November 2, 2014
Defining Coyote Psychotherapy
By Lewis Mehl-Madrona
In the recent meetings of the Institute for Psychiatric Services in San Francisco, Barbara Mainguy and I presented material on how we work with psychosis. We are exploring what it is that we do, and we know that it is inspired by indigenous elders, that it is centered on the body, which registers our traumas and stresses, that we are wedded to the idea of story occurring in a social context so that we are embedded with others.
We are just completing three presentations at the Institute for Psychiatric Services, which is the community and public psychiatry meeting of the American Psychiatric Association. We had the opportunity to present our approach to the psychotherapy of psychosis, and had realization that we could own the name, Coyote Psychotherapy, which is, as we playfully told people, indigenous inspired, body-oriented, narrative and social psychotherapy, and still a little more, because Coyote can never be completely contained.
In relation to my indigenous origins and to our active practice of Native American spirituality, whatever we do is indigenous inspired. The concepts are powerful and important. All healing is spiritual. To thrive we need the help of the spirits. Community is everything. Healing is energetic. Faith and the power of belief matter enormously. Relationship is everything. These are the core concepts of our work. Beyond this, traditional elders have inspired everything we do. I think of Vern Harper, an elder we love in Toronto. Vern is well past 80 years old. Every week he ventures into the worse part of Toronto to sit and listen to the homeless, the alcoholics, the drug addicts, to anyone who wants to talk. Vern has a profound respect for the humanity and the value of all these people. He doesn't need them to change for him to love them. He just does. Vern is our hero. We strive to achieve the radical acceptance that Vern demonstrates.
Immediately that calls into mind John Charles. While I lived in Saskatchewan, John Charles was my hero. I've written about John before. For years he was an Anglican priest. Then, he was discovered to have brain cancer, so severe that the conventional doctors gave him 30 days to live (how they figure these things out is beyond me). John realized that Christian spirituality was not going to heal him. He went to see a woman who practiced the traditional Cree medicine and did everything she said. Within the 30 days in which he was supposed to do, he recovered and the tumors disappeared. That put John into a quandary of faith. He had been Anglican for most of his life, but he was Cree, and the Cree spirituality had healed him. One night he had a vision. He saw four elders smoking pipes around Christ on the Cross in each of the four directions. He was told distinctly that it was all one. He could be traditional and Christian all at the same time.
I spent many a Sunday at John's house on Sturgeon Lake Reserve, being doctored, taking people to being doctored, sitting in ceremony with him, and feasting of fresh caught sturgeon. I also inspire to be as loving and as accepting as John. When someone missed ceremony because they had been drunk the night before, John sent his helpers to go get them. That's when they really need to be in ceremony, John said. All were welcome at John's. For John and Vern, and all the other elders I have known, nothing could shock them. Whatever people had done, they were welcome. So we aspire to put these principles into practice in our work with people who suffer emotionally.
Psychotherapy has always been a problematic word for me. What indigenous elders do is healing. I'd like to use the term healing, but it has such a New Age connotation, that it alienates many people. In this strategic move to be somewhat mainstream, the term is psychotherapy for the work we do with people with psychosis, bipolar disorder, anxiety, depression, and the like. Yet, what we do is not just mental. We involve the body -- sometimes directly through touch therapies, as with Cherokee bodywork, which I have learned, or in conjunction with colleagues who do osteopathic manual medicine. In preparing for our talks, we learned that a French psychoanalyst, Janet, preceded Freud by three years, and was very much involved in including the body in the healing of emotional pain (psychotherapy). Freud made the decision to reject the body for the "talking cure" and his followers went along, though at least one scholar points to the split with Wilhelm Reich (a good Mainer) as Freud's impetus to abandon the body entirely.
In the apprenticeship I undertook to learn Cherokee bodywork from traditional practitioners, I learned that life is energy. When energy moves, health follows. When energy is blocked, disease ensues. Our osteopathic colleague, Magili Chapman-Quinn, described how opiate use makes people's tissues feel as if they are stuck in concrete or think glue. These insights are important for healing.
I believe that psychiatry must reclaim the body. We should all be doing our own physical examinations on patients. We must overthrow the Victorian notion that all touch is sexual. The physical examination is a special moment of intimacy with patients. In examining their bodies, they often reveal concerns that would otherwise go unnoticed. I have found cancers on physical examinations that were being concealed by the patient. I have found skin diseases, the evidence of abuse in the form of bruises and other injuries, and, in the process of interacting through the exam, people have told me what is really bothering them. I believe psychiatrists must be doctors, too. We must stop hiding behind the Cartesian mind-body split and take control of the body.
When I present this idea at meetings, the inevitable response comes that we will be sued and charged with sexual assault. I note that it is we who have taught patients to think this way. Of course, every branch of medicine has doctors who abuse patients, and we are no exception, but the functions of the mind are manifest in and through the body, and we must examine the body to truly understand them. So, this is the sense through which our work is embodied. We understand that life is embodied and physical and that we have bodies so that we can be easily found (David Granger). Our bodies dutifully record the effects of the events of our lives. To recover from the effects of the events of our lives, we must address the body. We can do that through direct, hands on massage and manipulation, as in Cherokee bodywork, osteopathy, or tui nan. We can do it through embodied movement and dance therapies. We can do it through energy medicine, as in Reiki, Therapeutic Touch, or joh rei. We can do it through acupuncture or acupressure. But, however we do it, we must acknowledge the effect of a difficult life on the body (as well as the mind) and we are served if we liberate the body from the effects of these stressors and traumas even as we free the mind.
Our therapy is decidedly narrative in the sense that we understand that humans and stories are interchangeable. We are the stories that live through us. We live through the stories we enact. Stories are the default mode of the human brain. We evolved to make story about the many people in our lives. Stories help us keep track of our many social relationships. They inform us about how to seek the good life and how to interpret the events of our life. Stories help us construct meaning in our lives and find a purpose to occupy our time. Stories are very important.
We also recognize the healing power of community. I have written before about the power of being with others when having an experience. Gene induction is so much more powerful when we are in the presence of others than when we are alone. This seems to cut across the animal kingdom, and is called the audience effect in biology. Other people give us our sense of meaning and purpose. They help us create shared stories, which we feel are greater than us (transpersonal). They give us opportunities to be altruistic, to share, to demonstrate caring for others, and to learn and be supported from others. Our preferred hypothesis about brain development is the social brain hypothesis in which social experience is required to connect the circuitry from its rudimentary origins.
But there's more. Coyote has a thing or two to say. Coyote teaches us the value of humor and fun. We want to enjoy each client. We want to have something positive to say about them, and to them. Coyote teaches us to find the humor in each encounter and to have fun in our work. Over time I will write more about narrative work, but it is decidedly fun. When we can represent each of the voices inside a person's head with a puppet, and when we can get the puppets talking to each, it's inevitably lots of fun, and also very helpful. We are breaking the conventional psychoanalytic mold (as it was taught when I trained in the 1870's) and are finding the humor in life and its vicissitudes.
At the psychiatry conference, we presented outcome data. If people can stick it out with us for at least six months, they usually improve (over 90%). That was much better than I experienced in community mental health work. When I worked there, I tracked my patients, and, on average, no one improved (of course, some did, and some got worse, but the net impact was zero). So, we are arguing that we appreciate and enjoy our clients, we have fun with them, and they get better. However, it takes more than six months for serious problems, and sometimes years. Nevertheless, the joy is there.
We will be exploring this ideas further in our workshop with Peter Blum in Stone Ridge, New York, called Finding Magic in a Muggle World. As is usual with our Coyote Institute events, no one will be turned away, regardless of ability to pay. Here are the instructions for how to find us on November 15 and 16: http://www.cometomama.org/upcoming-events/. I hope we will continue the dialogue about what works and what is pleasing in the psychotherapy of psychosis.
Authors Website: www.mehl-madrona.com
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.