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| Angelina at Holy Angels Residence, Fort Chipewyan, Alberta Canada 1971 |
Are
we really ready for reconciliation in the delivery of our healthcare?
My
humanity clung to me like Saran Wrap, safeguarding my dignity somehow I find this is comforting. I am still the same person I was before. And As I struggle to understand my feelings of
disempowerment and to help me feel more empowered I decided to write this blog
post.
To
tell you the truth, it is complicated. The purpose of this post is to understand
my easiness during the few months that I stayed in a rehabilitation institute
following a stroke, in an attempt to understand the feelings I was experiencing.
Because
I had a lot of free time to think about – and to try to understand – what I was
going through, it got me to thinking about my late brother Samuel. A few years ago he had spent a number of
months in a similar situation after suffering a brain injury.
At
the time, he expressed his displeasure at being in an institution similar to
the one that I was now in. He said to me
one day when I was visiting him that they had “too many rules.”
“Of
course” I responded. I told him that the
rules were there to help and protect him. Had I known then what I know now I would have
been more understanding. I know now that
what he was feeling was a sense of disempowerment and oppression. I would have
been able to validate his feelings at the time, but I hadn’t gone through this
experience yet, and I couldn’t fully relate to what he was feeling.
This
is very much the way I felt at the rehabilitation centre. Inferior. The main
feeling I had is having no control over my circumstances, feelings of being “less
than.” It was as if I didn't matter,
that my opinion didn't matter, that even
though my program was being tailored to meet my needs, my input was never
requested and apparently considered irrelevant to my recovery.
Once
a week the team of doctors, nurses, physiotherapists and occupational
therapists would meet and discuss the patient's progress and alter the program
as required. I was never in those
discussions. It seemed to me that they
talked amongst themselves about me as a case, not a person.
In
my life I have usually had a great deal of control over myself and my
circumstances. If I found that I didn't
have control I always adapted and created some measure of control for myself. I
have always adapted to new challenging circumstances, and tried to use them to
my advantage. I don’t mean that I surrender or just accept the new reality. I mean that I try to improve and to make it
better for myself. In doing that, I actually end up having more control over my
life.
Here
is the important point. Even when you
have no control over a new situation you always, always have control
over your own reaction to it.
One
of the ways I adapt to a new situation is by writing about it. Writing often
helps me process the situation and understand it. It can open me up to the possibility of seeing
things from a different perspective and it provides a space where I can be
inventive in assessing possible reactions.
Of
course my situation at the rehabilitation center was different than my
brother’s. I am recovering from a stroke,
which has added another complicating layer to the mix. My brother, however
lived a different kind of life where he seldom, if ever, had much control over
himself or the circumstances of his life. I feel some guilt that I didn't
understand his predicament back then. I really wish I had understood, like I
now understand, what he was feeling. In hindsight it is easier to see. Although
he had been working on his emotional issues stemming from abuse in residential
school, he was still deeply disturbed by his experience. He always carried the
damage within him and didn't know how to deal with it. He was very unhappy.
Although if you saw him you would think that he was a pretty happy guy. To the world he masked his pain with
laughter, but it was always there.
That
is important to acknowledge because as I try to make sense of what I am feeling
and I begin to understand where these feelings are coming from, I have no doubt
in my mind that what I was feeling stemmed from my own experience in
residential school. My brother and I had
that in common, as did most of my large family.
Being
in a rehabilitation center reminded me of my childhood in an Indian residential
school. In both institutions, a group of people make decisions for a smaller
group for their benefit. It did not take
me long to become aware that the negative emotions I was feeling in
rehabilitation stemmed from my residential school experience, and this
realization helped me understand and reconcile my feelings.
I
was constantly being evaluated and accessed by a multidisciplinary team of
doctors, occupational therapists, and physiotherapist, while I was healing. Of course they were all attempting to help me
recover from a very serious Incident, and everything they were
doing was for my benefit. Just as the
nuns, priests and teachers took away our freedom and a bit of our humanity, like our language, culture, and who we were, while they were to giving us an education and hoping to indoctrinate religion into our souls.
However, at this point I would like to add the difference here, is I was no longer a child removed from her home and culture, I am a grown woman, a university educated woman, and I will emphasize able to to understand complex realities. It
would have been valuable to be able to communicate these feelings to someone
who had an understanding of residential schools. But having input into my own recovery seemed
to be an afterthought in the institutional culture.
In
these early days of reconciliation it is advantageous to understand the way we residential
school survivors have experienced the world.
“For over a century, the central goals of Canada's
Aboriginal Policy were to eliminate aboriginal governments, ignore aboriginal
treaty rights, terminate treaties and through a process of assimilation cause
Indigenous peoples to cease to exist as distinct social cultures .”[1]
In
fact the Truth and Reconciliation Commission in their final report went further
and described the Indian residential school era as cultural genocide, a label
that upset a lot of people. However, there really is no other way to describe
what happened to us. It is no wonder the
majority of us have an inferiority complex.
To
understand where I'm coming from I needed to accept that my residential school
experience had deeply impacted my worldview. Residential schools were designed
by the colonizers who had an agenda to erase the Indian from the Indian child,
and it played a major role in forming who I am today. And like it or not I have been influenced by
those childhood experiences.
I
have written elsewhere that my residential school experience at Holy Angels did
not include the kinds of abuses that others experienced – even my own family
members in the same school at the same time.
But the psychological legacy of that experience is still profound.
Sometimes
I find I am oversensitive and I would have a knee jerk reaction to uncomfortable
situations because I misinterpret something that has happened. It is difficult
to explain why I react as I do to certain situation unless you have had this shared
experience, you will not fully understand what I am trying to say here however,
it didn't just give me an inferiority complex. It also gave me something of a rebellious
attitude, a resistance to authority, to the kinds of arbitrary rules our days
were filled with.
But
it also gave me a curious approach to life. Holy Angels had a library where I'd
love to sit and read. I began reading as many of the books on the shelf as I
could when I had free time. It is where I developed my love for reading, serving
as an escape and helping me understand there was a bigger world than just my
small residential school.
I developed
a curiosity, always looking to understand the first principles of a situation; why
a certain thing is the way it is. Why people behave as they do. I learned to
look under the surface, to look deeper. For
example, some survivors automatically dislike authority, like myself, and being
told what to do, because of all the rules we had to obey, rules that were never
explained. But I didn't just accept the rules. I always wanted to know why they
were established and what their point was. It did not satisfy me that the
answer was for my own good. I also
didn’t like being observed, because we were continually under observation by
the nuns. Perhaps this is the reason I resented the multidisciplinary team who
were tasked with observing me.
Being
in residential school we were not exposed to healthy relationships. The only relationship we witnessed were
between the nuns and the students, and they were not always positive role
models because the relationship was on an unequal footing. The nuns were in an authoritative
role and always in a dominant position. And of course they had no experience of
healthy family life themselves.
It
gave rise to a feeling of inferiority that is deeply rooted within us
residential school survivors, like we don't measure up to the rest of society,
that we were inferior and that special schools had to be created because of
that inherent inferiority. The damage of trying to assimilate us is embedded
deeply within our psyche.
Over
the years since leaving residential school I have worked diligently in
understanding my childhood experiences and have been working on developing a
healthier attitude in my interaction within society. In fact, in my own
personal relationships, rather than working on a difficulty in the
relationship I would more often than not feel that walking away was easier
rather than looking at how I was reacting within the relationship, trying to
understand that and working through the difficulty.
I
still witness this type of reaction from many residential school survivors.
They would prefer to just walk away give up rather than to try to explore why
they are feeling and reacting to certain situations. For example In one of my relationships,
after a dinner, which included a number of lawyers from the University of
Western Australia, I got upset because I felt they were being racist towards
me. But the truth is they were just being insensitive Australian males, who on
the whole are of the mind that women have an inferior place in a relationship.
It had nothing to do with me being Indigenous but more to do with me being a
woman. I really don't know which of the two position is worse. At the time I
took it personally, and my first response was to leave. That is my default
reaction to difficulties.
When
we went home I decided that I was going to pack a bag and leave. I booked a
flight to Indonesia for a few weeks, while I pondered whether or not I wanted
to get married and stay in Australia. At
the end of the day, I decided not to marry him and I returned to Canada.
Since
then I have done considerable work on myself on understanding why I react in a
certain way to different circumstances and I have learned not to walk away at
the first sign of difficulty. I applied that understanding to my feelings at
the rehabilitation center. I have come
to the conclusion that my feelings of lack of empowerment, or perceived lack of
empowerment, was at the heart of it.
The
trauma I experienced in residential school sometimes will still cloud my
perception of an experience. I understand that now. Early in my relationship
with my husband he commented that I am an enigma. He has explained that he
simply meant that I was complex and that there were depths to my personality
beneath the surface. At the time his
description didn’t really seem accurate to me.
I have always liked to think of myself as uncomplicated and simple, drama-free. But given my history,
complicated is probably more apt description of me.
I
can’t emphasize enough the value of empowerment in healing. On the first day I transferred to this
hospital, I met a doctor who I immediately connected with, AKA Dr.Finest-one I felt that he was interested in me as a
person and not just a patient. It was evident in his mannerisms and the way he
spoke to me. More importantly he explained my medical condition in non-technical
terms that made it easier for me to comprehend, it is also important to note
that he assured me that what I was experiencing was not isolated to just me,
but is something experienced by most stroke victims. This was reassuring because I felt my recovery
was not something that I alone am experiencing. And it helped set the tone for the rest of my
stay, although that doctor was not part of the team that looked after my case.
When
you connect with another person on a human level it is transformational. It
creates a bond on a human level. You feel cared for. For example, you actually listen better to
one another, which results in more empathy and compassion for the other person.
This is an important factor when looking at rehabilitation because you have to
be cognizant of a patient’s history because it will play a significant role in
how the patient deals with their difficulty. And how quickly they recover.
I
can see the value of a multidisciplinary approach in rehabilitation. However, I think that an important element
was overlooked, which is communication with the patient. For me, this is
important. I am the type of person who
is curious about why certain things are done. And my personality it is one of
inquisitiveness, where I really do like to know and understand what is happening.
To be sure, I like to understand fully the methods and the thought process
behind implementing the big plan. specific
protocols.
For
example, in rehabilitation there is a lot of repetition of simple tasks, and at
the time I thought the need for constant repetition was a signal that I just
was not getting it, and that I was a poor learner. Having been home now for a
couple of weeks, I understand the need for repetition because that is how the
brain is trained to work around the damage caused by the stroke. Realizing this has served me well now that I
am home. Indeed, I appreciate that deferring to the experts in the field is required
because their expertise will ensure that healing and recovery is done in the
most efficient and complete manner.
Still,
it would have been beneficial to have the rationale for these repetitive
exercises explained to me, the patient. Instead
of eagerly engaging in the simple therapies that I needed for recovery, the
lack of explanation left me feeling less empowered than I already was. Each session seemed like a test that I was
failing.
When
you have suffered a dramatic event like a stroke your whole life can seem
uncertain. You need to have your own
human dignity recognized and affirmed more than ever. Instead, you have professionals watching you
go through various tests, nodding and making notes. Essentially you are a passive observer in
your own treatment. They share their
notes and discuss their conclusions with each other. But the patient, whose wellbeing is so
uncertain and whose sense of self is so impaired, is not included. Of course,
there can be no consent if information is not fully disclosed to the patient.
Having
the input and consent of the patient is also important. Communication within a
team of professionals Is vital but so is how this information is communicated to
the patient and then relayed back to the team. Communication has to be done in a way that
doesn’t undermine the self-confidence of the patient and they are being dealt
with as intelligent adults who are entitled to know and understand the details
of their program in a clear respectful way, which brings me to another
component, the issue of informed consent.
How
would you otherwise know when the patient understands and gives their true consent
to treatment? The evaluation of the
patient should include looking at them completely as an whole person. Which
means knowing and understanding their complete history. True empowerment begins with consent. And consent is only meaningful if it is fully
informed. In this climate of
reconciliation I feel that any protocols for rehabilitation of First Nation patients
must include a consideration of the emotional trauma of residential school
survivors. While my residential school
experience was not entirely negative, and I was neither sexually or emotionally
abused, I spent my formative years in an institution that was built upon
unhealthy power disparity and whose whole rationale was to forcibly change me
whether I wanted to change or not.
Similarity,
other patients from other backgrounds may also being these kinds of
difficulties into a rehabilitation setting too.
Many of my fellow stroke survivors in the rehabilitation institution were
immigrants, with little grasp of English and a clear sense of
bewilderment. Others were elderly people, clearly in distress at their
new state of helplessness and apparently surrendering to their fate.
Being
aware of the psychological dimensions of their patients would greatly help
professionals understand the psychological and emotional state of the person they
are dealing with. It is all about the human dignity of the
patient. We are human beings. The
underlying fundamental intent ought to be to preserve and protect our human
dignity. We are damaged, and we need
more than ever to feel that we are still worthy. We need to rebuild our self-esteem and to
have agency in our recovery. Our
professional caregivers need to know that, and to help us, not to reinforce
unconsciously our feeling of being less than fully human.
In
conclusion, I have never been one to see myself as a victim. In fact, I most often will view things from
the perspective of how it will empower me. And this experience is no different.
Which brings me to the subject of reconciliation.
Reconciliation:
what does that mean in the treatment of First Nations peoples? The TRC Commissioners
hope that it means Canadians will take their findings seriously and use it to
help them establish a healthier respectful relationship with first Nations,
that recognize and understand the history of residential schools in Canada,
this is my hope too.
The
TRC commissioners describe reconciliation as being about establishing and
maintaining mutually respectful relationships between Aboriginal and non-Aboriginal
peoples in this country.[2] I recommend you read their Final Report which
you can find here.[3] It
is the shared responsibility of Aboriginal and non-Aboriginal people to
establish and maintain a healthy relationship with one another.Which
is anther reason that I wrote this blog. I emailed it to people who I thought would benefit from reading it, and I received this lovely email from Paul. "
[1] What Have we Learned: Principles of The
Truth and Reconciliation Commission of Canada Final Report (2010)
[2] What Have we Learned: Principles of The
Truth and Reconciliation Commission of Canada Final Report (2010) page 113.
