between self and the world’ (Kalweit, 1992, p. 71).

Shamanism returns to being human rather than acquiring masses of techniques that offer radical improvements. Shamanic practice turns its back on Homer’s Calypso and the struggle to be superman or woman. Instead it undertakes a paradoxical journey, arriving back at the same place. On the day of my leaving the monastery I asked my teacher ‘What does it mean to be a monk?’ He answered ‘Tomorrow morning, a Zen monk will wake up in your bed and go and get some breakfast. I could have killed him and it took me years to appreciate his response.

The shaman’s art is based on the nature of interconnectedness.

In old Earth cultures, the shaman is the servant of the people, the gods and ancestors, the creatures, plants, and elements. When the world is out of balance, the shaman redresses this disequilibrium. In these cultures, like in Aboriginal culture, illness is understood as a loss of the sense of connectedness, of relatedness,  of continuity — the experience of a kind of existential alienation.

This sort of approach calls for a different posture — knowing nothing. How might an empty mind be used in nursing practice? I can only speak from my own experience. For some time I have been I part of a team offering to meet with people characterized as having severe and enduring mental health problems who are also usually veterans of psychiatric services.

Rather than ‘therapying’, we try to offer speculative comments to the people, which they may, or may not, find interesting. Early in my new experience, I found myself striving to divest myself of the belief that the theories that had been part of my professional socialization were more real, helpful, truthful than other; more vicariously adopted ideas. By doing so, I found that I could be more creative, playful, and interesting for the people who I were listening. (Stevenson, 1996).

Shamanic training would involve interrelated elements:

• Wounds: the shaman explores and uncovers his or her various wounds and stigma. For me, it was a long experience of violence, humiliation and anger. How can we use these experiences so that suffering can be forged on an anvil for healing? Newly forged it becomes the core of the healing.

• Empathy: the connections between us, the ability to put oneself in the shoes of the distressed other.

Can I see another is woe
And not be in sorrow too?
Can I see another s grief
And not seek for kind relief?
(Blake, 1794)

• Loving-kindness: to be a vehicle of affection for the world and the people in it; to make manifest the linking of all things. Schweitzer commented; ‘the only ones among you who will be truly happy are those who have sought and found how to serve.’ (quoted in Walsh,1990, p. 211).

• Rituals: the silence and preparation in the car before entering the house or centre to start interviewing. It involves an obligatory conversation about the perfidious English weather; drinking any tea on offer. Leaving the various bureaucratic forms for the end so that they can be completed together, a practical act of unity; summarising what has been agreed and saying goodbye. These rituals are important for healing as well as for mind focusing. These rituals are jointly accomplished. It is vital for the client to be centrally involved.

• Mindfulness: quietening the mind; daily discipline turning interviews into a meditative experience; concentrate on keeping in the now; keeping the mind single pointed. This sort of learning means giving up what we thought we knew already. It means disposing of our excess baggage.

• Mutual transformation: this process of disciplined helping trans forms both sides, becoming one. We are not helping so much as both being helped. Both shaman and client are students learning to uncover the mysterious elements.

‘All psychotherapeutic methods are elaborations and variations of age—old procedures of psycho logical healing} (quoted in Walsh, 1990, p. 184)

One study shows that some mental health service users increasingly prefer the perceived holism of complementary therapies to drug treatment. One user comments: ‘I have developed a style which combines a spiritual grounding with a variety of therapies, such as the use of art, music, verse and knowledge of stress management to help gain control over my emotions’ (MHP, 1997).

Imagine what great healing could be brought by genuine collaboration between nurses, doctors, social workers and other professionals, combined with the experience and vision of users.
Otherwise we seek answers to the problems of ordinary living that arise out of a profound dissatisfaction with the aridity of much contemporary psychiatry and other professional disciplines.

But as a wise once said to me: ‘just because we don’t fancy the shadows in Plato’s draughty cave, doesn’t mean we have to rent rooms in Disneyworld’. I think he meant we must take great care not take flight from reason as well as a genuine quest for nonexistent certainties.

At the basis of all our healing is increasing self-awareness and compassion to others. This asks us to be gentle with ourselves and others and to surrender our different images of perfection as deluded measures of the world, and to see it with honesty and love.

And not knowing is important too. The direct opposite of not knowing is pretending or even deluding yourself that you have knowledge. An American professor was anxious to learn more of Zen on a visit to Tokyo. Through the consulate it was arranged for him to visit a Zen master. Very carefully the master made tea whilst the professor chattered on about his readings of Zen. He talked of the books he’d reviewed, the seminar he`d attended, the important people he’d met. He continued his discourse until the tea was made and the master poured it into the cup held by the professor. The tea overflowed from the cup into the saucer but still the professor talked on.

It was only when the tea poured from the saucer and onto the floor that he stopped and exclaimed: ‘My cup is full’. The Zen master said softly: ‘So I see.’

Montaigne (1958 , p.25 5) had in mind people like this particular professor: ‘The learned generally trip over this stone. They are always parading their pedantry, and quoting their books right and left’.

But these drives have all sorts of origins. Some of us are driven by self-importance; others like this Japanese farmer, by a desire for increased material comfort and concern for the family. Many years ago a hard—pressed farmer in northern Japan sought help from an old Buddhist abbot who he respected a great deal. ‘I desperately need money. My daughter must get married soon and acquires a dowry. My son needs more land and a house of his own. I need to clear my debts, so my wife and I can rest easy in our old age. Do you know any sure way of making gold‘?’

The said the abbot, ‘What a relief, I thought you were going to ask something difficult. That’s simple. Follow my instructions carefully and you will make lots of gold, quite sufficient for all your needs. First get a large cauldron full of water and bring it to the boil on a roaring fire. Then put into the water two large smooth stones, preferably from the beach. Add a pinch of salt and pepper and the leaves of these herbs. Simmer for precisely two hours and the stones will have turned into pure gold nuggets?

The farmer was extremely pleased. He listened intently and rushed off to try out the recipe after profuse thanks and many bows. The abbot shouted after him:

‘Just one last thing. During the whole process you must not think of a green crocodile or else the whole process will fail.’

‘I understand’ he called back breathlessly.

Next week the abbot observed a head—bowed and defeated man. ‘What happened‘?’ he asked. ‘Well’, he explained, ‘I got everything perfect the cauldron, the boiling water, the pebbles, the salt and pepper and the herbs and the whole mixture is bubbling nicely when the image of a green crocodile enters my mind. The pebbles simple remain pebbles. The harder I try, the more the green crocodiles come into my head. I can’t eat or sleep. I wish l was dead.’

As usual and most annoyingly, the Zen story ends just as it gets interesting. Perhaps the farmer eventually realises that the abbot had given him something much more precious. He had skillfully cut at the scales over the gold seeker’s eyes. Perhaps the farmer now understands that he’s a shaman. Hopefully the ‘failure’ of the gold experiments is the beginning of liberation.

After a quarter of a century in paid and unpaid helping, one thing is clear: I can live with doubt and uncertainty and not knowing. I think it is much more interesting to live not knowing than to have answers which might be wrong. I have approximate answers and I possible beliefs and different degrees of certainty about different things, but I ’m not absolutely sure of anything and there are things don’t know anything about, such as whether it means anything to ask why we’re here… I don’t have to know the answer. I do feel frightened sometimes by not knowing things, by being lost in a mysterious universe without any purpose, which is the way it really is as far as I can tell. So in this respect it frightens me as much as it inspires. Now that is a million light years away from ignorance and much closer to humility.

Sometimes though, we cannot live with the ‘not knowing’, and that’s OK too. My friend Dave eventually plucked up the courage to call Debbie, and told her about his irrepressible concern for her wellbeing. Though he was still unsure and consumed with self-doubt, he didn’t hold back because a greater force was at work. When Debbie answered she was simply thrilled to hear from him, she had hoped he’d call. The conversation was to be a life changing event for both of them. Dave supported Debbie through the treatment of Leukemia and they are now engaged to each other. Vulnerability was transformed into a strength.

References supplied on request.

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