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Articles    H3'ed 3/13/11

Eqalitarian Healing: or What can we Learn from Vygotsky

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Today I want to discuss Vygotsky's Social Development Theory, which is an important precursor of what we are presenting about the social brain.   Russian psychologist Lev Vygotsky (1896-1934) believed that social interaction precedes and sets the stages for development.   Consciousness and cognition are the end products of socialization and social behavior. Vygotsky lived during the Russian Revolution. His work was largely unknown to the West until it was published in 1962.

Vygotskyan ideas are useful to explain a concept my colleagues and I are developing for egalitarian healing.  We are working to undermine the expert professional/defective client model and to put those who help people and those who are helped on a more equal footing.  Vygotskyan theory helps us understand how to do this.  Vygotsky describes a More Knowledgeable Other concept in which this Other can teach learner missing skills.

Jean Piaget currently still holds the mainstream academic position as the number one developmental theorist in the United States.   He believed that development necessarily preceded learning. Vygotsky believed the opposite -- that social learning precedes development. He stated: "Every function in the child's cultural development appears twice: first, on the social level, and later, on the individual level; first, between people (interpsychological) and then inside the child (intrapsychological)." (Vygotsky, 1978).   University College (London) anthropologist and neuroscientist Charles Whitehead affirms these ideas from neuroimaging studies, in which he has been accumulating evidence for how one's social environment and social interactions shapes the brain, rather than the brain shaping the social environment.   Lakota elders taught me that development and thought happen because we have relationships.   First come human relationships and then comes development, similar to what Vygotsky thought.   I suspect this perspective generalizes across indigenous cultures.   It points to the growing gap between our developing understanding of the brain as a social neuron in a communal brain and the conventional view of individuality and brains separated from other brains, more as if they were contained in a vat in a lab, than connected to others.   We are more interconnected than we are separated.

Vygotsky also had a concept of the "More Knowledgeable Other" or MKO, referring to anyone who has a better understanding or a higher ability level than the learner, with respect to a particular task, process, or concept. Anyone can be an MKO.   Furthermore, his "Zone of Proximal Development" or ZPD is the distance between a student's ability to perform a task under adult guidance and/or with peer collaboration and the student's ability solving the problem independently. Learning occurs within this zone with an MKO.   These concepts can help change our notion of psychotherapy as the interaction of an MKO with a Learner within a ZPD.   Conventional psychotherapy posits the therapist as being further developed or more mature than the client.   Applying Vygotsky's ideas would point to the therapist as simply having some skills that the client doesn't have.   This concept renders people as more egalitarian.   The difference between client and therapist is one of the therapist's having a particular skill set that the client can learn.   When the client learns this skill or skills, the need for therapy ends.

Therapy, and healing in general, become a social interaction process which precedes learning new stories or skill sets (skill sets include stories and represent an ease in applying new stories).   Psychologists then have to learn specific skills to teach others.   One of these skills can be the deep listening -" what French psychoanalyst Jacques Lacan called listening without judgment or interpretation, what the aboriginal people of Australia say that is often translated as "deep listening", what Jon Kabat-Zinn calls mindful listening.   Or we can have skills like those cultivated in cognitive behavior therapy, in narrative interviewing (asking questions designed to help people become aware of the stories about the life experiences that have led them to believe the way s in which they do), hypnosis, guided imagery, and more.   We can have skills in negotiating interpersonal relationships, managing voices, slowing down racing thoughts.   When our skill sets match the needs of the client, then we become the MKO and can enter into the ZPD together with the client.   When we don't have the skills the client needs, nothing happens.

Vygotsky believed that people communicate in order to mediate their social environments. Initially children develop communication skills solely to serve social functions, including ways to better communicate their needs and get those needs met. Vygotsky believed that the internalization of communication skills led to higher thinking skills. That means we learn to think by speaking to each other.   As we become better at speaking to each other, we start to have these communications silently without needing to move our lips.   This happens around age 4.   Once we can speak silently, we can have internal conversations with imagined others entirely within the confines of our brains.   This becomes thinking -" conversations with imagined others.   They can move toward more and more abstract levels as we practice and practice these internal conversations.   I think voices are just that -" internalized earlier conversations with others or from others.   Racing thoughts are these conversations that we cannot stop, as are ruminations.

Vygotsky's ideas mean that therapists (or teachers) do not function best by transmitting information to clients (or students).   Rather, Vygotsky's ideas would cause us to expand therapy into social learning contexts in which clients play an active role in learning. Certain kinds of group therapies fulfill these requirements, including action based therapies such as the dramatic therapies.   We have been playing with these ideas through Coyote Institute with what we call "Healing Camp", for lack of a better term.   In healing camp, people who want to learn about healing come together with people who want to experience healing, and we do it all together, all at once.   We learn that the roles of MKO shift frequently, as various collaborations arise for helping each other.   We have learned that everyone has some awareness of how to be healing for each other and everyone has a skill to share that someone else lacks relatively speaking.   This returns us to equal standing with each other.   We are looking for ways to take away the power differential in healing.   (Healing camp is by donation and either everyone is a client or no one is a client).   We have moved beyond diagnosing and treating to just being helpful to each other.   Healing, then, becomes a reciprocal experience for everyone.

How far can we take this?   We are also exploring with healing circles in which anyone calls those they know who want to come together for the purpose of being healing for each other.   These groups meet on a regular basis without any cost and people find ways to be helpful for each other.   I write more about these circle in Healing the Mind through the Power of Story: the Promise of Narrative Psychiatry, my newest book.  

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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