Monthly Archives: June 2013

Some More Thoughts from the Clinical Director: Power and Love in Rehabilitation

Posted on by

As I am in the process of leaving Buchanan, I find myself reflecting on many of the core principles of rehabilitation. In my reflections, I can’t help but evaluate how we, as a rehabilitative community, are doing – what is working well and what could work better. It is helpful for me to put my thoughts into some order and structure as a way of sorting them out. Perhaps some of you might find these reflections and thoughts on rehabilitation helpful, particularly as BRC has been going through such a process of change. We are struggling to address the rehabilitation needs of a very complex client group with multiple co-morbidities. It is both a strength and a weakness that we have multiple philosophies of treatment that we use – inpatient psychiatry, biomedical treatment, psychosocial rehabilitation and recovery. Depending on how we use these frameworks, they can end up competing with each other or complementing each other. It really depends on our choices, both the big choices as well as the little day-to-day choices that have so much strength in shaping our lives and actions.

For better or worse, I have decided to share my thoughts with you on a fortnightly basis.

Martin Luther King, Jr. said the following in the context of his human rights work to rehabilitate society:

“Power without love is reckless and abusive, and love without power is sentimental and anemic. Power at its best is love implementing the demands of justice, and justice at its best is power correcting everything that stands against love.” (This quote can be found in Power and Love: A Theory and Practice of Social Change, by Adam Kahane).

In a rehabilitation setting, we can consider power to be the aspects of our work in which we structure, contain and shape clients’ behaviour. We can also consider the structure of our systems and programmes as an aspect of power as we create these in order to shape our own work.

Love, in a rehabilitation setting can be considered to be compassion, empowerment and the desire to encourage the unfolding personal growth of clients.

We can see for ourselves in our work that an imbalance of power over love leads to behaviours that are “reckless and abusive,” and an imbalance of love over power leads to an environment that is “sentimental and anemic.”

So, what we are striving for is the right balance of power (structure, policy, constraint and paternalism) on the one hand and love (compassion, empowerment, the space to learn and grow and acceptance of the individuality of the client). This is a lot to balance, particularly since each client will need a different balance of power and love as they go through different stages of their rehabilitation. We, as mental health professionals who have taken on the stewardship of rehabilitation, must constantly strive to adjust ourselves and our service to the needs of the clients. We must do this while avoiding becoming “reckless and abusive” or “sentimental and anemic.” I see both of these temptations in myself during my daily work and I observe them in the behaviours and comments of BRC staff. We all have to struggle with these fundamental polarities in which the “right” action is a combination of both poles, rather than an either/or choice.

What each of us needs to strive for in our daily work (which is shaped by our beliefs, attitudes, comments and speech) is a balance of power and love, structure and openness, safety and empowerment. It is natural when human beings are under stress and systems are changing that we fall back on simple answers to complex problems. The simplest answer is to say that all we need is power or all we need is love (The Beatles non-withstanding).  While choosing only power or only love might seem like it makes our lives and choices easier, this is not the truth. Our work in rehabilitation requires both power and love in appropriate balance and structure. This is my vision for Buchanan: that we create a place in which we use our power to create a structure that is safe for staff and clients while also creating the space and acceptance for clients to make mistakes, learn and grow.

I will continue to end these fortnightly thoughts with a poem:

Jailbreak

It’s time to break out –

Jailbreak time.

Time to punch our way out of

the dark winter prison.

Lilacs are doing it

in sudden explosions of soft purple,

And the jasmine vines, and ranunculus, too.

There is no jailer powerful enough

to hold Spring contained.

Let that be a lesson.

Stop holding back the blossoming!

Quit shutting eyes and gritting teeth,

curling your fingers into fists, hunching shoulders.

Lose your determination to remain unchanged.

All the forces of nature

want you to open,

Their gentle nudge carries behind it

the force of a flash flood.

Why make a cell of your home

when the door is unlocked

and the garden is waiting for you?

Maya Spector

Amazon Review: The Creation of Faith, by Juan Mascaró

Posted on by

“‘The Creation of Faith’ could be the title of a book based on the solid foundations of the best in religious, common philosophies and common spiritual sense,” (179-180).

Juan Mascaró was born Majorca, Spain and lived in India and England. He returned to Majorca after his death for burial. He is noted to have accomplished the unique feat of translating the Sanskrit and Pali languages that were not his own into the English language, which was also not his own. His translations and introductions to the Penguin Classics editions of The Upanishads, The Bhagavad Gita and The Dhammapada continue to stand as excellent introductions to Eastern wisdom for the English-speaking world. While he was an accomplished scholar, linguist, translator and academic, what I find most wonderful about Mascaró is that he was a poet, a mystic and a unifier of the spiritual wisdom of the world. It was after reading his introduction to The Upanishads (as exciting as the text itself) that I became interested in Mascaró, himself, and sought out this out of print book, The Creation of Faith.

In his introduction to The Upanishads, Mascaró wrote that “an Upanishad could even be composed in the present day: a spiritual Upanishad that would draw its life from the One source of religions and humanism and apply it to the needs of the modern world,” (Upanishads, 8). That is the best way to consider The Creation of Faith, as a modern Upanishad, the lifetime culmination of the wisdom and poetry of a man who immersed himself in the poetical and spiritual literature of the world (“Spiritual visions are poetry,” (111), he writes).

The Creation of Faith is a posthumous collection that was edited by William Radice, as Mascaró died before his final work could be published. The book consists of aphorisms and sayings, usually only a couple of lines in length. The aphorisms are not arranged in any particular order which gives the book the feel of collected notes. There are some repetitions of almost identical sayings. Personally, I think the book would have been stronger if it had been edited a little more and if the aphorisms were clustered around various themes, such as creation, duality, unity, love, poetry, etc., or if they were organized so that they were allowed to comment upon the related facets of various themes. I think the book may have been stronger if it followed Mascaró’s own advice to be a: “book of 100 pages, 300 words a page–30,000 words,” (178).

“I have two lives: my inner life with God, and my outer life with nature and men. How mysterious these two worlds are,” (169). The beauty of Mascaró’s writing is that he works with dualities and polarities without negating, but allows each duality to complement to form a greater unity. “There is inner observation and experiment and outer observation and experiment. From the first comes poetry and spiritual vision and all human values; from the second science and technology,” (31). Still, as a mystic, he sees the ultimate aim of study and scholarly work to be supporting self-knowledge and through self-knowledge, one reaches God. “The end must be clear: how can we find ourselves, the best in ourselves,” (25). “If we could know what we are, we would know what God is,” (111).

One of the most interesting aspects of Mascaró’s unification of spiritual and poetical world literature is his view of faith and spirituality as creations of the imagination. He does not mean that they are false or “made up,” but that they are products of the creative function of human imagination, a field of play that is beyond the limitations of words and materialism. A few quotes illustrate this. “Faith is creation,” (148). “Your soul is your own creation,” (152). “What is faith? It is an act of creation and vision. We create what we hope,” (171). He also provides an understanding of how to differentiate between higher creations that contain truth and lower constructions that do not. “Imagination is strong and creative. Fancy is weak and passive. A hallucination is a powerful fancy that overcomes reason. Imagination is creative and above reason. Fancy is passive and below reason. This is also the difference between faith and fanaticism. Faith is above reason. Fanaticism is below reason,” (129).

Mascaró also wrote a more scholarly work of unifying comparative religion called Lamps of Fire. This has proven to be difficult to find and is also out of print. The Creation of Faith is a great source of spiritual and poetical inspiration and I found that it nicely complements the 80-90 pages, in aggregate, of the introductions to The Upanishads, The Bhagavad Gita and The Dhammapada. Mascaró also appears to have solved the dilemma of knower and the known. “In love we know. In knowledge there is the knower and the known. In love both are one,” (58). His is a voice that is beyond cynicism and divisiveness. He gently brings together a pure heart and a keen mind in a playful and creative search for the unification of all things.

Thoughts from the Clinical Director

Posted on by

I have decided that I will be posting my fortnightly “thoughts” column in the blog. I have been thinking about implementing this where I work for a year, now, but I have only just gotten the time and space to really do it. While some of the issues maybe particular to the specific workplace, I imagine that many of them are universal. Also, I end each column with a quotation of a poem. I have just written the 3rd installment, but I’ll post one of the old columns a week until we are caught up with the present time. Here is the column from one month ago….

Some Thoughts From the Clinical Director

I know everyone always works hard at Buchanan (Psychiatric) Rehabilitation Centre, but this has been a particularly tough week. I appreciate everyone’s work and concern for the Buchanan community in which clients engage in rehabilitation and staff strive to create an environment conducive to rehabilitation.

I had the experience with working with many services outside Buchanan this week, some of which were very supportive and others which were actively unsupportive. It made me realize that it makes a tremendous difference for the difficult work we do if we feel supported or unsupported.

We are going through a time of many transitions and I realize my decision to move back to the States is one of several big changes at Buchanan. I will keep everyone updated on where I am at in the process of that move. I just returned from leave and had a couple of job interviews, but I am not at the point of signing any contracts, so my time at Buchanan is still 90 days plus the time it takes for either Mary Pat or me to have a solid job. Mary Pat is now staying in Seattle and will be taking some licensure exams and looking for jobs there.

Our clients at Buchanan are often very difficult and challenging on the best of days and I do not see the referrals for new clients we are getting as being any easier than those currently at Buchanan. The work is going to continue to be difficult and challenging. We are going to have to continue to hold the hope for clients who come to Buchanan without hope. Hope is a precious commodity and we have to be very careful with how we care for our own hope. We also have to be careful about how we speak and act with clients because our words and actions can build hope or destroy hope. We also have to be careful with how we treat our colleagues at Buchanan and to strive to build hope and to make sure we are not endangering hope. This does not mean we always have to agree with each other. I saw a number of great examples where staff disagreed with each other this week, but still overcame those differences to work together for the best interest of clients.

I also went to a conference while I was in the States, it was called “Integrity in Health Care: The Courage to Lead in a Changing Landscape,” put on by The Center for Courage & Renewal. I thought a lot about hope while I was there, as well as of the shadow of hope, despair. We work with both of these on a daily basis in rehabilitation and we are no different than the clients in BRC who also struggle with these two fundamentals on a daily basis. What can be done to build and foster hope? That is the question I continue to return to during my time working in psychiatric rehabilitation. I generally return to human connection as the answer to that and during my remaining time at Buchanan this will continue to be my goal: increasing connection between staff and staff, clients and clients, and staff and clients. That can be a pretty lofty goal and sometimes it is nice to have something concrete to focus on, so my other goal I set for myself was to try to build more poetry into my life. I find that poetry can create a space to pause and reflect, to connect to my feelings and to connect to hope.

I have been meaning for some time to send out regular email of “Thoughts From the Clinical Director.” But, there is always so much important work that I do not get to everyday, this has been on the back burner. Perhaps it is not too late, even as I am in a leaving process from Buchanan to start this project. I will also share some of the poetry that we used at the conference. If it is of value to you and brings you hope, that is wonderful, if not, please feel free to disregard these periodic emails. Here is the first poem, it is a long one, but it was my favourite (Albuquerque is a city in the state of New Mexico):

 

Wandering Around an Albuquerque Airport Terminal

 

After learning my flight was detained 4 hours,

I heard the announcement:

If anyone in the vicinity of gate 4-A understands any Arabic,

Please come to the gate immediately.

 

Well — one pauses these days. Gate 4-A was my own gate, I went there.

An older woman in full traditional Palestinian dress ,

just like my grandma wore, was crumpled to the floor, wailing loudly,

Help, said the flight service person. Talk to her. What is her

problem? we told her the flight was going to be four hours late and she

did this.

 

I put my arm around her and spoke to her haltingly,

Shu dow-a, shu- biduck habibti, stani stani schway, min fadlick,

Sho bit se-wee?

 

The minute she heard any words she knew — however poorly used –

she stopped crying.

 

She thought our flight had been cancelled entirely.

She needed to be in El Paso for some major medical treatment the

following day. I said no, no, we’re fine, you’ll get there, just late.

 

Who is picking you up? Let’s call him and tell him.

We called her son and I spoke with him in English.

I told him I would stay with his mother till we got on the plane and

would ride next to her — southwest.

 

She talked to him. Then we called her other sons just for the fun of it.

 

Then we called my dad and he and she spoke for a while in Arabic and

found out of course they had ten shared friends.

 

Then I thought just for the heck of it why not call some Palestinian

poets I know and let them chat with her. This all took up about 2 hours.

 

She was laughing a lot by then. Telling about her life. Answering

questions.

 

She had pulled a sack of homemade mamool cookies — little powdered

sugar crumbly mounds stuffed with dates and nuts — out of her bag —

and was offering them to all the women at the gate.

 

To my amazement, not a single woman declined one. It was like a

Sacrament. The traveler from Argentina, the traveler from California,

The lovely woman from Laredo — we were all covered with the same

powdered sugar. And smiling. There is no better cookies.

 

And then the airline broke out the free beverages from huge coolers —

non-alcoholic — and the two little girls for our flight, one African

American, one Mexican American — ran around serving us all apple juice

and lemonade and they were covered with powdered sugar too.

 

And I noticed my new best friend — by now we were holding hands —

had a potted plant poking out of her bag, some medicinal thing,

 

With green furry leaves. Such an old country tradition. Always

carry a plant. Always stay rooted to somewhere.

 

And I looked around that gate of late and weary ones and thought,

This is the world I want to live in. The shared world.

 

Not a single person in this gate — once the crying of confusion stopped

— has seemed apprehensive about any other person.

 

They took the cookies. I wanted to hug all those other women too.

This can still happen anywhere.

 

Not everything is lost.

 

Naomi Shihab Nye

Website Launches Today!

Posted on by

My new Website is launching today!

close-up-holi-photo

Holi celebration with the Exploring Mental Health with Yoga group

I started the Website to support my soon to be published book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine. The book is currently going through a final edit and will be published late 2013. It will be available on Amazon in print and e-book formats.

Please check out the Website davidkopacz.com for information about the book as well as other writing, poetry, photography and paintings.