Body, Soul, Survival

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University of Washington, Seattle. Photo credit: Josephine Ensign/2017

“Health is politics by other means,” asserts Columbia University professor of sociology Alondra Nelson in her fascinating book Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (Minneapolis: University of Minnesota Press, 2011). Nelson acknowledges that her statement is inspired by French philosopher and scientist Bruno Latour’s assertion that science is politics by other means. For anyone who ever doubted either of these assertions—or thought they were alternative facts—you must live in the Land of Narnia.

Before reading Nelson’s book I knew that Black Panther Party for Self Defense had created community-based primary care health clinics in many major U.S. urban areas in the late 1960s/early 1970s. But I did not understand the true breadth of their healthcare activism. I worked as a nurse practitioner for about six years at Seattle’s Carolyn Downs Family Medical Clinic , originally formed in 1968 as a Black Panther clinic. It is located in the Central District of Seattle, a traditionally black neighborhood that is now significantly gentrifying. It is named after an early Black Panther community organizer, Carolyn Downs, who died at an early age of breast cancer—something that most likely could have been detected and more effectively treated if she had had better access to the primary care now provided by the clinic she helped develop. A highlight for me of working at Carolyn Downs Clinic was being able to care for one of Carolyn’s granddaughters.

The Black Panther Party for Self Defense was formed in Oakland in 1966 as a survival tactic “to afford protection for poor blacks from police brutality and to offer varied other services to these same communities.” (pp. 5-6) These services included the establishment of no-cost community-based primary care clinics, sickle-cell and blood pressure screenings, free breakfast programs for children, and after-school and summer tutoring programs. They also formed teams of patient advocates who accompanied their patients to hospitals or specialty care, heralding our current system of patient navigators. The Black Panthers were also instrumental in challenging the formation of the Center for the Study and Reduction of Violence at UCLA, a research center backed by the California governor Ronald Reagan, and which promised to find the origins of violence. It was to be headed by psychiatrist Louis Jolyon West, whose previous research included experiments with sleep deprivation, LSD, and correlating the era’s student activism with antisocial behavior. (pp. 153-154) The Black Panthers contended that aggression for people within marginalized communities was a legitimate response to oppression. They, along with many other activists, were successful in blocking funding for this center.

The American Journal of Public Health (AJPH) dedicated its entire October 2016 special edition issue to the public health work and legacies of the Black Panther Party. As physician and AJPH editor-in-chief Alfredo Morabia writes:

“Now that a new generation is carrying on the ideals of the health activists of the 1960s, it is time to revisit this history, understand the strengths and weaknesses of the BPP public health initiatives, and have a frank debate about what really happened. The stakes are huge for an emerging generation unwilling to accept that certain lives matter less than others, and that, as the recent massive lead contamination of the Flint, Michigan, water system shows, many poor (and Black) communities still remain defenseless against such overtly aggressive assaults to their health in a context in which, as Angus Deaton puts it, the infamous one percent is not only richer but much healthier.”

Read more in this AJPH special issue: http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303405

Additional resources:

The Seattle Black Panther Party History and Memory Project, part of the University of Washington’s Seattle’s Civil Rights and Labor History Project, led by UW professor of history James Gregory—contains videotaped oral histories, historical photographs and news coverage and more.

 

Commit to Mental Wellbeing

 

As we begin a new year, my wish is that we commit to mental health and wellbeing. This should start with our own individual mental wellbeing, but we need to use that as a base for supporting the mental wellbeing of our families and our communities. In the midst of so much turmoil, anxiety, bigotry, misogyny, and xenophobia in our country and our world, nurturing mental wellbeing is not a luxury—it is a necessity.

An essential ingredient for mental (and physical) health and overall wellbeing is social inclusion and a sense of belonging to a caring community. The adverse health effects of increasing population-based levels of social isolation and loneliness are now being highlighted. Dhrav Khuller, M.D. writes in “How Social Isolation is Killing Us” ( NYT December 22, 2016) that social isolation and loneliness, is linked in recent studies to a 29% increased risk of heart disease and a 32% increase in stroke.

Objective measures of social isolation include quantity and quality of social network ties, as well as living situation (living alone, whether housed or homeless). Loneliness is a person’s perception of social isolation and is, therefore, a subjective measure. Researchers point out that loneliness and social isolation are often not significantly correlated even though we commonly think of them as such. A recent large meta-analysis (a study of research studies) that included 70 independent prospective (following people longitudinally) studies representing 3,407, 134 participants, revealed a significant effect of social isolation—whether measured objectively or subjectively— on mortality. The researchers for this study also found that the largest detrimental effects of social isolation were for middle-aged adults as opposed to older adults. They call for social isolation and loneliness to be added to lists of public health concerns. (See: “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review” by Julianne Holt-Lunstad, et al. in Perspectives on Psychological Science, Vol 10, issue 2, March 11, 2015.)

In the U.S. we are good at doing yet more research documenting the adverse health effects of social isolation and loneliness; we are not so good at finding constructive and sustainable ways to intervene. Many industrialized countries, including the U.K., Australia, New Zealand, Spain, and Canada are way ahead of us in terms of implementing cost-effective, community-based interventions. (See: “Researchers Confront an Epidemic of Loneliness” by Katie Hafner, NYT September 5, 2016.) In the U.K. there is the Campaign to End Loneliness. In New Zealand there is the public mental health campaign that I love: the All Right? campaign implemented in the aftermath of the Christchurch earthquakes. And addressing gendered issues, there is the Men’s Sheds movement that began in Australia and has since spread to the U.K., Ireland, Canada, and New Zealand. Another lovely and creative community-based solution I learned about this past year is the Art Hive (La Ruche d’Art) in Montreal, as well as in many other communities, including in Spain. My other wish for 2017 is that we learn from these sorts of programs and find ways to implement them in our own communities.

** A note on my (intentional) spelling of wellbeing as one un-hyphenated word: I find it both fascinating and telling that all English-speaking countries except the U.S. have moved to the use of “wellbeing” instead of the Americanized “well-being.”

Home Is…

p1020046What is the meaning of home to you? What is the one essential ingredient of home? These are questions I pose to people in my workshops and talks on homelessness. I’ve adapted “The Meaning of Home” values clarification exercise that I learned from the (sadly, now defunct) Bay Area Homelessness Program, which was a dynamic collaborative of Bay Area universities and homeless-serving agencies. As they put it, the goal of this exercise is “to help participants understand the connection between home and humanity. It builds empathy for homeless people, shows the range of reasons why a person can become homeless, and shows the interconnectedness of human needs.” (Source: my copy of the exercise directions, dated September 1998).

Part of my adaptation of “The Meaning of Home” exercise is to give participants strips of colored paper (the size of a large bookmark), crayons, colored markers and pencils, and I ask them to write or draw (or both) their most essential ingredient—or essence—of home. And, if participants agree, I add their responses to a growing public art project I’ve named The Blue Tarp Tapestry. This is part of my ongoing digital humanities transmedia project, Soul Stories: Voices from the Margins, funded, in part by the National Endowment for the Humanities, the University of Washington Simpson Center for the Humanities, Jack Straw Productions, and 4Culture. (A special thanks to all of these.)

I highlight some of the participant responses here and today because they are especially pertinent to the season, the climate of our country, and the sort of community that people in Seattle seem to desire: safe, diverse, compassionate. Their responses also highlight the fact that, unfortunately for too many people, home is not a safe and cozy place. The photo above is a weaving I made out of responses to “The Meaning of Home” exercise. The photos in the slideshow below are some of the responses from recent workshops.

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My Homeless Shadow

IMG_1542“Most of us live homeless, in the neighborhood of our true selves.”
—Rachel Naomi Remen

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A few years ago, while working with Public Health– Seattle & King County on a medical respite project for homeless youth, my own homeless shadow resurfaced. I was in downtown Seattle at the YWCA women’s shelter, waiting inside the front lobby for the rest of our group to arrive. We were scheduled to have a tour of the facility to see how they ran their medical respite program. I’d taken the city bus and had purposefully dressed down in jeans, a sweater, and a raincoat. It was late afternoon, raining out- side, and I saw soliciting, pimping, prostituting, and drug dealing happening on the sidewalk in front of the shelter. The members of my medical respite group were buzzed in the front door. At the same time, a homeless woman resident walked up to me and asked, “Did you stay at a hotel last night on Aurora instead of here again?” Aurora Avenue is one of Seattle’s main prostitution areas. I looked up at her in alarm. “I’m sorry. You must have me mixed up with someone else. I’m not staying here, I’m just visiting.”

The people in my group overheard this interchange. Later, they teased me about it, saying how preposterous it was. I was a university professor, for God’s sake! There was no way I could be homeless, much less a homeless prostitute. But I couldn’t shake the feeling that my cover had been blown, that I’d been found out, that my homeless shadow was showing. You were homeless—why? What was wrong with you? Those are the questions people ask me—or want to ask me—whenever they discover I was homeless. Coming out of the closet about my own homelessness was never an option for me. It could derail my career, hurt my family, and marginalize me even more. It was largely why I had moved across the country to Seattle, to escape the memories of having been homeless in my hometown of Richmond, Virginia. But standing there in the YWCA shelter, I recognized the irony—and the hypocrisy—embedded in my reaction to the woman’s question. Here I was an outspoken advocate for people who were homeless, while secretly judging them, and by extension, judging myself.

Homelessness is exhausting and soul sucking. Homelessness has marked me. Like the star-shaped surgery scars on my belly, the body harbors secrets. Homelessness is a type of deep illness, a term coined by sociologist Arthur Frank for an illness that leaves you feeling dislocated, an illness that casts a shadow over your life. That shadow never completely goes away. At some point it was time to acknowledge my homeless shadow, time to remember.

Note: This is an excerpt from my recently published medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (Berkeley: SheWrites Press, August 9, 2016).

The Pebble in My Shoe

IMG_1805“I write about what most fascinates me right now,” said John McPhee, by way of Robert Michael Pyle, both amazing trail-blazers, or perhaps trackers, of that strange beast that is creative nonfiction. McPhee has written books on subjects such as oranges, the island of his Scottish ancestors, family doctors, college basketball players, the shad as Founding Father fish, and the history of the birch-bark canoe (my personal favorite). Pyle, who is also a biologist, a lepidopterist (butterfly expert), and founder of the Xerces Society for invertebrate ecology (saving our butterflies and bees), has written about butterflies and trees and Big Foot and life. My favorite contemporary female trackers of, or perhaps more fittingly, expanders of the boundaries of creative nonfiction are Terry Tempest Williams and Rebecca Solnit. When Women Were Birds: Fifty-Four Variations on Voice (New York: Farrar, Straus, and Giroux, 2012) by Williams and A Book of Migrations (London: Verso, 211) by Solnit remain two of my all-time favorite books.

Each of these great writers of creative nonfiction sweep us along on explorations of their own current fascinations, obsessions, questions–the pebbles in their shoes, as one of my writing mentors, Stephanie Kallos puts it so aptly. What is it that you carry with you, that at each step insistently reminds you of its existence? The pebble of obsession doesn’t have to be a large rock-sized, inscribed with the muse-whisperer one as shown in the photo here (my historian son made that for me a few years ago–coolest present ever!). But is should be of sufficient significance to be likely to matter to other people besides yourself.

My pebble, my obsession, is and has been for many decades now, the wicked problem of homelessness. I call it a wicked problem, not so much because it is evil or immoral (which I happen to think it is), but because it is so vastly complex a problem that it defies easy solution. Hence, all the well-meaning but expensive and time-consuming ’10 Year Plans to End Homelessness’ implemented (much more than 10 years ago now) in so many U.S. cities, and that largely failed. The term ‘wicked problem’ was coined by two UC Berkeley professors of urban planning, Horst W.J. Rittel and Melvin M. Webber, to describe difficult social policy issues such as poverty, crime, and homelessness. (Read their still surprisingly relevant journal article “Dilemmas in a General Theory of Planning” Policy Sciences (4), 1973, pp. 155-169.)

Rittel and Webber write, “As distinguished from problems in the natural sciences, which are definable and separable and may have solutions that are findable, the problems of governmental planning–and especially those of social or policy planning–are ill-defined; and they rely upon elusive political judgment for resolution. (Not ‘solution.’ Social problems are never solved. At best they are only re-solved–over and over again.)” (p. 160)

But who would we be, as individuals, as a society, if we didn’t even try? That is the core question, the obsession, the pebble in my shoe.

Going Home

IMG_7388I was born and raised and became homeless and then ‘back-out-of homeless’ in my hometown of Richmond, Virginia. Richmond, as the Capital of the Confederacy,  is a complex city with a complex history. I left Richmond in 1990, ostensibly to move to Baltimore to go to graduate school, but mainly to try and leave the ghosts of my past behind. But there’s that irritatingly true maxim of “wherever you go, there you (and your ghosts) are.” That’s why I researched and wrote my forthcoming medical memoir Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (Berkeley: She Writes Press, August 9, 2016). It was an attempt to make some sense of my past, of my relationships–including my relationship to the South that formed me.

For my book, in a chapter tilted “Greyhound Therapy,” I end with this paragraph:

“Here’s the thing: some geographical cures do work. Sometimes it takes radical change to get your life back. I wanted to move as far away from my birthplace of Richmond as I could get. It was a place I found disorienting. Once I graduated, I took a full-time academic nursing job in Seattle and I got my son back full-time. I also met a wonderful man, Peter, and his young daughter, Margaret, who have both become my family, my home. I can now revisit Richmond—for a short time—and not get lost.”

But then, in a recent essay version of “Greyhound Therapy” published in the Front Porch Journal, (Issue 32, May 2016) I added the sentence, “The real truth is I no longer return.”

Be careful what you write. Less than a month after I wrote that sentence I was back in Richmond, eating at my favorite restaurant there (Comfort), as a pitstop on my family’s cross-country road trip to Washington, DC. And today I found out that I will return to Richmond again this fall, for a Catching Homelessness book reading/signing at my favorite Richmond indie bookstore, Fountain Bookstore, located downtown in Shockoe Slip, an area with a sullied history of slave and tobacco trade. So for all of my friends and relations,  and former co-workers at the Daily Planet and Fan Free and CrossOver Clinics, and students/faculty/staff/alums of the Virginia Commonwealth University School of Nursing, and fellow members of the James River Writers Association, come on down to the Fountain Bookstore on Tuesday October 11, 2016 at 6:30pm and we can share stories of the meaning of home–and of homelessness. And of writing your way back home.

Safe Sleep Matters

IMG_8022Good sleep supports good health, including mental health. We’ve all experienced sleep disruption and sleep deprivation at some point in our lives. Pulling ‘all-nighters’ while cramming for exams in school. Being a new parent. Being a caregiver for someone ill or injured. Being a night-shift nurse or other worker. Times of insomnia. We know from experience that not getting enough sleep can make us cranky at best and dangerous to ourselves and others at worst (as with driving-while-fatigued). So why, as a society, do we insist on making it a crime for homeless people to sleep, or even to simply rest?

This morning, while walking my dog in my Seattle neighborhood, I passed a small public park where a man dressed in ragged clothes lay sleeping in the shade of one of our lovely Pacific Northwest conifers. It is a hot day, and it gladdened my heart that when I passed him again several hours later on my way home, someone had placed bottled water near him–and he was stirring, reaching for the water. And no police officer was shooing him away. An increasing number of cities are criminalizing homelessness, including passing tough anti-loitering laws for public parks and sidewalks.

For anyone who has ever been homeless, or who takes the time to talk with and understand more of the lives of people experiencing homelessness, finding a safe place to sleep is one of the biggest difficulties. People who are homeless and are rough-sleeping are at great risk of being victims of crime, including of targeted hate crime (although homelessness is not a ‘protected’ category under federal hate crime laws). Whatever meager belongings they have are at risk of being stolen. Women are especially vulnerable to sexual assaults while they are sleeping or resting.

That is why I was heartened on my recent stay in Portland, Oregon to be able to visit the consumer-run nonprofit group Right to Dream Too. This is how they describe what they do and why they do it :”Right2DreamToo (R2DToo) was established on World Homeless Action Day, Oct. 10th, 2011. We are a nonprofit organization operating a space that provides refuge and a safe space to rest or sleep undisturbed for Portland’s unhoused community who cannot access affordable housing or shelter. We exist to awaken social and political groups to the importance of safe undisturbed sleep.”

The city corner lot where Right to Dream Too is located is a noisy one, what with being on a busy street (Burnside) and with wrecking balls whacking down buildings all around them. Yet it is an amazingly welcoming and peaceful oasis inside. A check-in desk, people doing shifts of self-policing the area for security, a small eating area next to a couch and bookshelves filled with books. Covered, airy gym-type thick mats raised on pallets where people can sleep. Neatly stacked piles of sleeping bags and pillows. (They told me that most of their budget goes towards laundry for the bedding). Tents in the back for staff members who stay there longer term. Well-maintained port-a-potties. Flower boxes. Brightly painted cast-off doors around the perimeter. Donated bicycles and clothing. A special tent filled with computers and information on job-hunting and health, social, education, and legal services. A palpable sense of peace and community. And even a small community garden!

The five-year-old program is, of course, at continual odds with the various powers that be in Portland and are soon to be moved to another site out of the downtown core–less convenient for the ‘houseless’ consumers of their services, more convenient to the downtown developers, condo and business owners. Here are some photographs I took of my visit (with their permission).

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