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Dividing People into Parts: What the Medicine Wheel and Science Have to Say Ann N. Dapice, Ph.D. Zarrow Mental Health Symposium—September 2005 Humpty Dumpty sat on a wall. Humpty Dumpty had a great fall. All the king’s horses and all the king’s men. Couldn’t put Humpty together again. (**HUMPTY SLIDE) In the news there were differences of opinion regarding Humpty’s fall. Sociologists said that given crime statistics Humpty was probably pushed off the wall. Psychologists said he had most likely repressed his feelings, become too weighty from unexpressed emotions to stay balanced on the wall. Psychiatrists said his plight was probably related to a chemical imbalance of genetic origins. Physicians said it was clear Humpty had a history of muscular-skeletal problems, but in any case, the internal injuries and broken bones were too great to repair. Spokespersons from the local clergy said it was obvious that his fall was due to moral weakness and he should have just “surrendered himself to God.” The only agreement found among the professionals was that Humpty did in fact fall and that none of them knew how to put him together again. And so, like Humpty, we are a people divided—individually and collectively. As individuals, our physical bodies are divided into parts we call organs—brains, hearts, lungs, stomachs, kidneys, etc. These organs often compete in importance with each other when treated by different specialists. As collectives we are divided into clans and tribes, groups that are ethnic, racial, political, religious, and socioeconomic, and nations recognized by some and not by others—all competing for the same limited resources: land, air, water. Although you wouldn’t know that when looking on from afar.(**EARTH SLIDE) There are institutions to help us—family, schools, religions, hospitals, for example, with their related roles: parents, teachers, clergy, physicians, nurses, nutritionists, and so forth. So we hapless Humpties trudge from one specialist to another in attempts to be put back together again—assuming we have health insurance and fewer and fewer of us do. If we do not, we find ourselves joining the many who fall through the cracks. The various specialists do what they know, too often forgetting systems theory that says if you tinker with one part it may well affect another—known well to all of us as treatment “side effects” that we hear endlessly from soft melodious voices coming to us from the television. We Humpties are given a variety of diagnoses by as many experts, diagnoses like —metabolic syndrome or chemical dependency. Is anyone here in the audience not dependent on chemicals? The last I heard our bodies require all kinds of chemicals to survive. So we often self medicate in a vain attempt to feel like we’re together again. We Humpties go to drug stores, liquor stores, smoke shops, and the internet—where we can get almost any drug we want without a prescription or the inconvenience, or danger, of a street corner “pusher.” And don’t forget restaurants and grocery stores where we no longer eat to live, but live to eat, giving rise to our latest “epidemic” substance abuse. We are thus a nation of substance abusers writ large. Not only do we abuse our own bodies, but as individuals and nations we abuse the body that nourishes us and sustains us all—the earth. As professionals we ignore the old spiritual that says, “the head bone’s connected to the neck bone, the neck bone’s connected to the back bone, the back bone’s connected to the…”—notice I said “old spiritual,” it’s curious that the information given by the “spiritual” is anatomical! Yet in every Psychology I textbook are pictures showing that in the sympathetic and parasympathetic nervous systems the brain, eyes, heart, lungs, stomach, pancreas, gall bladder and bladder are all connected. The release of noradrenalin stimulates the heartbeat, raises the blood pressure, dilates the pupils, trachea and bronchi, stimulates the conversion of liver glycogen into glucose, shunts blood to the skeletal muscles, brain and heart in preparation for “fight or flight” which we will discuss below. We are, as individuals, all related. And now to the medicine wheel. (**MEDICINE WHEEL SLIDE) As Clark will tell you in his presentation that follows, there are a variety of medicine wheels used by different tribes for different purposes. What Indians call the medicine wheel is a universal symbol known in psychology as the Jungian mandala—a symbol of wholeness. The particular medicine wheel that we use at T. K. Wolf includes all races, all life—including two-leggeds, four-leggeds, winged things, plants and medicines. All are considered sacred and equal. This is related to the philosophy of Mitakouye Oyasin, a phrase that comes from a Lakota prayer which translated means, “All my relations” or, “We are all related” Tinker, G., 1996). The scientist and Pulitzer Prize winner E. O. Wilson (1984), states that we humans are hard wired to the natural world with an innate affiliation with other living organisms made necessary by our dependence on the earth for survival. Eric Fromm (1976) wrote about a mode of being versus that of having where we experience a profound kinship with nature. The Medicine Wheel includes all directions and the four aspects—mental, emotional, physical and spiritual. No one aspect is complete. It combines Eastern and Western philosophies. Eastern philosophy tends to be cyclical with the sense that what has been will be, where change is not possible. Western philosophy assumes linear cause and effect and is interventionist. Thus the Medicine Wheel includes cycles, seasons and passages, but also assumes that change can and will occur. Through the Medicine Wheel we learn that if we focus on or become stuck in the mental, emotional, physical or the spiritual we lack wholeness in all aspects. It is important to work on achieving health, positive change and growth in each aspect for balance and wholeness. What is mental, emotional, physical and spiritual? The immediate problem to address is: When is something mental, emotional, physical, or spiritual? The mental aspect. If you notice, we talk about mental health and illness when we are often referring to emotional symptoms. When we say mental, do we mean cognitive and affective, or do we include both under that term? When we say mental, do we mean “mind?” And by mind, do we mean brain? A number of philosophers have long distinguished between mind and brain, saying that the mind is not limited to the brain. When we say mental health do we mean how well students learn in school, does their learning occur in a healthy way that includes understanding, and not just rote memory? Do we mean that school teachers and educators are the professionals in charge of mental health? Clearly, cognitive health is not generally understood to be the same as mental health, but it is a major human need. And, school teachers are increasingly becoming involved with what we typically call “mental health” problems, never mind those of cognitive health. We loosely use the word “head” to mean both brain and mind. Are they the same? The emotional aspect. Is emotional the same as mental health? We hear people say that they are speaking from their hearts and not their heads, or that someone responds rationally, not emotionally? What do they mean? What is an “open, sharing heart? We generally understand the use of “heart” in terms of emotions versus that organ that beats in our chests without which we have no life. If one is “sick at heart” what does that mean? Most would understand that to mean emotional distress. In the eighties I taught a nursing student who wrote that she loved to take care of “sick hearts.” When she described a patient returning from the operating room after surgery, she referred to the “sick heart” lying on the stretcher. I had visions of a heart struggling to beat on a stretcher—no person attached. This is similar to conversations heard in hospital elevators where physicians and nurses refer to patients as the “gall bladder” in room 202. People suffering from panic often think they are having a heart attack. The physical aspect. Haven’t we already been talking of the physical? Where exactly are the head and heart located if not in our physical bodies? As we noted above, the organs in the human body are all related anatomically and physiologically. We know that when people have physical illnesses, both acute and chronic, they often have emotional and cognitive problems as well—even if these are time limited—as in acute illness. We once thought that people only became depressed when physically ill because of their illness or pain, we know now that depression can be one of the early signs of a “physical” illness. We have organs of perception—eyes, ears, noses, tongues, and skin. Yet, the interpretation of these organs remains in the brain and is given meaning from our experiences, cultures, religions—and physiology or pathophysiology. Long ago, our perceptions and experiences saw the earth as flat. It was only later that we would come to understand that the world is round and that it is the limits of our eyes that tell us otherwise. It is only in my lifetime that we have actually been able to see pictures of our “round earth” as taken from space (shown earlier). With microscopes and telescopes we now see what once was invisible. The spiritual aspect. When we come to the spiritual aspect, things become even more confusing. Our country, still dominantly Christian, often understands religion and spirituality to be the same—not that religion is an institution, like the family and other groups, that attempts to respond to spiritual needs. We talk of high spirited horses running in the meadow—and probably don’t mean that they are having a religious experience. A dog wagging its tail and licking the face of a family member is seen to be in good spirits. If it had been abused, it would most likely hide tail between legs and we would say that it is de-spirited, or has a broken spirit. Once upon a time, patients’ charts in hospitals had summaries that said they were in good—or poor spirits. However unscientific such records were, people understood what was meant. When we use the word “soul,” we are similarly confused, yet we understand when someone is said to be “soul-less” or to have a damaged soul. We even speak of music that has “soul” in comparison to music played in a mechanical way. Use of other related words such as “sacred” and “holy” has similar difficulties. What is sacred and holy to one may not be to another. Most people would willingly locate the mental, emotional, physical in the human body, but would be more conditional about the location of the spiritual. However, with brain imaging we can readily see parts of the brain that are activated when people are in states known as being “spiritual”—whether prayer, meditation, near death experience, or similar phenomena. Written scriptures speak of the body as a “holy temple.” Ways of knowing. We have different ways of knowing. **(Fog) Some six years ago, several of us were driving along Riverside Drive here in Tulsa. I said something about the fog that lay like a blanket over the river. My Muskogee Creek colleague began talking about the river and the temperatures—the scientific reason for fog. My Wichita-Caddo-Cheyenne colleague Clark said, “The Wichitas say that when there is fog, the relatives have come to visit.” A year or so later I was driving my teenage grandsons to school and we saw that on either side of Highway 75 were large patches of fog. I told my grandsons the Wichita story. One said, “Well why aren’t they all together?” The other answered, “They never got along well anyway.” Humor is even a way of knowing. I am knowledgeable about the scientific reasons for fog (mental aspect), but this knowledge doesn’t keep me from appreciation (emotional aspect) that my relatives have come to visit—especially those who have passed on. Fog is soft and falls gently around us—we can feel it with our senses (physical aspect). My own experiences of fog in Pennsylvania and New Jersey, home of my Lenape ancestors, are fond memories. Fog covers what you know to be there, that your senses give no evidence to. It is memory (mental or emotional) and hope (spiritual) at the same time. Fog is a metaphor for much that is life. Need for balance Because people spend time in one aspect, or even in all aspects does not mean that there is health. By genetics (nature) and experience (nurture), some aspects of the medicine wheel are more dominant than others. By Myers-Briggs Psychological Type, some choose to focus on the mental and distance themselves from anything emotional—also reinforced by culture in Western society. Some focus on the physical—telling you of every ache and pain, often in details that you’d prefer not to know. Some focus on the spiritual, avoiding the mental at all cost—and try to convince everyone of their beliefs and practices. We can become stuck in our areas of preference. In the T. K. Wolf office we have a Pendelton Medicine Wheel Blanket on the wall in the room where we counsel. We often point to one aspect or the other, and ask clients where they are stuck—where they are uncomfortable, where they fear to go. (**PEOPLE-WHEEL Campbell). Some hold onto the outside edge of the preferred area as in the slide, and continue to be bumped as life’s wheel rolls on. Thus we teach our clients the need to develop the non-preferred aspects for wholeness and balance as described by Carl Jung (1923). In the Medicine Wheel, as in psychology, the center of the wheel is where we need to be for centeredness and balance. For Indians, the center is where the Creator is. Divided we fall The strength of modern science is that it can isolate areas and study them intensely. The weakness of modern science is that, having isolated the parts, we often don’t, or are unable to, put them back together into wholes. I suppose that most of you have studied statistics, statistical designs and performed at least some numerical correlation equations. If you remember, r= stands for relationship or correlation. For those careful scientists, we are stressing relationship here, not necessarily cause and effect. Let’s look at some of the relationships from recent science in the news. Mothers pregnant on 9/11, who barely escaped attacks on the World Trade Center, were tested along with their babies when the babies were a year old. Both mothers and children had low cortisol levels (Yehuda, R., et al, 2005). This is not surprising since Eduardo and Bonnie Duran, in their book, Postcolonial Psychology (1995), write that American Indians experience intergenerational PTSD similar to that of survivors of the Jewish Holocaust. Not only did the survivors of the Jewish Holocaust suffer from PTSD but many of their children did as well, including lower cortisol levels—even though they had not directly experienced the events of the Holocaust. (Yehuda, R. et al., 1995, 2002). Also in the news and related to smoking during pregnancy, a recent study of 723 sets of identical twins and 1,173 sets of non-identical twins suggests a biological cause for anti-social behavior. Symptom scores for both anti-social behavior and ADHD increased with the number of cigarettes smoked by the mother. (Button, T., 2005). Relationships! Harvard researchers Martin Teicher (2002) and Carl Anderson (1999, 2001, 2002), who spoke here at the Zarrow Symposium two years ago (2003), have demonstrated through brain imaging technology that there are three major changes observed in the brains of adults who were abused as children: 1) Limbic irritability with increased incidence of clinically significant EEG abnormalities. 2) Deficient development of the left hemisphere of the brain (throughout the cerebral cortex and hippocampus). 3) Deficient integration of the left and right hemispheres of the brain with diminished development of the middle portions of the corpus callosum. These changes do not require actual physical damage but are most often the result of neglect, emotional, verbal, and sexual abuse. This changes the old nursery rhyme to, “Sticks and stones will break your bones and words will hurt you.” Anderson found that repeated abuse affects the blood flow and function of the part of the cerebellum that is “exquisitely sensitive to stress hormones” and regulates not only physical balance but also emotional behavior. This damage may cause an individual to be particularly irritable and to seek external means, such as drugs or alcohol, to quell the irritability. In his recent book, Nearness of Grace, Arnold Mandell (2005, p. 30), writes that exaggerated pruning of unused neural connections as a result of high levels of stress hormones, leads to an extremely reduced range of potential behavior which results in individuals “who lie without reason, get drunk, binge on promiscuity, steal unneeded things, or withdraw into interpersonal isolation.” Relationships! The National Institute of Drug Abuse (2002) has reported extensively the relationship of stress hormones that lead to drug-seeking behaviors by humans and animals alike. Researchers at the Scripps Research Institute in California (Koob, G., 1999) observed that heavy drinking not only depletes the brain’s supplies of neurotransmitters necessary for feelings of wellbeing and pleasure (dopamine, serotonin, GABA, and opioid peptides), but it also promotes the release of cortisol. This release of cortisol causes tension and depression which in turn causes the individual to drink more which leads to an ongoing vicious cycle. Never mind that EEG patterns are different in alcoholics and non-alcoholics (Porjesz, B., et al. 2002; Propping, et al., 1981; Pollock, V.E. et al.,1983; Begleiter, H., 2001; Begleiter, H., et al.; 1984. Begleiter and Porjesz, 1988, Tabakoff, B., & Hoffman, P.L., 1988; Volavka, J., et al., , Pollock, V., 1985)—differences that are present at birth in identical twins (Volavka, J., et al., 1985; Propping, P., et al.,1981), and that a reduced P300 wave is a good predictor of future alcoholism as well as relapse (Bauer, L., 2001). (**Brain Wave Picture) Yet we too often call addiction a disease, while treating it as a moral or spiritual failing. Would we say that lab animals have a spiritual disease? The mechanism known as “fight or flight” that allows people to protect themselves in emergency conditions becomes destructive when people cannot fight or flee, or when the stress becomes chronic. Cortisol, produced during these times, becomes toxic to the body and the brain, killing brain cells and leaving depression in its wake. Once there is a permanent state of stress our immune systems are impaired, our bone density decreased, our muscles weakened, heart and vascular diseases are increased, as well as our resistance to Type II Diabetes. Relationships! A just published study (St. Clair, D., et al., 2005) notes that women who go severely hungry during early pregnancy face twice the normal risk of having a child who develops schizophrenia based on studies of famine in China and Holland. Robert McCarley (2004), chair of the Harvard Psychiatry Department and his team have identified a fault in the brain waves of schizophrenics that may explain their hallucinations and disturbed thinking, noting the need to promote normal gamma response and that current anti-psychotic medications do not target brain wave patterns. Carl Anderson noted in a personal conversation a year or so ago that the amino acid, L-Glutamine, is missing in the brains of smokers, but not in the brains of those who can take or leave tobacco products. L-Glutamine also helps regulate blood sugar and related cravings for carbohydrates and alcohol (Mathews-Larson, 1991). A new study comprised of 2,273 teenagers exposed to cigarette smoke shows that they are at increased risk for metabolic syndrome, a condition associated with excess belly fat that increases the chances of heart disease, stroke and diabetes. If the teens themselves smoked, the rate nearly doubled (Weitzman, M., et al., 2005). Tobacco and obesity are the top two causes of preventable death (Tanner, L., 2004) and recent research demonstrates that brain circuits involved in drug addiction are also activated by the desire for food. The right orbital-frontal cortex is involved in compulsive behaviors characteristic of addictive states and this same brain region is activated when addicted individuals crave drugs such as cocaine. Food stimulation increases the levels of dopamine and when obese individuals were examined they were found to have fewer dopamine receptors. Fewer receptors occur in addiction to other substances (Brookhaven National Laboratory, 2004). It is, of course, important that food be satisfying for the survival of the species. Having fewer receptors increases the level of food intake, when possible, and this was once adaptive to prepare for winter months, or times of famine—and still is in some parts of the world today. Relationships! Food and tobacco are connected to other addictive substances in important evolutionary and physiological ways. Processes formerly necessary for our safety and well being that work together are 1) the so-called “thrifty gene” and 2) mechanisms for fight and flight. Our bodies and brains continue to function according to hunting and gathering needs appropriate thousands of years ago. The body stored food substances through the production of insulin in response to the ingestion of carbohydrates. This allowed for fat storage in the body for protection during the winter and times of famine. Similarly, the body and mind sought to limit the amount of energy expanded through physical activity. Thus one ate large amounts when foods were ripe and available and exercised only as needed for existence. The benefits of civilization have given us mass production and preservation of foods, tobacco and other substances through agriculture, the industrial revolution and global transportation. Substances such as tobacco, once rare and localized to a particular area, required first slave labor and then industrialized technologies to produce in amounts sufficient for addiction. Tobacco, once scarce and used for ceremony only, is now plentiful, used in addictive ways, and kills in large numbers worldwide. As it happens, its preservation, which includes large amounts of sugar, adds to its addictive qualities by appealing to the brain’s natural survival need for carbohydrates (Bennett, A. E., R. Doll and R. W. Howell, 1970). Relationships! We are related both internally and externally. What we do affects, and is affected by, others. (**BACKDROP MEDICINE WHEEL) I’m showing the medicine wheel model we use working with American Indians. But you’ll see that different groups will have similarities since we still have genocide, racism, poverty and other stressors, never mind war and threats of terrorism. Losses in the different aspects are seen as well. For Indians, elders are rapidly dying from diabetes and alcoholism. In our youth oriented dominant culture, our loss is evident as we appear to value plastic surgery more than wisdom and humility. While dominant culture’s educational research continues to demonstrate that experiential learning is preferred to fact based instruction, we too seldom implement it, especially when it comes to learning about and relating to nature. Americans are notoriously language illiterate. Without knowledge of more than one language, we suffer the loss of subtle understandings from other worldviews. In the emotional direction, dominant culture suffers from a different loss of identity than that of Indians. When we first opened our Indian organization, most of our clients were white. They told us they came to us because they didn’t have the culture and identity that we Indians have! Stress, anxiety, depression, and PTSD seem to be fairly well distributed among groups if for different reasons. We work and play increasingly indoors, with exercise removed from schools, except for competitive sports, where we build larger and larger stadiums. We suffer the related physical diseases. In the spiritual direction, we become confused between nurture of the spirit—and all spirits, and belief systems that cause us to war one with another locally in our religious congregations—and at national and international levels socially, economically, politically, and with a variety of weapons of destruction. When we look at the impact of genocide and terrorism on its victims, it’s important to pause to remember the words of Abraham Maslow who said, “..sickness might consist of not having symptoms when you should.” He continued, “Which of the Nazis at Auschwitz or Dachau were healthy?..Was it possible for a profoundly human person not to feel conflict, suffering, depression, rage, etc.” (1968, p. 7). (**Medicine Wheel in Practice) How does this translate into practice? As we work with clients we ask ourselves what will nourish and stimulate positive growth and change. Our clients come from a variety of ethnic, racial, socioeconomic groups and religions. Science and the Medicine Wheel both serve to remind us to address each aspect for balance and wholeness. Education and learning are important in all counseling. We explain the research our treatment is based on as part of counseling. We gear our counseling according to clients’ Myers-Briggs learning types. We have found that FDA sanctioned cranial electrical stimulation (electromedicine) works well for anxiety (Overcash, S. J. & Siebenthall, A.,1989; Schmitt, R. et al, 1986), depression (Passini, F. G., et al.,1976; Marshall, A. G. & Izard, C. E., 1974; Yudofsky, S., 1999), and PTSD, as well as cognitive damage from substance abuse (Schmitt, R. 1984, Smith, R., 1977; Smith, R., 1982). It has been studied in double and triple blind studies for several decades and since it does not have to cross the blood brain barrier has no serious or lasting side effects. It stimulates neurotransmitters and normalizes brain waves (Heffernan, M., 1997), including the P300 craving wave (Braverman, et al., 1990. It is inexpensive self-administered micro-current delivered by a 9-volt battery. It responds well to the science underlying conditions mentioned above. For our clients addicted to alcohol and tobacco with sugar cravings (Anderson, C. M., 2004), we encourage the sub-lingual use of powdered L-Glutamine which is available over the counter at most drug stores. In addition, we respond to the cellular needs for adequate nutrition, encouraging a diet that is low in carbohydrates, high in protein and omega 3 fats, all shown to be needed by the brain for healthy functioning (Mathews-Larson, J. & Parker, B., 1987; Mathews-Larson, J. 1991). We also encourage physical exercise. In our experience, clients who are depressed are not eager to change their diets or exercise, however once they use cranial electrotherapy stimulation and begin to feel better, they will then be able to change their diets and add exercise. Since we have an art therapist on staff, we use art therapy as it helps us understand the variety of meanings of life experiences on the lives of clients. As an Indian organization we teach interested clients about the Medicine Wheel and the importance of balance and wholeness regardless of their individual or group beliefs. Since the Medicine Wheel connects us to non-human life as well, we stress a re-connection and relationship to the nature that surrounds us. It is easy in our busy lives to miss the beauty of sunrises and sunsets, the spectacular show of a thunder and lightning storm, and the vibrant life all around. Knowing that all too many people use ceremony and religious beliefs in a negative way, we encourage clients to seek practices that nourish their spirits in a positive way that is not addictive, compulsive or destructive. We teach and encourage moral and faith developmental theory from Lawrence Kohlberg (1984) and James Fowler (1981) that causes people to seek experiences, not limited to self interests, but those that will help them seek to serve all others. Finally, for too long, we have ignored genocide, oppression, racism, rape, and abuse in our midst, with the resulting destruction of minds, bodies and spirits described above. Instead, we like Freud, have bent under peer and political pressure, choosing to believe that people are only imagining what happens to them—as when people reported after Katrina that they had no food, water and plumbing, which was then denied by top officials. When we as professionals have eyes but do not see, ears but do not hear what our clients tell us, it doesn’t matter how many credits we accumulate in ethics workshops, we are weighed in our out of balance state and found wanting. These are matters of justice—and dare I say righteousness. We healers must heal ourselves for the healing of others, because, Mitakouye Oyasin, the air we breathe, the waters we drink, we are all related! Wanishi! (For references, contact author via this website.)     Thank you to Active iNet Services for hosting this website.    visitors since March 9, 2006