Justice in the Exam Room

The entire issue of Family Therapy News was interesting. Though it has never been a top of the charts specialty for me, I’ve collaborated on the development of a MedFT focus in graduate education, presented at various conferences on the topic, taught a course at African Christian College on the theory and practice of MedFT, published a thing or two, and helped to develop the emphasis with an AI tribe. All of those things are laid alongside my personal narrative of being in and out of hospitals when I was a kid with a dying father and a mother with numerous ailments and surgeries.

There is one thing that I think was missed in all of those articles, and maybe I just overlooked it.  That “one thing” is the cultural expression and values of the patient. Back in the previous chapter of my professional life, I was hired out of the MFT/ACU program to develop “family-oriented and culturally engaged” programming. That meant more than one person in the room and that also meant respecting, listening for, and engaging with the native culture of the patient/client in the therapy room or the exam room. I have no clue as to where these programs are these days. My sense was that those who followed me were less committed to these notions in principle and practice than we were when I joined up ten years ago.

In essence, a “family-oriented, culturally-engaged” approach to therapy and the Medical Family Therapy is radically different than the traditional approach. Family literally means more than one person in the room and culturally-engaged means connecting with and utilizing the family’s cultural strengths toward positive outcomes.

I believe that the literature speaks to the validity of both. Some conditions are especially amenable to a systemic engagement. Check out the names of Susan McDaniel, Jennifer Hodgsosn, Angela Lamson, Adam Moore, Tai Mendenhall, Russ Crane, and Jacob Christianson for examples. I also have come to believe that the healthiest of persons are those who can walk in two cultures, the one in which one is born, i.e., American Indian, Hispanic, Muslim, etc., and the one in which one lives, i.e., the “dominant culture,” or the white world.  This obviously goes against the grain of much of the rhetoric in public places and spaces these days.

My work in the MedFT world for the AI tribe was that of “consultant” to the physicians in family practice or internal medicine, amongst others. I recall the day in which I was called in to consult with an older AI woman who was not compliant in taking her medications. Though it took a while to figure out what she was thinking and feeling and doing, it became clear that we had missed her worldview. She was “going across the river” and consulting a medicine man from another tribe and getting treatment through those means.

To back up a step or two, I had been observing for about seven years the underlying messages of Indian people. The categories get very complicated, but here are a few. A phenotypically white person with AI status who identifies as AI with a low level of cultural engagement, and a low desire to become more engaged. Or, there was the phenotypically brown skin AI with a high identity, a low level of cultural engagement, and a high desire to be more engaged. Or, there could be a phenotypically white person with a high degree of cultural engagement and a high desire to be more engaged. Imagine those categories, with highs and lows in each and you begin to see complexities. Then, multiple that times the number of AI tribes, and you get even more complexity.

We then designed a 39-item enculturation scale which could be pared down and used in all settings as a “screening inventory.” Why? By doing so, we would then know things related to identity and cultural engagement and respond medically and therapeutically in appropriate ways.

I remember the day when a young clinician was troubled with how to treat a case of an acting out adolescent. We discussed who else lived in the house or was part of the family.  The clinician invited in grandmother who simply had to say something like “straighten up and fly right,” and the kid starting behaving.

So, I think there is a gross injustice when we fail to think family-orientation with problems. I think there is a gross miscarriage of justice when we fail to consider the cultural themes of the person and her or his family coming in to see us.

I think that justice means get the training in both. Engage both. In those ways, we bring about a correction to the injustice that dominates peoples’ lives. The break in shalom is corrected by hearing well and treating well.

And the Tears Came: MLK Day Reflections

MLK Day is always a poignant day for us. We know it's coming, but it always stops us in our tracks. This year's MLK Day is actually different than before. My hope is placed in a different direction and projection than the one we have been on.

So, this morning, as I stumbled into Monday and into my usual ritual of coffee, clearing the cobwebs, and reading the Text and other things, the tears came. Yes, the tears came for no explicable reason. Then I started thinking and writing. And this is what came up and out.

Raised in the racist, rural South in the afterglow of Jim Crow, those things shaped me in ways I still am deconstructing. Mr. Washington, my first black teacher, believed in me and fostered my love of learning and my interest in music. Seeing the lone black girl in our now "integrated" school is still frozen in my mind.

Lubbock Christian College, black students in Meistersinger Chorus and Bible classes, theater, social clubs, and the like, expanded my vision for people. Influenced by a drama coach who envisioned a brighter day for people of color, and shaped by her choices of productions. Influenced by a fiancé/wife who would not tolerate racist slurs.

Graduate school in Memphis and part time youth ministry at the Highland Church of Christ hit me between the emotional eyes. A predominantly white church, a black woman who worked there as a custodian taught me up, and the place and space of whites and blacks, wealth and poverty, again challenged me. When we first moved there, while looking for an apartment, Charles told us that we were not getting an apartment because of him. We did not know. He did. He was black, and a friend.

Almost two years in El Paso with a youth ministry that moved fast. Kids and families of all colors and shapes and sizes. Black kids, white kids, Hispanic kids, Indian kids, intermarried families, Spanish only in some homes of the grandparents, and again, wealth and poverty, and the distinctions between races and the ways in which adolescents of races respect each other. Going to classes at UTEP was like being in a foreign country, it occurred to me, as I looked across the Rio Grande River one morning into one of the poorest sections of Juarez. We never went there, but we did go to some fine restaurants in another section of town, but we were accompanied by people who knew the area well. We studied with and baptized a bunch of kids of all races during that time. They were hungry for connection in their violent world.

A return to Memphis opened my white eyes even further. Again, we worked with a biracial, bi-cultural group of teenagers. They were of all descriptions and family types, rich, poor, black, white, from the projects, from Germantown, intact nuclear and single parent families, and the challenges and opportunities of engaging them were rich, meaningful, and challenging. Terry Bell directed the bus program, and many African American kids came and grew up at White Station. Kids are kids without the deep seeded prejudices of us older folks, so we experimented with a huddle ministry that attempted to connect the kids into groups with each other. A weekend retreat co-led by Terry and me was the beginning of getting the kids to venture across the racial barrier into each others lives. Those were challenging days of working in the Robin Hood apartments and then speaking in the local private school. Formative days indeed.

A two year journey to West Virginia and to Ohio Valley College again proved pivotal as we worked with very poor, first time college students who grew up in the hollars, or skilled athletes who came from Cleveland, Ohio to attend this small private college. The notions of races and class continued to be imprinted upon my heart. How are we the same, how are we different, and where is this thing going?

Then after those two years, we began a 24 year stay in Abilene and at ACU. Teaching and mentoring all manner of students, men and women, just out of college and those returning to be retooled, Protestant, Catholic, Mormon, and as a reflection of the field of mental health, not very many people of color. Some, though, came from other states, Africa, South Africa, the Pacific Rim, and we all grew together. We knew what we needed to teach, but we had to learn how to teach and they needed to learn what they needed to learn and to return to their people. In many ways, that task made their people my people.

Then, a life-changing call came from a civil rights attorney one afternoon, offering me the opportunity to engage in the Black farmers movement as a consulting psychologist, doing psychological and family evaluations and assessing for damages to health and well-being for those seeking justice before the DOJ and USDA. This was life-changing and earth moving in my head and heart. Still does. That decision led to trips to the farms, to Washington, DC, and to seeing how those in power treat those who are disempowered. I could never return to the comfort of my previous space and place.

Then, after 24 years, we bought into the vision of developing programs and services for my wife's ancestral people in Oklahoma. We did not buy the vision without much prayer and consultation. We laid out seven or eight of those proverbial fleeces. So, we moved, despite my deeply held inside misgivings. This part of the journey involved envisioning and building things that would serve the marginalized American Indians of a 13 county region. It was a challenge. Stepping out of my comfort zone and working with those whose tribes had been marginalized for centuries, who had been kicked to the curb. At some point in that journey, I transitioned to building supra-structures and budgets and administrative sorts of things. I struggled to keep the vision of serving marginalized people alive because I was living and working around wealth, far beyond what I had ever earned. I had transitioned from being a social justice advocate to a part of a bureaucracy, and I had moved away from my first love.  Still, we learned a lot in those days about language, culture, values, history, privilege, marginalization, and what red and blue meant.

Finally, when the time was right, we returned to our beloved Homeland and to the work that calls deeply within my heart. I understand that I play only a minor role in the grand scheme of things. That does not trouble me at all. We are more involved in the Black farmer movement than ever before. Speaking at land summits, serving informally with BFAA, and fund-raising for African American farmers are some small things that I can do. Researching stories of farmers and working toward publication of several things keeps the dream alive of telling their stories in places and space where they cannot go, a promise I made to them while on faculty renewal leave in 2005.

The invitation to join Regenerative Outcomes was not a quick decision for me. When Charla pointed out that it involved among many other things the notion of justice. If these treatments are not covered by major medical insurance, only rich white people will be able to afford them.

We will soon begin fund raising for one of the most compelling stories of an African American families I have ever met. Their journey is one that moves me deeply, their story one that is in our hearts, and it is friends that we call them, and they call us. All stories move me, this one in particular.

So, all of these things flowed just sitting and pondering the fact that this is MLK Day in America? Yes and no. I will read things he wrote today. We will watch his speeches. We will once again be moved by his dream. On the one hand, I feel as if his dreams are being derailed in the current political climate. I am deeply distressed by that.  On the other hand, his dreams are more deeply embedded in the hearts of good people than can be taken away by one administration at one point in time. I am committed to working toward that end.

So, to sum it all up, in my days of retirement, I am still just one white voice in a huge wilderness. There are other voices of all races, genders, and classes, and we are committed to equality for all of God's children. The voice of the church must sound the call to justice loudly and clearly along with political and economic voices.

When we listen today to "I Have a Dream," my heart will be moved. My convictions will be pricked. I am praying that across this great land of ours, we can all work to make justice and equality something that endures until the Lord returns.

That is my story and why the tears came, at least part of it and a small slice of why.

What about you and why your heart is moved on this day?