Last Thoughts from the Clinical Director: Idealism and Cynicism; Endings and Beginnings

I was going to write this column on endings, as that is the obvious choice for the end of my time as Clinical Director at Buchanan Rehabilitation Centre. I was looking at poems about endings and trying to write the column backwards from those poems. It just wasn’t coming together. Endings are times for reflection, assessment and good-byes. I find myself immersed in emotions and logistics of planning an international move. Oftentimes the demand of the logistics leaves little time for emotional processing and the emotions leave little intellectual energy to deal with the logistics. I feel there is so much more that can be done at Buchanan to make it not just an alright place, or an ok place, but to make it a real gem of a service that combines the best of psychiatry, rehabilitation and recovery. Of course, this implies that there are things that we could be doing better and this is what leads me to a discussion of Idealism and Cynicism.

I am an Idealist, I have come to terms with this in my life. It means that I often see how things could be “better,” different, and it can lead me to a dissatisfaction and frustration with “the way things are.” The Greek philosopher, Plato, can be considered an Idealist. His allegory of the cave illustrates this. He describes a person whose only experience of reality is in seeing moving shapes on the cave wall. These shapes are created by light striking objects and casting shadows. There are two implications here. The first is that the person is only seeing an image or representation of reality (the object). The other is that the person could get up and leave the cave, go out into the sun and experience the external real world. Either way, it can be said that the person is not in touch with reality, but just a shadow of it. The spiritual and philosophical concept of “awakening” is relevant here – that the awakened person recognizes the limited or even illusory nature of the reality that we tend to respond to in day-to-day life. It can be said that an Idealist sees the ideal, that which could be, but is not found in mundane reality. Visionaries and transformers are Idealists.

Psychiatrist, Carl Jung, borrowed from Plato’s concept of “archetypes,” these ideal forms that exist outside of the day-to-day realm. These forms exert an unconscious and sometimes conscious influence on the development of the individual. While he listed many different examples of archetypes, the primary one he was interested in is called “The Self,” which is an image or representation of wholeness that works within the individual, who is by nature a small, separate being when compared to larger reality. Jung saw this archetype or force of the Ideal at work in spiritual and artistic creations and experiences in which the individual had some form of healing or renewal in a connection within the self as well as a sense of connection to a larger whole or purpose in the world.

Plato and Jung are Idealists, they view a True Human Being as actually something that is in the process of becoming through a dialogue with the Ideal (or Real). In the last column, I discussed this dilemma about a True Human Being, whether Truth is something in the moment or whether it is something that is gained in the future. I suppose this argument is reduced if we say that a True Human Being is someone who is in an open dialogue with the Ideal (or we could say the Real, or even the Divine if you are spiritually-oriented). In this sense, it is the connection between the Ideal and the individual that is crucial, rather than some present or future state of the individual.

A discussion of Idealism is incomplete without a discussion of Cynicism. There is a Greek school of philosophy called Cynicism, but my own view is that Cynics are Idealists whose dreams and ideals have been frustrated and unrealized. This calls to mind Nietzsche’s saying that man would rather will nothing than not will. Cynics are Idealists who put their energy into tearing down dreams. In a way, you could say that Cynics are the most important part of an organization because they hold a lot of energy, but it is being directed in a destructive rather than a constructive way. A rehabilitated Cynic will bring far more change to an organization than a level-headed Pragmatist. You can always find Idealists, any young person going into health care is generally an Idealist, but most quickly become either Pragmatists or Cynics as they become frustrated and disillusioned with the idea of being able to do the “best” at their jobs.  Really, a healthy and growing organization needs a balance of all 3 types. The Cynics can pull back the extremes of the Idealists, the Idealists can inspire the others, the Pragmatists can be in the middle, working on what is possible in the moment.

These are my thoughts this morning and they link back to my work on my book, Re-humanizing Medicine, which is essentially a guide for maintaining Idealism and rehabilitating Cynicism. How well have I done in my role as Clinical Director? Well, my answer to that changes minute to minute sometimes throughout the day and ranges from extremes to middle ground. I suppose my answer to that question is sometimes Idealistic, sometimes Cynical, and at times Pragmatic.  Perhaps I could have done more or “better,” but I did what I could. Perhaps if I stayed longer and worked harder, it would make a difference, but it is time for me to go. What do I hope will be the outgrowth of my work? I suppose it is related to all this talk about Idealism and Cynicism in some way.

I have had (before the movers so efficiently and swiftly packed up all my things around me) a plaque on the wall with a quote by Howard Thurman, “Ask not what the world needs, but what brings you alive, because what the world needs is people who have come alive.” This is a good definition of Idealism and includes the Jungian concept of Self, that what is ultimately important is in discovering what it is that brings you alive, that enthuses you and fills you with energy. The challenge of the Idealist is in bridging the gap between the Ideal and the mundane world. Most Idealists would agree that this is never completely possible, that it is always a work in progress and always a compromise to some extent.

A successful Idealist, one who can continue to work and create, must come to terms with this dual-natured reality: on the one hand, to be true to the Ideal vision and on the other hand, to accept that the Ideal is unrealizable. Rebecca Solnit, in her book, Hope in the Dark, describes “activists” (who I would say are a kind of Idealist) who work to make the world a better place. She sees activism as a mode of being, a moral responsibility, that is ongoing, and that one engages in regardless of the “state of the world,” or the “chance to succeed.”  She describes the term activist “to mean a particular kind of engagement – and a specific politic:  one that seeks to democratize the world, to share power, to protect difference and complexity, human and otherwise,” (18).  “For a long time, I’ve thought that the purpose of activism and art, or at least of mine, is to make a world in which people are producers of meaning, not consumers, and writing this book I now see how this is connected to the politics of hope and to those revolutionary days that are the days of creation of the world,” (115).  To define an activist or Idealist as a kind of engagement or a mode of being, de-couples it from the outcome. One maintains hope because one has decided to be a hopeful person. One is an activist because they have decided that it is right to work to make the world a better place, regardless of the chance of success. One is an Idealist because they have made the choice to work to bridge the gap between the Ideal and the world.

What does all this have to do with Buchanan and my departure? I have said before that in psychiatric rehabilitation we are in the business of hope. What I hope I have contributed to Buchanan is some of this attitude that we can and should work to bring the Ideal into the actual. This means we can and should work for change and growth in ourselves and for clients. What about endings and new beginnings? Well, those two always seem to go together, don’t they? I’ll have to leave you to work that out for yourself.

 

The Layers

I have walked through many lives,
some of them my own,
and I am not who I was,
though some principle of being
abides, from which I struggle
not to stray.
When I look behind,
as I am compelled to look
before I can gather strength
to proceed on my journey,
I see the milestones dwindling
toward the horizon
and the slow fires trailing
from the abandoned camp sites
over which scavenger angels
wheel on heavy wings.
Oh, I have made myself a tribe
out of my true affections,
and my tribe is scattered!
How shall the heart be reconciled
to its feast of losses?
In a rising wind
the manic dust of my friends,
those who fell along the way,
bitterly stings my face.
Yet I turn, I turn,
exulting somewhat,
with my will intact to go
wherever I need to go,
and every stone on the road
precious to me.
In my darkest night,
when the moon was covered
and I roamed through wreckage,
a nimbus-clouded voice
directed me:
“Live in the layers,
not on the litter.”
Though I lack the art
to decipher it,
no doubt the next chapter
in my book of transformations
is already written.
I am not done with my changes.

(Stanley Kunitz)

 

 

Thoughts from the Clinical Director: Becoming a True Human Being

“we are…making ourselves better heart people,” (Joseph Rael)

A hobby of mine is personal growth and transformation. This is a larger context for human being than a focus on psychiatric treatment or symptoms, although it can include addressing those. During my time at Buchanan Rehabilitation Centre, my goal has been to bring this perspective into our daily work in psychiatric rehabilitation.

What does it mean to be “A True Human Being” or to be Fully Human? What I have found is that it is a funny paradox that involves both acceptance of where someone (or one’s self) is, that people are “ok” (with all their quirks and oddities and problems) and it also involves being on a path of change, growth, self-knowledge and transformation. Every human being is unique and will hit a unique point in their life in which the drive or need to change becomes stronger than past patterns and ego defenses. Rehabilitation is fundamentally holistic – it requires many different approaches and disciplines to support the growth of the True Human Being (by this I mean, again, both for ourselves as health professionals and for clients). That is why a collaborative Multi-Disciplinary Team (MDT) is so important. Each discipline brings a different perspective and dimension to working with human beings and this fosters authentic growth and transformation.  A collaborative MDT is like a healthy human being or ecosystem – comprised of significantly different organs or organisms that all work together in an expression of their unique individuality while simultaneously working together as a collective. Sometimes this is how writers describe the difference between reductionism and holism – that reductionism is about breaking down something large into standard, interchangeable component parts, whereas holism is about something greater than the sum of the component parts. This means that somehow, beyond the biochemistry, trauma history, family dynamics and substance abuse, there is something larger that is both already present and in the process of emerging – the True Human Being.

Ok, I admit that there is a serious paradox here. Is the True Human Being something that is already present in the individual (maybe already ok as it is or maybe just obscured and waiting to be uncovered) or is the True Human Being something that is always in the future – waiting to emerge? As with any paradox about life, the answer is generally both/and rather than either/or. We can look at the relationship or dialectic between Being (already present in the moment) or Becoming (unfolding in the present and into the future). In spiritual terms, this is the dialectic between immanence (already there) and transcendence (something separate that needs to be moved toward). Being is similar to mindfulness, which is a slowing down with awareness of who one is in the moment. Becoming is like what is often called the road or path of growth and transformation, for instance M. Scott Peck’s, The Road Less Traveled. Of course these are artificial distinctions for connected processes, as the mindful act of the Acceptance of Being actually is quite transformative. Joseph Rael (Beautiful Painted Arrow), a Native American spiritual teacher describes this paradox in the following quote:

In each moment that we live there is an opportunity to change ourselves in some way. We shatter what we were in the past, so that in the new moment we can remake ourselves. In a day’s time, we go through many different moments, many different opportunities to re-make ourselves and therefore evolve…What is a road or a path? The road is the metaphor for the head of the family of ideas continually investigating themselves to find out who they are being in every single moment. Because we are changing constantly, we have to be continually investigating ourselves. Otherwise, we lose who we really are. Another meaning for road is the direction or form by which our fears are challenged and the manner in which we face them, (Joseph Rael, Being and Vibration, 57-58).

An earlier column that I wrote on Adam Kahne’s theory of Power & Love in social change brings this back to our work in rehabilitation. Love, in its many forms, is acceptance and support for how someone is in the present – it promotes transformation from the inside. Power is more external change from the outside as it structures and shapes external behaviour. In psychiatric rehabilitation Power takes the form of medications, the Mental Health Act, and behaviour plans. Notice how I use the word transformation for the internal process and change for the external process.

Rather than an either/or, Kahne recommends a both/and approach which promotes a balanced dialectic where through the harmonizing of Love and Power a transformation emerges that is greater than what can be achieved through the application of either principle alone.

Thus, for rehabilitation of the True Human Being, both Power and Love; both External Structure and Internal Transformation; both the work of individuals and the collaboration of groups are necessary.

Let’s return to Joseph Rael and hear what he has to say about “Becoming A True Human Being.” (Word of Caution: this might get a bit spiritual and mystical, which is what is often lost in a reductionistic view of human beings).

The true human is someone who is aware, someone who is, moment by moment, totally and completely merged with life. He is a listener. She is a listener. Out of that capacity of inner and outer listening, comes the capacity of humility. The true listener is no longer defined by desires or attachments. Instead, he or she is sensitized to consciousness, (67).

In the language of nature, working and listening are the same. Working, or listening, means sensitivity, (65).

A true human is a person who knows who he is because he listens to that inner listening-working voice of effort, (68).

Rael introduces the pair of human activities of plowing and playing (which we could take as more examples of being [playing] and becoming [plowing]).

Plowing is a metaphor for this physical way of looking at life…What ideas do we want to cultivate? We study something and then walk it out so that we can plow the fertile field of consciousness and then move forth and plant the seed in that field that we have plowed, which in this case is our bodies. In that way, we plant what we cultivate in the weeks to come and it eventually produces fruit, (68-69).

The metaphor of playing is quite different. Playing means strengthening oneself…making the self what is becoming…Whether we are playing a violin or a guitar, or playing football, tennis or cards, we are, through playing, making ourselves greater heart people, (69).

For the true human, the first thing is to find out how to listen. Listening is different from seeing. Seeing, and the eyes, were created so we could move into things and through things. The ear, on the other hand, was created for the art of giving. One of the attributes of the ear is the give-away; to give into the effort of giving, to give into the effort itself, the effort we can find in the toil of our work in our lives. When we are listening, we are giving. When we are giving of ourselves, we are strengthening the work-listening aspects of ourselves. We are listeners to people’s cosmic needs. First we listen to what needs to be done. But if we start with trying to see what needs to be done we will miss the point and we will not really touch the basic humanity of the situation that is talking to us at that moment in time, (70).

To return back to what all this mystical stuff means for us as health professionals and the clients, we can see a couple things in these quotes. First, to be human is to listen and this is also related to work (work-listening), and this is all related to giving. We must listen with our hearts first, and then see with our minds what needs to be done. This can all be another example of the listening-heart (as holistic transformation) and the seeing-mind (as reductionistic action).  The recent presentation I gave at the Health of Health Professionals conference in Brisbane focused on this aspect of giving as crucial to providing whole person care as well as to supporting the whole person of the professional. When we view work as a gift rather than a time-limited resource or a uni-directional vector, we move from a draining experience to a collaborative and regenerating experience. Lewis Hyde describes the gift experience as:

*         “the gift is not used up in use” (187)

*         “a gift makes a connection…a gift establishes a feeling-bond between two people, while the sale of a commodity leaves no necessary connection” (72)

*         “A gift that has the power to change us awakens a part of the soul” (65)
(Lewis Hyde, The Gift: Creativity and the Artist in the Modern World)

So far, I hope this all can be at least partially translated back to our work in psychiatric rehabilitation. Let’s go ahead and follow Beautiful Painted Arrow a little further, though, even if it might become a greater challenge to bring it back to our work in a psychiatric system. For the most part, I just let the words speak for themselves.

We become human in order to continue listening so that we can continue to verify that we exist, (72).

In the end, the mystery is the infinite void and the mystery of the void is all of us remembering, because, truly speaking, we do not exist, (75).

Sorry, if you follow any mystical line of experience and inquiry you generally end up with strange statements about the void and reality.  Let’s just close with a poem by Rael and then I’ll add an appendix for those of anyone who wants to hear more of Rael’s ideas.

Life is the road of Goodness.
Life is connected to time
as crystalized meanings.
Life purifies itself with heart connection
so it can ascend beyond the heavens as radiating innocence.

(Joseph Rael – Beautiful Painted Arrow)

Appendix: Eighteen Ideas from Joseph Rael

1. Planet Earth is constantly giving life to all things on the earth so that, in the act of giving to us, she shows us all how to serve, to give to her and ourselves.

2. First was the Dream and then the Vision that became the walking, talking, light of the one Great Mystery, which is all of us who are living on the Earth.

3. Taah-Keh (The Big Bang) was created “to initiate action” and from this came the first circle of light. [Taah-Keh refers to a Tiwa myth in which two fawns being pursued by the Old Giantess hide inside the crack in a plow. When the Plowmaker hits the plow with his hammer, the fawns go flying out.]

4. The eyes are channels for the “washing lights” that bring clarity to ideas.

5. The rainbows are hues (vibrations of the rock people) of life on the earth. And the rainbows represent, in metaphor, the breath of the Butterfly of Dream Time, the bridge to eternity.

6. The Earth is the Mother Starship of the Ancient Ones.

7. Resonating energy is simply universal intelligence descending onto its own understanding of the vast greatness of its own greater, inner self.

8. The idea of enteringness created the first form of the face.

9. Water is crystallized light which produces physical light as well as spiritual light. Interestingly, the symbol for water in chemistry is H2O. In Tiwa, the sound of HO, “Haah-Oo,” means “Little Leaf.” The leaf is the symbol for life.

10. From the first mist of the first cloud comes the idea of birthing as dropping from the biological mother’s womb. And the thread that keeps us connected to our origins was primarily created to help us keep vigilance over what we do and say: right actions/right thoughts.

11. Life on the earth is a living daily experience of inspiring qualities and inner knowing. We find them, these gems of truth, only as we are ready to acknowledge them in our lives.

12. The light is always chasing the shadow and the shadow is always following the light.

13. The breath is the key to all of the mysteries.

14. The breath is the infinite void from which all creativity is first given life, then its purpose.

15. Dream essence of life is what heals life, whereas living life is the visionary part of it.

16. The first visionary who came from the first dream was in the dream state too because he was dreaming his vision. That is, he was the dreamer and the one being dreamed. Consequently, all of life is simply made up of a healing sate that is dreaming itself beyond itself.

17. The eyes are how the Great Mystery sees, how it holds on, moment by moment holds to the gifts of each moment before the next moment appears, bringing with it its own face.

18. The earth is a large stone which is the holder and keeper of all the mysteries that created the life potential here on this earthly home of the People.

Having read these ideas, go outside and sit on a rock that has been heated by the sun. As you sit on the stone, the warmth of the rock will travel through all parts of your body and when the radiant heat from the stone has traveled through all the different parts of your body, the knowledge that lives in what you have just read will be acknowledged and appear in your life. Hereafter, you will get greater clarity on these principles.

 

 

Thoughts from the Clinical Director: Change

I tend to be somewhat philosophical and the more change and stress I am under, the more philosophical I become. Sometimes at night when I don’t know what to do, I lay on my back on my back stairs and look at the stars. Tonight there are patchy, fast moving clouds concealing and revealing the stars. Moby has a song called “We Are All Made of Stars.” The refrain is “people they come together, people they fall apart, no one can stop us now, because we are all made of stars.”

Scientists think we are literally made up of stars – that is that at the time of the Big Bang, there was only hydrogen and helium and these elements made up the first stars. Eventually when these stars died and exploded, they created heavier and heavier elements, such as some of the medium weight elements like carbon, oxygen and nitrogen, and these are the elements that we are physically comprised of.

We are going through a lot of change at BRC in the upcoming months, personally the most relevant change to me is my final day on 24/10/13. We are looking for locums to fill in for the clinical work and will be having interviews for the permanent position in the upcoming weeks and will keep you updated as we have more information. There is also the change of our psychologist leaving, our nurse educator having left as of today, and our other consultant leaving in February. That is a lot of change in the clinical team and it is likely to have some ripple effects in how stable BRC feels.

There is actually something called the Book of Changes, as the I Ching is sometimes translated. This is an ancient Chinese text that dates back to between the second and third millenium BCE. This book is all about studying change. It states that “When change is necessary, there are two mistakes to be avoided. One lies in excessive haste and ruthlessness, which bring disaster. The other lies in excessive hesitation and conservatism, which are also dangerous.”

Psychiatrist, Carl Jung, in his foreword to this book discusses the role of chance and synchronicity that influence how changes play out. No matter how well change is planned for, there will be unforeseen chance events. This makes managing change as much an art as a science.

Here are some more quotes from the Book of Changes, maybe they apply to BRC.

Everything is in motion: therefore if one perseveres there is a prospect of great success, in spite of existing danger. When it is man’s fate to undertake such new beginnnings, everything is still unformed, dark. Hence he must hold back, because any premature move might bring disaster. Likewise, it is very important not to remain alone; in order to overcome the chaos he needs helpers…In order to find one’s place in the infinity of being, one must be able both to separate and to unite…If a person encounters a hindrance at the beginning of an enterprise, he must not try to force advance but must pause and take thought. However, nothing should put him off his course; he must persevere and constantly keep the goal in sight.

I know that the goal at BRC is always to provide supportive care to clients in order to promote mental health, recovery and rehabilitation.

The I Ching discusses three kinds of change: non-change, cyclic change and linear change. Non-change is the fixed background that makes change possible. (At BRC this is the continual goal of supporting rehabilitation; for staring at the sky, it is the, relatively, fixed and unchanging background of stars). Cyclic change is the recurrent change of the organic world, or we can see cycles in the history of psychology, such as between nature/nurture and biology/psychology. (At BRC when changes are proposed I often hear, “we used to do it that way;” with the sky, it is the cycles of clouds covering and uncovering the same stars). Linear change is a form of progress and this creates a specific history for a given place or person. This is another level of viewing cycles of change, that when sequenced together they lead to a progress toward a certain goal. (While there are cycles of change at BRC, there is also a continual adjustment to the changing needs of the clients and the changing philosophy of the DHB. While there are similarities of current change to past methods, we are continually at a unique point in time in which we are striving to bring about the right elements at the right time to support change and growth for clients. For the sky, the interplay of cyclical change against the background of the non-changing sky creates unique moments and configurations which will not happen again, but which create a kind of linear, beautiful movie).

I’m not sure how much the I Ching can help us during this current change, but maybe these concepts can help to put the current anxiety and change into a larger context. The Greek philosopher, Heraclitus, wrote that “There is nothing permanent except change.” I do know that having a larger context in which to view change can lead to greater acceptance of the change in the moment as well as to allow one to work effectively in the current moment rather than resisting the reality of the present.

The Promise of the Inner World

If you take away all a person knows,

you are left with the mouth of a fish

gulping water as fast as it can. If you

take away a person’s coverings, you are

left with the naked freedom of a star.

If you take away all a person has done,

you are left with a soul eager to build.

And if you take away what a person has

saved, you are left with a life that

has to live now.

Stripped of too many thoughts, we

grow wise as stone. Stripped of too

many accomplishments, we grow

possible like the sun. And stripped

of what we hoard, we grow immediate.

So taking away is not just about loss.

Like it or not, we are forced, again

and again, to the nakedness of freedom,

to the eagerness that wants to build its

way out of nothing, and to the poverty

of time that has to live now. If blessed,

we wake, one more time, gulping

our way into tomorrow.

(Mark Nepo, from Reduced to Joy)

Thoughts from the Clinical Director: Crazy?

Sometimes I think that the work that we do at Buchanan is pretty crazy. This is a word that can mean a lot of different things. It is often considered a pejorative term for mental illness. Cultural critics sometimes say that it is a made up term used to label as deviants people who do not think and act the way the dominant culture dictates. What I mean by crazy is that we hold hope for people who often do not have any hope and whose objective circumstances are pretty hopeless. I suppose our work could also be viewed as crazy because it does not fit within the box of inpatient or outpatient mental health treatment that views people as illnesses and symptoms that need to be “normalized” or “controlled” with psychiatric medication. At Buchanan, we still use the standard biomedical treatment approach, but this is not the only way that we view human beings. We strive to see the needs and strengths of the whole person and this could be considered crazy from a reductive biomedical perspective of psychiatry.

I have heard people talk about different kinds of crazy, like “good crazy” and “bad crazy.” Maybe we’re that good kind of crazy by constantly working to bring hope to the hopeless and by taking on clients who are complex and don’t fit squarely within the categories of mental illness and who do not seem to get better in other treatment systems. I think this is good kind of crazy to do this kind of work. It does mean, though, that our work is often not easy, predictable, or straightforward. It takes time and effort to get to know the whole person. It requires patience as we work with people to change life-long patterns. But it is also really fulfilling work when we get the privilege of seeing someone change and grow, which is a double bonus, because I think that also means then that we are changing and growing, too!

In Praise of Craziness, of a Certain Kind

On cold evenings

my grandmother,

with ownership of half of her mind—

the other half having flown back to Bohemia—

spread newspapers over the porch floor

so, she said, the garden ants could crawl beneath

as under a blanket, and keep warm.

and what shall I wish for, for myself,

but being so struck by the lightning of the years

to be like her with what is left, loving.

Mary Oliver

Thoughts from the Clinical Director: Being Lost

I am a week late in writing these fortnightly thoughts, as I was traveling back in the States for a couple of weeks. Right now I have two homes, one here in New Zealand and one back in the US. I have to admit that I feel a bit lost at times, but I think about the clients at BRC and how much more lost they must feel, lost in psychosis, lost in drugs and alcohol, many lost from families and lost from trusting human relationships. Those are much more painful conditions of being lost. I see the problem of being lost as one of the primary things that we work on in a rehabilitation setting as opposed to a mental health centre or an acute inpatient ward, where the focus is primarily on treating symptoms.

One of my favourite writers, Rebecca Solnit has written a wonderful book called A Field Guide To Getting Lost. She explores all the ways that people can get lost, but as always, she searches for how being lost is part of the human condition and can even lead to growth and transformation (as well as risk destruction and dissolution). She quotes the Greek philosopher, Meno, as asking “How will you go about finding that thing the nature of which is totally unknown to you?” (4). She goes on to say:

The things we want are transformative, and we don’t know or only think we know what is on the other side of that transformation. Love, wisdom, grace, inspiration—how do you go about finding these things that are in some ways about extending the boundaries of the self into unknown territory, about becoming someone else? (5).

I often think about this seeming paradox in our work with clients and in personal growth: to what extent are we working to support our clients to “become someone else” and to what extent are we supporting them to become more authentically “who they are,” or to realize their potential? I sometimes get uncomfortable talking about potential, because that seems to imply that someone is less than who they could be. It all gets pretty complicated sometimes when you start talking about change and transformation. But I would definitely say that the work that rehabilitation and recovery requires is transformative and we are asking our clients to extend their boundaries of self to include new possibilities. You should know me well enough by now to know that the next thing I am going to say is that as staff working in rehabilitation we need to extend the boundaries of ourselves as well. One of the ways that psychiatrist Carl Jung looked at psychotherapy is that the therapist has to get lost along with the client and then act as a guide to help both of them become found. As Solnit writes, “Sometimes gaining and losing are more intimately related than we like to think,” (38). That implies that if we seek to gain anything, we must tolerate becoming lost, and possibly even seek out becoming lost. “Not till we are lost, in other words, not till we have lost the world, do we begin to find ourselves, and realize where we are and the infinite extent of our relations,” (15).

Even though it is necessary for finding ourselves, being lost also has serious risks and that is what we and the clients struggle with at BRC. How can we reach someone who has lost hope? How can we support clients in a positive way who are lost in repetitive cycles of addiction, depression, psychosis, trauma or violence? This is where the art and skill of rehabilitation comes in. This is where we have to be willing to become lost ourselves and to say, “I really don’t know what the **** to do next!” In trying to reach clients, we often have to realize that the text book is not working and we have to find it within our hearts to be patient with ourselves and with clients when we are in these lost spaces. I sure wish that I could say that I was often successful in this work. I cannot say that I am. It often seems that many of our clients make small changes and some clients seem not to change at all. I still have the unshakeable belief, though, that the work we do matters and makes a difference. When we go looking for someone who is lost and when we maintain the hope of a searchlight we are offering clients a pathway back from wherever they are lost. Sometimes that is all we can do is to stubbornly maintain hope. I may have already quoted Vāclav Havel in an earlier column, but it is he who I always turn to when I am trying to maintain my own hope when I am lost or when I am trying to reach someone who is lost. “Hope is definitely not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.”

Since I am in this 90 day period of leaving Buchanan, I have found this website that allows me to calculate how many days are between two dates. At this point it is down to 62 days that I have left at Buchanan. What can I do in that short amount of time? I have to let go of any grand plans for transformation and really just focus on connecting to people and starting to say goodbye. I have to admit, I feel a bit lost at times, but I know we are all working together and that gives me some comfort.

 

Lost

Stand still. The trees ahead and the bushes beside you
Are not lost. Wherever you are is called Here,
And you must treat it as a powerful stranger,
Must ask permission to know it and be known.
The forest breathes. Listen. It answers,
I have made this place around you.
If you leave it, you may come back again, saying Here.
No two trees are the same to Raven.
No two branches are the same to Wren.
If what a tree or bush does is lost on you,
You are surely lost. Stand still. The forest knows
Where you are. You must let it find you.

David Wagoner

 

It is I who must begin

It is I who must begin,

Once I begin, once I try—

here and now,

right where I am,

not excusing myself

by saying that things

would be easier elsewhere,

without grand speeches and

ostentatious gestures,

but all the more persistently

—to live in harmony

with the “voice of Being,” as I

understand it within myself

—as soon as I begin that,

I suddenly discover,

to my surprise, that

I am neither the only one,

nor the first,

nor the most important one

to have set out upon the road.

Whether all is really lost

or not depends entirely on

whether or not I am lost.

Vāclav Havel

 

Some (Parting) Thoughts from the Clinical Director (26/7/13)

It is with great sadness that I am writing to tell you that I am handing in my 90 day notice for my resignation from Buchanan Rehabilitation Centre and Auckland District Health Board today. That means that my last day at Buchanan will be Thursday, October 24th, 2013.Why am I leaving? A client at BRC recently asked me if I was leaving because of something he had done. That is so not true at all, I am not leaving because of anything at all having to do with BRC or what anyone has done or hasn’t done. I am leaving because it is time for me to leave. My wife, Mary Pat and I have decided to move back to the States and we’re in the process of relocating to Seattle, a city in Washington State in the Northwest corner of the United States, not too far from Canada and the city of Vancouver. I will be taking a job at the Veterans Administration, which is a federal job working with war veterans. (It will be a bit of a full circle for me as my first job was at the Omaha VA and the University of Nebraska). I will be working in a clinic that integrates primary care and psychiatry and I’ll also do a day of telepsychiatry over the internet, connecting with patients who live in rural Washington, Idaho, Montana, Wyoming and Alaska. I will also have a joint appointment with the University of Washington, so that I can teach – which is one of the things that I love the most and which I am very enthusiastic about; and I’ll also have a paid writing day each week!

Seattle with Mount Rainer looking South

 
Seattle with Mount Rainer looking South

What is Seattle like? It is a beautiful city set in some of the most beautiful mountains, forest and ocean in the United States. I have always been particularly fond of the Olympic National Park where I have spent many memorable camping trips. Both Mary Pat and I have family in Seattle and we also have a lot of really great friends there.

Seattle with Olympics, looking West

Seattle with Olympics, looking West

Leaving Buchanan is really difficult for me, because I love it so much. I am so grateful to have had the chance to work here, and it has been a privilege to have served as Clinical Director. I only wish I could have done more and that I could have stayed longer and sometimes I wish there were two of me so that I could both stay at BRC and go on with my new life. Why am I leaving then? Well, I said because it is time for my family to relocate back to the States. I think about a quote I have always liked by Henry David Thoreau about why he left the cabin he built on Walden Pond, where he lived for 2 years, 2 months and 2 days (I will have been at Auckland District Health Board for 3 years 3 months and 5 days – you might think I stayed a couple days too long!). Anyway, I will share a long quote from Thoreau:

“I left the woods for as good a reason as I went there. Perhaps it seemed to me that I had several more lives to live, and could not spare any more time for that one. It is remarkable how easily and insensibly we fall into a particular route, and make a beaten track for ourselves. I had not lived there a week before my feet wore a path from my door to the pond-side; and though it is five or six years since I trod it, it is still quite distinct. It is true, I fear that others may have fallen into it, and so helped to keep it open. The surface of the earth is soft and impressible by the feet of men; and so with the paths which the mind travels. How worn and dusty, then, must be the highways of the world, how deep the ruts of tradition and conformity! I did not wish to take a cabin passage, but rather to go before the mast and on the deck of the world, for there I could best see the moonlight amid the mountains. I do not wish to go below now.

I learned this, at least, by my experiment; that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours. He will put some things behind, will pass an invisible boundary; new, universal, and more liberal laws will begin to establish themselves around and within him; or the old laws will be expanded, and interpreted in his favor in a more liberal sense, and he will live with the license of a higher order of beings. In proportion as he simplifies his life, the laws of the universe will appear less complex, and solitude will not be solitude, nor poverty poverty, nor weakness weakness.” (H.D. Thoreau, Walden)

Dave at a Replica of Thoreau's Cabin

Dave at a Replica of Thoreau’s Cabin

So, now that I am leaving, what next? Well, Adele, our manager at BRC, and I have been talking about this for months and now we will launch into action recruiting a new clinical director to take over my job. We hope that this goes smoothly and that we find someone with values that match those of Buchanan, where clients and staff continually have the opportunity to grow and learn together and to bring the best of the heart and the mind to work every day.

I will continue to keep you posted with our progress of finding a replacement and I’ll continue to write these fortnightly “Thoughts.”

I will tell you that I will be away for a few weeks during the next 90 days. I am heading to Seattle to see Mary Pat (and our cat, Sofia, who recently made the journey there) and to take care of some things with my new job. I’ll be away August 6th and I’ll return to work on August 19th. I also have had a conference proposal accepted in Brisbane for the Health of Health Professionals conference and I’ll be away from October 2nd until October 14th. Otherwise I’ll be around BRC working business as usual, although I’ll be starting to gradually say goodbye to all the wonderful clients and staff at Buchanan.

Thank you for everything,

Dave

Thoreau Quote

Thoughts From the Clinical Director: Soft Institutionalization

We all work in rehabilitation because we want to help other people, right? Giving more help is always good, right? Well, not always. I sometimes have talked about the difference between help and support. Where help is doing something for someone that they cannot do for themselves and support is creating an environment in which a person learns to help themselves – i.e. learn and grow. The challenge of rehabilitation is an act of continuous triage in which we are always adjusting our expectations of what clients can do for themselves, encouraging them to reach a little bit beyond their current ability and comfort zone. If we expect too little, they don’t grow. If we expect too much, they fail or lose hope and then we put in even more help which can maintain them in a state that requires a high level of input from staff, in other words: institutionalization.

Most of us at Buchanan understand that human beings deserve human rights and that people should be supported to live as independently as possible. But sometimes our desire to be kind by over-individualizing care or overly-lowering our expectations of what are clients can do for themselves leads to de-skilling and dependency. While most people have come to see that institutionalization is a harmful thing to the human spirit, we still inadvertently bring about dependency in our clients through a distorted form of kindness – this is what I call soft institutionalization. Growth and learning require a certain amount of destabilization and discomfort and mistake. If we try to shelter clients from destabilization, discomfort and mistake, then from our kindness we are creating soft institutionalization.

Soft institutionalization occurs as the result of a series of small things that prevent a person from taking on more responsibility. I sometimes think of this as the “negative Buchanan bubble.” This is where a client appears to be functioning well at Buchanan because of numerous small things that we do to shelter them from the reality of responsibilities that they will have in the community. This creates a kind of pseudo-independence. If we shelter clients from the consequences of their actions, we interfere with learning opportunities.

Some examples of soft institutionalization would include: providing transportation for clients instead of challenging them to take the bus, keeping them at Buchanan past the time that they are actively learning and growing, lowering our level of expectation to a person’s current level of functioning instead of always challenging them out of their comfort zone, and making exceptions to BRC/ADHB policies (what in the outside world is called reality) to promote patient comfort over adaptation. While it is true that reality in the community can be harsh, the goal of rehabilitation is to provide clients with the tools and skills to adapt as much as possible to that reality. The goal of rehabilitation is not to try to create an alternate reality that shelters clients from discomfort as that prevents learning opportunities. Everyone at BRC (staff and clients) should be on a journey of growth and learning – that is what working in rehabilitation is all about.

After my last “thoughts” column, Mars had written a nice response and she said that I could quote her statement, “good will always continue,” this was in regard to the question of when is enough, enough? The good that we do at Buchanan, in terms of compassion and inducing hope, does stay with people after they leave. I would add to this that growth will always continue. If we, as staff are continually growing, we teach by good example. If we have taught clients growth while they are at BRC, that growth will continue. If we have not modeled growth and taught growth, then we have not done any real rehabilitation work.

I know this concept of “soft institutionalization” is a difficult one and I do not feel I have totally explained myself on this topic. It is another “work in progress” in which I am still growing.

 

The Real Work

There is one thing in this world that you must never forget to do. If you forget everything else and not this, there’s nothing to worry about; but if you remember everything else and forget this, then you will have done nothing with your life.

It’s as if a king has sent you on a journey to do a task, and you perform a hundred other services, but not the one he sent you to do. So human beings come into this world to do particular work. That work is the purpose, and each is specific to the person.

You say, “But I spend my energies on lofty enterprises. I study jurisprudence and philosophy…and medicine and all the rest.” But consider why you do these things. They are branches of yourself…but remember the deep root of your being.

(Rumi)

Thoughts From the Clinical Director: When is Enough Enough?

[Isn’t this interesting! For this fortnightly installment I went back to my first draft I wrote when I first thought about this project, June 11, 2012 – one year ago! It is interesting to read this now, to look back at where we were and at how much great work we have already done addressing some of these issues. For that opportunity to look back, I won’t edit this, so please bear in mind that you are reading something written one year ago. I’ve made a few small comments, in brackets, in the text, but otherwise it is what I wrote one year ago this month. Special thanks for the poem that Sue Bailey supplied when she realized that it was by the same author of the poem about the spontaneous community that sprang up around the distressed Palestinian woman in the airport lounge.]

This is the first in what I am hoping will be a series of weekly thoughts from me about our work at Buchanan. I know that we are all very busy and that we all work very hard. I know that our daily work is often so crisis-driven and that we all have so many meetings, that we don’t have the time and opportunities to sit down and really talk together about our work. I am working on creating the time and space for such important discussions through the Recovery Forum, the working groups on Substance Use (AOD) and on the Recovery Culture; and I know we really need a planning day as soon as we can get that organized – however, it just seems that this isn’t enough, what more is needed and what more can I do? Until we can have these dialogues in person, maybe sharing my thoughts with you can help you to understand what I wish for – for Buchanan. Maybe this can get us all starting to think about how we do things and what is working well and what could work better.

Please do not feel obligated to read these messages. I offer them with the hope that they will be supportive and promote dialogue; I don’t want them to be just one more thing that you have to read during the week. I am writing these messages as much for myself, in order to get some clarity, as I am for the benefit of anyone else, but I hope that you find something for yourself and our work together in them. Some of these initial messages may be a little long, but I am sure that many weeks will just have a short thought or an inspirational quote.

When is Enough, Enough?

We all go through our days trying to do the best that we can. Yet, often it seems that something more is needed. Things don’t always go smoothly, systems need to be tuned up – just as cars need routine maintenance. What we did before was good, but what needs to change as we change [our clientele changes] and as systems change around us?

Sometimes I find myself asking the question: “Am I doing enough?”  “Is there something more that I could be doing, or should I be doing things differently?”  When I answer that there is more that I could or should be doing, I push harder, I try new things, I rush to get everything done so that I can get to the real work that needs doing. Sometimes in my work, I feel like I am so busy doing things that come up all day that I never have time to get “my” work done. I recently came across this quote below that I thought summed this up and I wonder if you relate to it the same way I do.

“As work turns into an ongoing series of emergencies, our efforts to achieve our major goals give way to damage control. Time is spent in stop-gap measures: putting out fires, plugging leaks, and filling cracks. There is no possibility for creative action or for enjoying the flow of productivity because all our resources go into catching up, repairing mistakes, and adjusting plans. The cycle is self-perpetuating: We do not have the time to make a good plan because our time is taken up dealing with the flaws in the old plan; we cannot clear up our communication because we are processing emotions stirred up by previous communications,” (Tarthang Tulku, Mastering Successful Work, pages 31-32).

Can you relate to those words?

How can we change the feeling that no matter how hard we work, it seems like it is not enough? (I am assuming that you relate to at least some part of this). As individuals, we can decide that enough is enough, that we aren’t putting in any more effort because we don’t feel that we are being recognized for our efforts, or that we feel we are already putting in too much. Sometimes this is necessary as a boundary or of recognizing our human limits, but we have to be careful that it is also not a sign of burnout, hopelessness [for ourselves, our jobs, or even the clients we work with], giving up, withdrawing, going through the motions, or even quitting.

There is another way when we reach this point, and that is to re-evaluate our expectations, our systems, and where we are putting our energy. This can be an evaluation as an individual, or it can be an evaluation of the system in which we, as a group of individuals, are working. As individuals, it takes time and space in order to be able to take a deep breath, to be able to see and understand our situation clearly, and in order to make decisions to change the way we are working on a day to day basis. This may mean looking at what really matters, what is important to us in our work, and what our needs are. Tony Schwartz and colleagues, in the book The Way We Are Working Isn’t Working, write that everyone has physical, emotional, mental, and spiritual needs, and that contrary to the way jobs have been set up in the past, that for an individual to be the happiest and most productive, these needs actually need to be addressed at work. This doesn’t mean that work is the only place in your life that you address these needs, but that in order to not only do your job, but also to feel replenished, valued, stimulated, and rewarded in your job, that we need these elements in our work. (Perhaps in another column, I’ll go into these four needs in more depth).

As individuals working together in a system, we need to look at how the system is structured to see if it makes our work easier or more difficult. We also need to look at other people around us, our friends and colleagues, to see if we can support them in getting their work done. I know that when I feel stressed, burnt out, over-worked, the last thing I want to do is look for more work, but in the business we are in – working with people to support them in their recovery and rehabilitation – the outcome for a client depends on all staff being able to do their jobs effectively. The other really important way that we, as individuals working in a system, can greatly affect our individual work, is by stepping back and looking at the structure of the system. We as individuals may not have created the system, but how we work every day maintains the system. Systems are full of complexity, however, and changing one aspect of a system often has unforeseen consequences, but this isn’t a reason not to evaluate and change systems when necessary, it is just a challenge of working with systems. The benefit of going through the change (which is hard work, just as any kind of therapy, recovery, or rehabilitation is hard work) is that putting in more energy, doing a little more, up front leads to our work becoming easier, more rewarding, more effective, and more productive down the road. In a way, changing a system is an investment of energy in the present that pays dividends in the future.

These are some questions that I have been asking myself, in my work, and in our work together:

How can we work better as multi-disciplinary teams, in such a way that we are better supporting our clients in their journey, and that we are happier in our work with clients and with our colleagues?

 

How can we feel more supported and valued in our daily work?

 

How can we keep our eye on the big picture, on what is really important for both ourselves and the clients we work with?

 

How can we change the system so that it feels more like we are all pulling in the same direction?

 

We have choices as individuals in deciding when we enough is enough. If things feel too hard; if it seems we work and work and work, and yet, it seems to have no effect; if we start to feel like it just isn’t worth it – that enough is enough – then we make have hard choices to make: we can do less, we can go through the motions, we can even quit, and quitting can take many forms, including just doing the bare minimum and going through the motions. However, I would like to offer another choice, and that is to re-evaluate our daily work as individuals and the functioning of the system that we are maintaining every day. If we change, the system changes; if we change the way the system functions, we can change the nature of our work every day.

I invite you to re-evaluate the structure of the system where we work:

How can we bring more of our natural caring and compassion into our work?

 

How can we nurture and support that part a client that wants to change and grow?

 

How can we make our work less stressful?


How can we improve our working relationships with our colleagues?

One way of doing this is a programme called “Releasing Time to Care,” developed in the National Health Service in the UK. We will most likely be using this as a framework for change where we work [this may happen in the future, but it is a complex, lengthy process and there are no immediate plans to implement this]. I will write more about this program in the future, but my understanding of it is that it can be applied in a way that is consistent with the recovery and rehabilitation model that we use with clients. I believe that we can only create an environment supportive of recovery and rehabilitation for clients if we are able to create the same environment for ourselves. Perhaps we can use this programme, as well as any other existing programmes, or even programmes that we create that are particular for our work, to support our daily work, so that we can feel energized by our work, valued for the work we do, intellectually stimulated and engaged in our work, and to feel that our work is purposeful and has profound meaning.

[Doesn’t it seem like I should have written something about when “enough is enough” with working with clients and we decide to move them on from BRC? I thought I wrote something on that, maybe we’ll have a part II of “When is enough enough?”]

Kindness

Before you know what kindness really is

you must lose things,

feel the future dissolve in a moment

like salt in a weakened broth.

What you hold in your hand,

what you counted on and carefully saved,

all this must go so you know

how desolate the landscape can be

between the regions of kindness.

How you ride and ride

thinking the bus will never stop,

the passengers eating maize and chicken

will stare out of the window forever.

Before you learn the tender gravity of kindness,

you must travel where the Indian in a white poncho

lies dead by the side of the road.

You must see how this could be you,

how he too was someone

who journeyed through the night with plans

and the simple breath that kept him alive.

Before you know kindness as the deepest thing inside,

you must know sorrow as the other deepest thing.

You must wake up with sorrow.

You must speak to it till your voice

Catches the thread of all sorrows

And you see the size of the cloth.

Then it is only kindness that makes sense anymore,

only kindness that ties your shoes

and sends you out into the day to mail letters and purchase bread,

only kindness that raises its head from the crowd of the world to say

It is I you have been looking for,

and then goes with you everywhere

like a shadow or a friend.

Naomi Shihab Nye

Thoughts from the Clinical Director

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