Today is Day 10 of the Australian Cross-Cultural Mental Health Journey. Today we talked about trauma in aboriginal communities and how to address that trauma. We collaboratively arrived at some ideas to propose. We agreed that narrativizing is necessary. We need to hear the stories of woundedness that people have to tell and to celebrate their resistance to abuse and to focus more on the resistance than on being a victim.

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Today we are back in Canterbury, an Eastern suburb of Melbourne, at the headquarters of Life Is " Foundation to present a workshop to mental health professionals on approaches to dealing with trauma in indigenous communities.  With our aboriginal colleagues, we had already come to the conclusion that a narrative approach is closest to aboriginal thought and that narrativization is necessary.  Historical and intergenerational trauma is a huge issue in aboriginal communities in Australia, New Zealand, the United States, and Canada.  Wherever we go, there have been residential schools, forced relocations, removal of children from families, and implementation of a reserve system that denies rights to First Nations peoples, making them less than human.

We began with the idea that "trauma" is not a good noun.  I shared the teachings of a favorite Lakota elder, that good nouns can be eaten, can eat you, or, at least, you can touch them.  You can't eat trauma, and it can't eat you.  You can't touch trauma.  Therefore, it's not a good noun.  I shared how everyone has a different idea about what is traumatic.  In neuroscience, we talk about indexing, that our concepts are indexed in associational networks.  When a word is heard, all the potential networks are activated by particular areas in the frontal cortex (Brodmann's areas 8, 9, 43-46) and then areas in the orbitofrontal cortex (Brodmann's areas 11, 12, and 25) help us to eliminate potential choices that are way off the mark.  Thus, what I experience to be traumatic is not necessarily the same as what you experience to be traumatic.  What we are really considering, I said, is what has wounded you.  What wounds do you carry?  What wounds do your communities carry?  The question we want to ask is how you have healed, fully or partially these wounds?  In order to understand your wounds, I need to hear your stories about the things that have wounded you and how you have responded.  This is why we need to hear each other's' stories.  When we hear each other's stories, we can learn new ways of responding.

We talked about the nominalization of trauma as creating an industry to manage trauma -- therapists, drugs (mostly selective serotonin reuptake inhibitors like Prozac), and treatment centers.  I mentioned Ethan Watters' 2010 book, Crazy Like Us.   In Chapter 2, Watters wrote about how "PTSD came to Sri Lanka".  He told how the President of the U.S. PTSD Post-traumatic stress association) happened to be vacationing in Sri Lanka when the tsunami hit.  She quickly anticipated hundreds or thousands of cases of PTSD and mobilized U.S. therapists to come to Sri Lanka to treat the incipient PTSD.  However, Sri Lanka didn't actually have anything like PTSD yet.  Some of the explanation came from their intact villages and families and their spirituality which gave them a way of conceptualizing "bad" events in more positive terms than Americans.  They had support systems in which they could tell their story.  They didn't feel the need to talk to strangers when friends and family sufficed.  Nevertheless, huge amounts of money were wasted on bringing PTSD therapy to Sri Lanka.  For more details, see the Watters book.  Generally, I suggested, people need each other and need ways of telling their stories and of feeling heard more than they need counseling professionals.  The agreement with this was unanimous.

Then I talked about my view that what is called trauma is the results of have experiences that are so disruptive or huge that no story can contain them yet.  We all need to incorporate the events that happen in our lives into our master narrative that tells us who we are.  When the events are too disruptive, or impossible to explain, or too difficult to be assigned meaning, we flounder.  We need to answer the question, "Why did this happen to me?"  We need to be able to tell a story to give meaning to what happened.  This is especially true with large scale trauma like residential schools in which meaning is evanescent.  How do I grapple with children being removed for the purpose of destroying my culture?  What helps there is to focus on stories of resistance, on the stories of people who hid their children, the children who ran away, on the children who found ways to fight even inside the residential school.  This brings heroism and meaning into the story.
Trauma, then, is largely an unstoried experience, waiting to become storied.  How do we story that experience.  In their book Furthering Talk , Tom Strong and David Pare write about conversation as a way of working out meanings together as we go.  Nick Todd and Alan Wade (in Chapter 9 of that same book), write about the importance of switching the stories that are told by people who have been abused from stories that conceptualize their actions as "evidence of victimhood" to stories that ponder their active and courageous resistance to that abuse.  Indigenous people have been saturated with the dominant language and discourse to describe their abuse.  Monk and Sinclair write about the need to help people to reflect upon the negative fallout that comes from the use of dominant culture language by marginalized people for representing their experiences.  They invite people to find new ways of speaking about their lives that do not utilize the words and templates of the dominant culture who perpetrated the abuse in the first place. 

We agreed that most of what passes as therapy in the indigenous world is monologic rather than dialogic.  The talk flows downward from professionals to clients in a demeaning way.  Strong and Pare wrote that therapeutic conversations become institutionalized when we fit clients' meanings into our (not their) interpretive framework.  Improvised dialogues based upon collaborations particular to the emergent preferences and resourcefulness of clients and therapists sound dangerous by contrast.  Like any dialogue they might take clients and therapists to unexpected places. 

Tom Strong talks about the tradition in therapy to go after what Lynn Hoffman called the "thing in the bushes", which is what we see as the culprit causing problems or constraining our solutions.  They say that therapists "colonize clients with their passion", hijacking conversation for particular ideological purposes.  Therapists become disrespectful when they see clients as dupes needing their guidance.  We need to focus on a language of response rather than a language of effects. 

We proceeded in the workshop to do a series of exercises to bring these concepts home.  The first exercise involved people dividing into groups of three -- a teller, a listener, and an observer/reflector.  The task was to tell the listener a story of a time of wounding and how the teller had managed that wounding.  The listener was to absorb the story without associating to too many stories of his or her own.  When the teller was done, he or she was to ask questions to clarify any symbols or metaphors used that were not clear and also to ask questions about any holes in the story.  Then the listener was to tell back the story in a way that turns the teller into a hero instead of a wounded person.  This exercise was very successful and people were able to hear stories of themselves as heroic, despite how uncomfortable it made them (It does make us uncomfortable to hear others talking about us as heroic!).
 
From there I did a guided imagery exercise in finding a wound who wanted to speak and letting that wound speak.  Stories emerged that continued into lunch.  After lunch we did an art exercise with charcoal of drawing the face of a character in our heads which was related to our wounds who wanted to speak with us.  Then I modeled a narrative interview of this character with the person holding the picture in front of her face.  I asked the character for her name, which was Harriet.  She had been with the person present in the workshop (Marion) forever, through many reincarnations.  Unfortunately, Marion rarely listened to her and found herself floundering and lost.  Harriet kicked her behind the knees when this happened to get her attention.  We talked about how Marion could become more aware of Harriett and take her advice more often so as to feel less isolated, alone, and lost.  Harriett told a story about Marion's taking excellent care of her two dogs, which made Harriett very proud.  I suggested that Marion would have more trouble ignoring Harriett's help now that she had drawn Harriett because she could hang Harriett's picture on her wall.

Then the group broke up into small groups so that people could interview each other's drawings to find out who they were, what they called themselves, where they came from, how they helped their host, and what story they wanted to tell.  This also worked well.  We discussed the exercise and finished with a pipe ceremony in which everyone had a chance to pray.

This workshop represented a small step toward exploring how to deal with trauma in aboriginal communities.  The lessons appeared to be:
1) Forget the labels and concentrate on the stories of woundedness and the struggles that happened in resisting the trauma.

2) Search for the heroism in the stories of woundedness and augment that heroism, drawing it out.

3) Focus on the stories of past and present resistance to trauma and abuse.

4) Create opportunities for people to fully tell their stories through the spoken word, through the written word, through art, through poetry, through song, through drama -- whatever means people are drawn to use.

5) Continue the dialogue in which new avenues for strengthening and resisting abuse emerge.

6) Keep people connected in dialogical communities as these processes unfold.

7) Get help from the spiritual dimension, from the voices inside our heads who inform us, and from all the parts of us.

8) Pray.

That's all I have to say for today except that I think we will be having fish and chips for dinner from the wonderful chippery just down the block.

Authors Website: www.mehl-madrona.com

Authors Bio:
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 Narrative Medicine.