Narrative - Dr Allan Peterkin, another seminar delight

Notes: The speaker was Dr Allan Peterkin, McGill, Psychiatry, Mental Health, He has written 14 books for adults and children. Journal of Medicine, Narrative group for HIV for 14 years. Dr Peterkin reported that medical students inquire about spiritual care. What Dr Perkin does is he gets people to write their stories. It helps them for us to be narratively cognitive. His own father is a physician and his mom is a writer. He is both. His dad informed him he shouldn’t be a physician but a poet. Dr Peterkin explained how stories shape our world and the understanding of our identities. What are the elements of the stories? Being open to narrative. There is heart failure but how does a patient see it? Narrative Humility - we hear a story and we think we hear what it means, but it may not. In medical school you have a literary companion - short story perhaps three pages/4 year training. Invites them to experience the patient. They stretch our world view. Enter a world extremely different from our own. Allows us to stretch our world view and allows us to experience the unfamiliar. Illness narratives allow us to reflect on suffering. Stories engage right and left brain (analysis and creative). Narrative medicine - “I came to understand that what my patients paid me to do was to listen expertly and attentively to extraordinary complicated narratives.” Dr Rita Charon - In the U.S.A., the narrative is disappearing. Questions to patients are designed for more tests. Dr Rita Charon states, “‘ The ability to acknowledge, absorb, interpret and act on stories and plights of others” can be accomplished by reading of literature and or reflection writing. Narrative competence provides for self-reflection - develops professionalism - strengthens the provider- patient/client relationship. As one becomes narrative competence your work with your patient/client deepens. Stories - logic and feelings. We get close to what is really happening. Critical reflection on action and being. Self - assessment of values, attitudes, beliefs, biases, blind spots, reactions to experiences, learning needs. People with tatoos are used to test for STD etc…..Howard Brody, “….patients come to physicians with broken stories as much as broken bones……..There are three types of medical stories. Restitution: progress from disease and to treatment, to restoration of health. Most happy ending. Heroism filled with tests. The “wrong and right”. Some belong to a culture where they should not complain. Let them. Second is Quest: Illness becomes a condition from which something can be learned, something transformative, even healing is not possible (their choice). Third is Chaos: no order or answers in a whirlpool of suffering. Dr Peterkin hears all three in their stories. Patients can be left with a sense of bitterness, impotence, often misunderstood, wrong tests. The system itself often causes chaos. You may ask, “What would you like me to know?” Do not interrupt. Cry of the Wild - me. Dr Peterkin indicates that of course you are not going to tell the client/patient your own pain but to be aware of it. Our job is to be witness, to be in the now. A big challenge in training someone is how to sit with someone. In medical health one is trained to be hard on ourselves, particular with medical students, pretending they don’t need to go to the bathroom or to eat. Regarding patients look for the mystery in the patient and not only the problem. A white light comes into the room and the cancer is gone. “If you can’t name what you are doing, than what are you doing?” - one of his supervisors at M’Gill. Code Orange - mass casualty. Experience of the van attack at Yonge and Sheppard. “Organized chaos.” If you are involved in any hospital, expect the unexpected. Give your expertise to the people who may need it. I will not discuss anything else pertaining to this conference because personal experiences were being shared and policies that I think are Confidential. There were talks about the Bronco incident and the Danforth incident. Obviously once this happens in Canada we recognize a new awakening which previously was associated only with the States. What I think was a very nice gesture was how American emergency personnel demonstrated their condolences which was very appreciated here at home. The next topic the psychiatrist spoke of was the need to respect if the person wants to talk about it or not. Don’t keep pushing. Respect our own sense of limits. More is not more. #Toronto Strong# Holding on to the weak is called strength” TAO Te Ching (Book of the way) There is an importance to rituals. Therapeutic writing groups - You don’t have to and you don’t have to share - can just sit and listen. We must be responsible and not re-traumatize. Allow people to voice their anger. People need to voice their anger. We talked about secondary trauma which therapists can develop. I won’t talk about that because experiences were shared which I consider confidential. Clients often tell me their story. At times I do interrupt depending on what is being said. I will let them know that what they are saying is very important and perhaps it needs to be examined a bit closer and require some reflection. However, more often than not, a client in crises may need to tell his and her story and I will notice the urgency of the need do so which may take up an entire session. That is ok too. Often the client will state that they feel a burden lifted after a long sigh. In those situations regardless of what is said I do not interrupt. There is always time to examine at later sessions. Another thing I rarely do is follow up with clients who come for sessions and then stop. By not calling them I offer them the opportunity to recognize their own independence. I offer them the opportunity for their own decision making. It is their decision if they wish to have therapy or not, if they want to talk or not. They have the choice to continue, to stop or to return anytime. I have never refused a client to return to me, regardless of the time away. My job is to enhance their quality of life, not to impose upon them. I agree that rituals are important. Mothers who have had abortions and have regretted them find solace of having a ritual where they acknowledge, name and offer a rose or other flower or candle in their child’s memory. At the hospital where I interned there were ceremonies conducted for those patients who had died and their families returned to mourn. I found that this was welcomed by so many who were able to weep and find some comfort. I often suggest that clients begin to start a journal. I let them know that they can share with me if they wish. Sometimes they do and sometimes they do not. For clients who have been traumatized I often let them know that if they get a new memory, or they find themselves becoming upset, to stop writing and to discuss those feelings and memories in therapy. A person should never endure more than they can deal with. I also encourage support groups and they do not have to say anything or share until and if they are ready. Some times there are no groups and I am always willing to help them start one, if they wish. My fees do not fluctuate. Sometimes I am asked if I charge more if there is a couple or family in the room. I charge by the fifty minute hour which at times becomes an hour or more. But if one is charged more I would be questioning that.