Drilling Down to What Worries Our Soon-to-Be Grads
David Schleich, PhD
I listen to my mountains, desperate about their enclosures, their cul-de-sacs, their canyon conundra, but my courage swells like a discarded sponge ravenous for the flash flood for one instant, carved against my tableau of gray geosyncline as you move through new doors there comes this soft bomb behind the eyes to help me see while I listen
David Schleich, Quarry Magazine, July 1984
What to Pay Attention to and What to Ignore
The reticular activating system (RAS) of our bodies is about 4 inches long. Not much bigger than a wedge of apple, it radiates upward as a tiny cluster of cells from our brainstems. Reductionists like to postulate that here lies the physiological connection between mind and body (oddly relegating the RAS to one or the other; isn’t that always the catch?). In any case, Irvin Dardik and Denis Waitley, in their landmark 1984 book, Breakthrough to Excellence: Quantum Fitness, describe this miraculous collocation as the “fibre which decides what is important information and what is to be ignored” (p. 23). They also observe that this stunningly efficient system “knows what is going on better than any other single part of the brain” (Dardik & Waitley, 1984, p. 23). Over the years, the thudding demands of the different kinds of psychosocial work that are intrinsically bound up in the professional lives of NDs, particularly as these manifest in the tension between “the breadth of skills workers could use on the job and their authority over decision-making” (Karasek & Theorell, 1990, p. 31), have exacted a significant spiritual and physical tax on the profession we serve. In some ways, the point may have been reached in the evolution of this “psychosocial work environment” when those NDs are having more difficulty than ever distinguishing between the important afferent data about the formation of the profession and the ignorable. For example, should we worry that the DOs were so adamantly opposed to us in the legislative efforts in Iowa this year? Will we ever have enough evidence to satisfy the biomedicine-inclined legislators? Or should we keep on keeping on and see this or that as something merely to pay attention to, and not worry so much that we second-guess our successes and our worth as a medical system?
Each year in high spring, a half-dozen students come together in a three-meeting focus group. This year, we explored what we should pay attention to and what we should ignore, in terms of professional formation, personal and aggregate. With the long view in mind, we decided ahead of time that we were trying to distinguish between what is important information about the nature and arrangements for the work our soon-to-be grads were preparing so hard to do, especially in view of the competition from so-called integrative medicine providers, and what information might be better ignored. After all, we all had our respective jobs to do, encouraging and building confidence and optimism about what is possible. I volunteered that my job was freckled with altruism and principle-centered leadership, both expensive paradigms within which to operate, an attractive feature to some and self-consciously annoying to others. While not exactly a dilemma, the transformative aspects of our journey through this tension reminded me of a time earlier in my working life when, as editor of a literary journal (Quarry Magazine), I wrote about trying to see and understand some of the major forces acting on me and my contemporaries. With that quest, as my modest poem from that era attempts to explain metaphorically, came a “soft bomb behind the eyes,” a kind of recognition and awareness that made it tough to return to old cul-de-sacs, to old “carved instants” on which I had relied to chart my personal and career paths. I got reminded about something I had begun to take for granted.
The Candle at Both Ends
Very engaging in our three 90-minute meetings were several “catalytic presentations” by these inspiring naturopathic students. One participant wanted to share what she had discovered from observations by Karasek and Theorell (1990) about healthy work. She showed our small group how, differentiating among high-strain, active, low-strain, and passive jobs, Karasek and Theorell, using data from “quality of employment surveys” generated over a generation ago, present occupation distribution charts that are hugely elucidating and are as representative of NDs as any professional group. Their conclusions about psychological strain hypothesis were one such soft bomb for our little group, for me in my role as a manager and for the six students as professionals-in-waiting. In particular, Karasek and Theorell pointed out the part played by “decision latitude” in burnout, exhaustion, and depression among hardworking professionals. Of special note are their remarks about healthcare personnel. Citing Kanner, Kafry, and Pines (1978), Karasek and Theorell point to the lack of positive job factors as an antecedent of burnout, a phenomenon very common in the early years of an ND’s professional pathway, and well known among students and the educators in our schools. Burning the candle at both ends is a well-known phenomenon across a wide spectrum of graduates who, once past Naturopathic Physician Licensing Examinations, have entered the workforce and among students and their teachers.
The undeniable links among material, social, and economic environments and worker and illness further complicate the issue. Not only are there psychological and physiological linkages, we learned, but there are also intimations that a “new tyranny of the international market” (Karasek & Theorell, 1990, p. 309) needs much focus to be fully understood as the dangerous development it is. For example, the International Organization for Standardization people in Switzerland have approached the acupuncture world to “standardize” the work of Traditional Chinese Medicine graduates as “technicians.” Yuk. Were the ND populations as large, there would no doubt be a similar interest to homogenize ND modalities, the better to “integrate,” my dear. Nevertheless, Karasek and Theorell suggest that alternative, humane work environments are “entirely feasible” (1990, p. 313), despite the urgency and energy of the burdens ahead, both financial and political. But there is more. Our second focus group meeting went on for 3 hours, instead of the appointed 1 and a half.
The Curious Paradox Within the Third Sector
Teresa Odendahl and Michael O’Neill (1994) point out some of the “more.” The paradox of women (who have a statistically dominant role in the emerging naturopathic profession) and power in that same sector is an area of considerable concern and interest. Kathleen McCarthy, for example, calls our attention to the “elusive forms of power that participation in professional organizations allowed [for women]” (Odendahl & O’Neill, 1994, p. 25). These scholars also remind us that it is worth noting how “women’s membership [in a profession] can be concomitantly ‘powerful and marginalized’” (Odendahl & O’Neill, 1994, p. 187) in most primary care health professions. Ostrander (1984) adds to this indictment of the power disparity between male and female professionals in the healthcare sector by stating that “power bases have been institutionalized and, despite some progress, are still maintained by white men, excluding women, people of color, and poorer people” (p. 211). Rothwell (1988) puts it more pointedly by declaring that “it is but a short step from economic marginality to political impotence” (p. 222). The late-middle-aged, white male in power listened closely.
Dealing with questions and issues such as these, we spent the best part of that meeting talking about the role of health activists, labor leaders, and progressive industrial and political leaders in challenging many assumptions about what is tolerable, what is fair, and what is inequitable in contemporary working life. We had a brief presentation during this meeting by one student about the dynamics of the “Occupy Portland” event many months back, a phenomenon that occurred in many U.S. and Canadian cities. This led to our conclusion—after we finished the meeting for that evening and escaped to a noisy, wonderful Portland, Ore., pub downtown for a sequel—that the stewardship of the ND in his or her community will require steadily increasing attention to a big list of factors: competition and market vulnerability from all kinds of other healthcare providers, the costs of getting started, the burden of student debt, and the indifferent incursions of other professional groups into naturopathic territory. It was not all half-empty glass conversation, though. Attached to improvements in NDs’ prospects (a growing number of models of reasonable incomes and better positioning in primary care) is the very real potential for the ND in that place of shifting market vulnerability. This is despite the boulder in the backpacks of recent graduates who have had to shoulder during their preparatory years the rising cost of education and training (described by Paul Bouchard as “the development of human capital” [1998, p. 132]), against a national and global landscape of underengaged youth in the workforce, deteriorating physical plant and equipment in many industries as recapitalizing priorities shift to global sectors with lower labor costs, the unrelenting and transformative influence of information technology on production and distribution systems, a metamorphosing consumer, and persistent and uncontrolled global positioning of the factors of production.
You can imagine that it took at least two cold ales each to drink all this in. The image is a national and global economy gradually recovering for all producers and consumers in which NDs absolutely have a place; the reality is an increasingly alienating global economy, including in the United States, where healthcare costs are spiraling uncontrollably in some sectors and where producing goods and services comes at a huge cost to the ecology of the planet and to the spirit of its human producers. That global economy has been wearing out its people and its buildings and equipment, not to mention the planet itself. Fixing the roof and adding some skylights, though, is considerably easier to organize and implement than jigging diluted principles and practices that shelter living things under that roof. We all looked forward to meeting number three.
The Trap of “Permanent Potential” and the Training to Coax It Forward
Given that the human nervous system has a tough time distinguishing between actual and vividly imagined experiences, the most effective naturopathic professionals will want to base everyday decisions on the best information from both resources available, the material and the spiritual. By material, we can agree, for example, that we mean such things as useful practice management data, office facilities and property issues, money, human resources, available capital, and so on. By spiritual, we can mean intuition, imagination, the influence of accumulated experience, emotional well-being, principles, and values, to name a few. Here at National College of Natural Medicine (Portland) we have a department of professional formation, for example, working assiduously with thin resources to pull into use every bit of information, every tool, and every network possible to help our graduates succeed. The purpose of the department is to coach followers out of a kind of “permanent potential” into continuous, conscious success so that income goals can be reached, budgets (including the inevitable payback of student loans) balanced, market share in the fiercely competitive primary care market achieved and jealously guarded, and grievances resolved. Such a universe for every newly minted vanguard of NDs is predicated on assumptions of abundance and continuous personal and professional growth. Malthusian scarcity had no place in the scenarios we explored during meeting number two.
Why Malthus came to mind was that another student at that meeting taught us that T. W. Schultz (a social anthropologist) took issue with Malthusian scarcity, refusing to subscribe to what Bouchard reports as an “entropic view of human economics” (1998, p. 129). Bouchard slices through this optimistic lens, however, with his cryptic analysis of the interplay of demographics and culture, especially as these reflect the opportunities and limitations that greet women and young people (1998, p. 135). Bouchard claims that a carefully choreographed “ideology” has been foisted on the young professionals and college grads in the productive economies of the world, an ideology characterized by what Bouchard calls “reification” and “legitimization” and underscored by “training as panacea.” We decided to repair to a coffee café to cope with that strand of the debate.
The Emmetropia of Shifting a Paradigm
The human eye has a precise and remarkable capacity to accurately focus light rays on the retina so that we can see things sharply and clearly. This process is called emmetropia. There exists no apparent emmetropia illuminating a pathway for easy paradigm shifting. During our third meeting, we concluded that courageous and dramatic shifting could easily move us away from traditional power structures that favor men with capital, at the expense of men, women, and children without capital, although there are plenty of male ND graduates who face financial constraints too. In the present paradigm—which we spent a good chunk of an hour trying to demystify before we repaired to the café—there seemed to exist no organic mechanism, as it were, for assembling scattered filaments such as those suggested by, for example, the encouraging addition of North Dakota to the state family that “recognizes naturopathic medicine” or the prescient inclusion by the legislature in New Hampshire a few months back of NDs as eligible to be covered by insurers for their modalities. To shift our paradigm away, then, from assumptions about the status quo, we see and hear, as if for the first time, a more optimistic response to the naturopathic profession’s participation in government health programs, educational organizations, agencies, and social movements, topics that have been in the forefront of higher education and health promotion since the late 1990’s (Stalker, 1998, pp. 238-249).
Our little group was a good place to do that kind of focusing. Whether we were discussing the internalizing of stress (in our own lives and in the lives of those who work with us or near us, in the sense of patients, friends, and colleagues) or trying to get a handle on the theme of whose responsibility it is to provide continuing education and in what proportions (Karasek & Theorell, 1990), we were open to a “moment of knowing,” to cite Virginia Woolf, as one of the participants explained. Certainly, the “development of human capital” (a term experienced by one of our group as inherently offensive) could have a different value and power as a process should a “nonprofitism” umbrella or vessel be its context.
I brought along an article I had read years back by Belenky, Clinchy, Goldberger, and Tarule (1986) to help look differently at our topics. We got into the concepts and ideas by Belenky et al. quite readily, landing “on the other side of silence” (1986, p. 103). What Belenky and her colleagues identify as “women’s ways of knowing” resonated with the group and struck us all as inherently familiar as we moved through the five different perspectives Belenky et al. write about “from which women view reality and draw conclusions about truth, knowledge and authority” (1986, p. 3). We talked about the exclusivity of the categories and descriptors, and I was reminded of the familiarity and possibilities of the feminine in the naturopathic psyche. Models of intellectual development are without doubt enormously compromised by the male frameworks in which they are constructed.
As part of preparing for the three-meeting focus group, I had reread Carol Gilligan (1982) to help me take a little break from that gridlocked framework that years of driving a growth agenda in naturopathic medical education can generate. I also looked back on the work of William Perry (1970) in charting the epistemological development of students, beginning with an explanation of “basic dualism.” Working through the epistemological categories (silence, received knowledge, subjective knowledge, procedural knowledge, and constructed knowledge), I came to agree with Belenky and her colleagues that the categories were not carved in stone and that similar categories could work for men too, despite the majority presence of women in the profession these days. I took the liberty of indulging my own metaphorical “mind’s eye” (Belenky et al., 1986, p. 19) to get a handle on what they labeled as “alien expertise” (logic, analysis, abstraction, and linguistics). Emmetropia again.
Breaking New Ground . . . to the Other Side of Silence
To a certain extent, the boundaries that lie among the intuitive, the abstract, and the pragmatic were not as crisp at the end of our three meetings as we thought they might be. In my own work as the CEO of an organization whose essential learning content is at odds in places among the curriculum with the reductionist, atomistic, and mechanistic worldview of the allopathic practitioner and biomedical scientists, it became clear to us all that we had to be willing to absorb new metaphors and language to dust off the nasty fact that we have become, in part, what we have fought for so long. In too many ways, perhaps, the naturopathic profession has been silent and authority oriented in its own way, looking to science and the informing systems of regulatory frameworks and higher education accreditation, despite itself, for “final answers” (Belenky et al., 1986, p. 71). So, the students and I decided that we were likely ending our three sessions where we began, in a certain sense, in a “quest for self” (Belenky et al., 1986, p. 76).
Marguerite Duras (a French feminist writer), according to her own words extracted from an interview published in The New York Review of Books (White, June 26, 2008), explained that to write Le Ravissement de Lol V. Stein (Duras, 1964) was specially complicated because in the very act of writing “I was always afraid of writing something common” (White, June 26, 2008). She went on to say that “men, on the other hand, have all the old words on the tips of their tongues, and so they can speak right out” (White, June 26, 2008). She added that men “begin from a theoretical platform that is already in place, already elaborated” (White, June 26, 2008). We talked about Duras for a bit, and we found it interesting that our group (four women and three men) were unanimous in concluding that “the language of engagement” with the world that we inhabit professionally and personally still presents with ongoing tensions, economic, social, spiritual, and philosophical.
In many ways, our mini-class learning community entailed many such “sharpenings” of our focus. To a certain extent, the kind of “connected teaching” (Belenky et al., 1986, p. 223) that most of the participants engaged in naturally and seamlessly in our mini-class series (and humorously, I must add) may well be a strategy to remember for welcoming contributions to the successful emergence of similar communities, in the same city, state, or region. Our little class dynamic was such that all the learners, including myself as the facilitator, were encouraged to contribute to our experience of “connected teaching” (unlike what Freire calls “banking,” or traditional teaching in which the teacher’s role is to “fill” the student “by making deposits of information” [1972, p. 214]). The result is a very safe learning environment where the consistent, natural focus is on an attempt, as I suggested during this class, to “discern the truth inside the students.” Now, if we can only accomplish that in every state and with a common sense of what we want.
Signal-to-Noise Ratio Analogy
Perhaps the well-known “signal-to-noise ratio analogy” by Peter Drucker (1990) is handy here in explaining the energy that such connected teaching can generate. Drucker explains that the addition of each relay in an electric circuit halves the amount of signal that passes through it, doubling the noise. My rather male perspective on management, leadership, teaching, learning, and working is saturated with relays and more relays, circuits and more circuits, to which I give a lot of energy. The message and value of published works by Karasek and Theorell (1990), Stalker (1998), Odendahl and O’Neill (1994), Rothwell (1988), Belenky et al. (1986), and others could easily have been overwhelmed for me by the “static” that threatened to accompany my first exposure to this literature and being reminded of it so many years later. The safety and creativity of our mini-class environment is not unlike what Max De Pree suggested about “ground rules in the doing of anything worthwhile and enduring” (1989, p. 57). He explained that if one of us is to catch someone’s fastball (new ideas, new concepts, or new paradigms), there must be a mitt. The mitt for me is the collective curiosity and generosity of our amazing naturopathic students. I love them. They teach me a lot, all the time.
This opening to the life
we have refused again and
again, until now.
Samuel Taylor Coleridge
David Schleich, PhD is president and CEO of NCNM, former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Previous posts have included appointments as vice president academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd), and the University of Toronto (PhD).
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