Lewis Mehl-Madrona, MD, PhD, MPhil, has studied indigenous doctoring with traditional North American healers for over 30 years and incorporates these approaches in his medical practice, and in workshops in which he guides others to explore indigenous methods and perspectives. In his books Coyote Medicine, Coyote Healing, Coyote Wisdom, Narrative Medicine, and the upcoming Narrative Psychiatry (slated for July publication), Dr. Mehl-Madrona describes and supports, with impressive rigor, the importance of a person’s whole life story to their health—not just the medical history, but a story that includes ancestors and friends, interests and spiritual orientation, and myriad other influences including unseen relationships in the purview of quantum physics.
A graduate of Stanford University School of Medicine, the Psychological Studies Institute in Palo Alto, California, and Massey University in Palmerston North, New Zealand, Dr. Mehl-Madrona first perceived the need for a parallel path to biomedicine in 1973, when, in medical school, a professor asserted that “life was a relentless progression toward death, disease, and decay. The physician’s job is to slow the rate of decline.” Mehl-Madrona quickly found a Cherokee healer with whom to study, and has continued learning from indigenous elders ever since.
“It’s not too late to acknowledge the merit of indigenous perspectives for the modern world,” Mehl-Madrona says in Narrative Medicine. “In the indigenous worldview, for example, each person is the sum of all the stories that have ever been (or ever will be) told about him; the idea that our identity is formed from telling ourselves these stories leads us to realize that each person is unique and must be approached individually to discover how he will heal.” As a doctor, Mehl-Madrona helps patients discover their own stories of illness, and create ones of healing to pull them forward to recovery. He may also recount stories he has learned from the patient’s ancestral heritage that parallel his patient’s struggles. Through metaphor, these stories help create a context of hope and a path to wellness—features that often are lacking from the “story” patients get from mainstream medicine based on statistics and life expectancy tables.
Dr. Mehl-Madrona also encourages and teaches ceremonies, based on indigenous practices, to immerse the patient in a culture of community and spiritual support for healing. Again from Narrative Medicine, “Ceremony is an important part of how I work to help people transcend limitations. Like healing, ceremony should be seen as a verb that submits us to a process of transformation, and not something that has efficacy in the way of a drug or a surgery. Ceremony provides the context from which we dialog with the Universe, with angels, spirits, ancestors, and the Divine. It guides us into the work of the soul and its healing—providing a road for personal and spiritual transformation as well as community revitalization. Ceremony gives us a path to follow away from our limitations.”
Dr. Mehl-Madrona is at the forefront of bringing narrative medicine to mainstream medical practice, but others are beginning to incorporate story and indigenous techniques into healthcare, and in the fall of 2009 Columbia University Medical School will begin offering a master’s degree in Narrative Medicine. “Through narrative training, the Program in Narrative Medicine helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues,” says the program’s website (www.narrativemedicine.org).
From May 8 to 10, Dr. Mehl-Madrona will be at the Center for Creative Education in Stone Ridge offering a series of public events: on May 8 at 7:30pm, an overview talk; on May 9 from 10am to 6pm, “Coyote Energy Healing, Indigenous Doctoring”; and on May 10 from 9am to 3pm, hands-on “Cherokee Bodywork,” concluding with a sweat-lodge purification ceremony at 3pm.
In anticipation of the weekend workshop, I caught up with Dr. Mehl-Madrona by telephone to ask a few questions. Some key points of that conversation follow.
The full meaning of “narrative medicine,” or a “storied” approach to medicine, becomes apparent through reading your books, but could you give our readers a short version of what you mean by “narrative medicine”?
Narrative medicine is the encompassing of our awareness of health and disease into a storied structure. We embed the illness into the life story of the person in such a way that we discover meaning and purpose in both the illness and the experience of recovery. And we come to a new respect for the illness, in the context of the life that it appears in.
It’s hard, sometimes, to give a simple definition, but in a diagnostic sense, the labels of sickness become second to the life of a person that has a particular sickness. Within the context of healing, in order for a person to get well, there has to be a story that everyone believes that leads them back to health. A friend of mine, when she was 20, was on the Navajo Reservation for the first time, and went way into the hills to do a [healing] ceremony with a traditional Navajo healer, who was probably past 100 years old. At the end of the ceremony, she asked him if this would work for white people. He said no. She asked why not. He said, because they don’t believe it will work. She asked if it would work if they believed it would, and he said, sure. That really captures it.
Someone’s belief about their illness, and about how they can get better, has actually been shown to make a difference in their outcome. In your books you describe studies that support this.
Cleary, the character of the person who has the disease is important. That seems like such a no-brainer. But it can be a huge leap for my colleagues to realize that the person is as important to the outcome as the histology of a biopsy in the laboratory, maybe more important. They are used to the notion of disease being independent of people who have it. Much of the research has been misdirected in looking for specific isolated traits [of patients] to predict recovery or healing. But it is looking at the illness in the context of the whole life that is predictable. A study done in London found that acupuncture works best for Chinese people born in China, second best for Chinese people born in London, and least well for people in London who were not Chinese. Chinese people who grew up with the practice of acupuncture had the best response to it. They believe in it.
In a study of cancer patients, observers who didn’t know a patient’s outcome watched the patients tell their cancer stories, with all the medical data taken out. The people who watched the stories could predict with 96 percent accuracy which of the patients had recurrence and which didn’t. It wasn’t clear how the people could predict this, but they were using some aspect of the story—the feeling tone, the plot—somehow they could take in the stories and figure out the ending. It was mind-boggling, how good they were at it. It’s something we all understand on a deep level, sensing from our awareness of story what the most likely outcome will be.
When we talk about the placebo effect, it’s misnamed. It should be called the faith response; you heal because you believe. Like Jesus said, with enough faith, you can move any mountain. Another way of saying that in a more scientific way is to say that whatever you do to get well, it has to fit into the story you have about how people get sick and get well. I suspect that the stronger our commitment to a particular worldview, the more difficult it is to heal.
Given that many of us have grown up with the belief system that when we are sick, we need to go to a Western-trained medical doctor and take pharmaceuticals or whatever treatment is recommended, how do we open to believing that a different way of healing will work?
In the approach I take, first I would work with a patient in such a way as to be really clear about what their story is—what the sickness means to them. Once we’re aware of their story, then probably I would use guided imagery or hypnosis to begin to explore how we might plant the seeds of other plausible stories. I would probably also do some sort of bodywork or body awareness, to explore how the story is embodied—how it is held in the tissues. I don’t know if the person would change, but that is how I would begin the exploration. I might also get together a meeting of everyone that person knows, to explore the range of possible stories in their community. You can’t change your story too far from what other people around you believe.
But what do you do if family and friends are not into alternative ways of healing, and only believe that modern, Western medicine will work?
I would have a talking circle with everyone, trying to explore what we can negotiate as possible and acceptable, in hopes that there is some middle ground, and to see where the wiggle room is. Because if nobody will buy into the story [of an alternate healing method], it’s going to be really difficult. Sometimes people go to an alternative practitioner just to satisfy someone else. People sometimes come to me, late in the game, in order to say to some loved one, “See, I went.” But, of course, it won’t work.
I was interested to read that while you have witnessed among your patients healings that can’t be explained by conventional medicine, and you have researched many other cases, you aren’t promising that you can cure people.
“Sudden miracle” stories do exist, though my colleagues like to look at them as outliers. But I see them as what we are capable of, what can happen. To the extent that we study the stories, we’ll begin to learn more about miracles. I certainly don’t know enough that I could do a randomized, controlled trial to produce miracles, though I know they happen, and the stories are qualitatively different for people who go on to survive than those who don’t.
I never deny the possibility of miracles, because I think they exist. There are some people at the top end of the survival curve who live many years with whatever cancer or illness we’re talking about. I think it’s terribly unscientific for a physician to tell people how long they have to live, because we don’t know. Why should we terrorize you with the mean lifespan of people with your illness when you might be one of those who lives a very long time? It’s a terrible thing, to tell people when they should die.
But I don’t imagine a mainstream doctor is going to start using a storied approach, or encourage patients to believe in miracles, any time soon.
Western medicine has been involved in constructing stories, too, from the beginning of time. We have theories, which are stories about how people get sick and get well. Historically, until 17th-century France, physicians had always placed the illness in the context of the person who has it. But since the 17th century, when autopsies were begun [and damaged organs were seen], the story shifted to placing the illness in an organ instead of in a person. In either view, the pathological changes are the same. In the first story, the changes in the organ are a result of the person’s whole life story. In the second story, the contemporary story, the suffering is in the internal organ of the person. Both are just stories. We are arrogant enough to believe that today’s story is the truth. But in Western science the story changes every few years. Today’s truth is tomorrow’s error. We don’t have any facts, just stories that we are continually changing.
A point I am trying to make to physicians is that they need to understand that the natural science perspective is not borne out by research—we can find people who don’t die on command, who get well when they’re not supposed to, who don’t do the suggested treatment and get well anyway. So our theory that a disease has a certain natural history is incorrect.
For me the first shift [needed] is to respect the story of the people who are sick, and be more respectful that their physiology might follow their story more than their doctor’s story. People who survive against all odds according to Western medicine show that the doctor’s story sometimes is not right, and the patient’s story sometimes is.
You make it clear in your writing that the process of telling one’s story is, in itself, a rich and valuable process.
I think it seems fairly universal that at the end of life we all like to feel like we had meaning and purpose. It’s easier to die then. Much of what goes on around people who are dying is the preparation of story, to allow everyone to agree that the person’s life had meaning—with the funeral being the culmination. So we might use video, photos, or have people write stories about the person, and that’s so much better done when they are still alive. Especially when it’s a younger person, parents can prepare stories about losing their children, and that it has some higher purpose or value, in order to move on and keep going. It’s so much more valuable to do that when they are alive.
Sometimes when people come for the magical cure, which I can’t give them, or if someone manipulated them to come and see me, which won’t cure them, I end up doing this other work, which is incredibly valuable and important. The beauty of the narrative approach is in people getting to tell their story, to speak their life and make sense of it.
Dr. Lewis Mehl-Madrona will conduct an experiential workshop exploring indigenous techniques of healing and a sweat-lodge ceremony on the weekend of May 8–10 at the Center for Creative Education in Stone Ridge, call
(845) 247-8839; www.mehl-madrona.com.