He is the author of The People’s Pharmacy, and the drugs editor of Medical Self-Care Magazine.

TF: You were saying that you first got interested in helping laypeople learn about drugs because your friends used to ask you questions.

JG: Yes. When people learned I was a pharmacologist, friends, neighbors, and complete strangers would have all these questions about the drugs they were taking: “the little blue pill I’m taking for my high blood pressure,” “the little white pill for depression,” and so on. And when I asked them the name of the drug, they practically never knew. I was struck by how commonly people take drugs—some of them very potent ones—completely on blind faith. They didn’t know the first thing about them. They didn’t know the side effects, they didn’t know the possible interactions with other drugs. In many cases they didn’t even know exactly what the drug was supposed to do.

They certainly wanted to know, but their doctors just weren’t making the information available. And I began to realize that there were a lot of people out there who wanted to know about drugs. who weren’t getting the information they needed from the people who should be supplying it. So I thought, who better than a pharmacologist with a special interest in communication to try to provide some of this information.

What are the most important things for people to know about drugs?

The first and foremost thing is not to focus exclusively on drugs. If you have an ailment, the most important thing is to understand what’s going on and how it relates to the rest of your life. First, try to understand the problem, its causes, its signs and symptoms. Then you can go on to possible ways of treatment, with drugs being just one possible kind of treatment.

What are the things a person should be sure to ask when his doctor wants to prescribe a drug?

You should ask whether the drug is intended to give purely symptomatic relief, or whether it will actually help the body cure the underlying ailment. People tend to focus exclusively on side effects, and while that’s vital, it’s also crucial to know what the anticipated benefits are. Any time you’re considering taking a drug, you’ve got to weigh potential benefits against potential drawbacks.

And that would be true for over-the-counter drugs as well.

Yes. Another thing you should always do when your doctor wants to prescribe a drug for you: Know the name of the drug. That should be an absolute rule. It sounds simplistic, but it’s frequently not provided to the consumer. Make sure that your doctor pronounces the name of the drug so that you can understand it, and pronounce it back. Many drugs have difficult names.

And have your doctor write the name of the drug down for you.

Yes. And not only write it down, but write it down legibly. It’s not going to help too much if it’s an unreadable scrawl. Any health worker who prescribes a drug should not let the client go out of the of office without having in his or her possession the name of the drug, typed or neatly printed. Ideally, they should also be provided with a sheet of written information about that drug.

If the drug is prescribed by brand name, your doctor should also write down the generic name of the drug. And if it’s a combination product, he or she should write down the name of each ingredient.

What else should people know besides the name of the drug?

Find out precisely how to take it. “Before meals.” is not specific enough. You need to know exactly how long before meals. Find out the reasons behind these instructions so that they make sense to you.

How about side effects?

That’s the next thing. Be sure to find out about all the common side effects, whether they’re serious or not. Also be sure to find out about any dangerous side effects—no matter how infrequent.

I’m not going to be worried about a very minor side effect which occurs in one out of two thousand people. But if 20 percent of the people taking the drug feel drowsy? I want to know.

I’m also going to want complete information on very rare side effects, if they’re serious ones, even if they only occur in one out of ten thousand people. I’d want to know what the early warning signs are for the serious side effects.

I guess the other thing would be possible drug interactions.

Yes, and this is more of a problem than ever because so many people are taking more than one drug— sometimes prescribed by different doctors. I’d want to receive a list of all the drugs and foods that might interact with the drug I was taking.

I think it’s vital for the prescriber to give not only verbal information but written material to take home. There’s a wonderful book available for exactly this purpose. It’s called Drug Information for Patients, by H. Winter Griffith. It’s published in a looseleaf binder with removable pages so that a health worker can remove the appropriate pages, copy them on the office copying machine, and give the client a copy. It gives information on taking the drug, possible side effects, how the drug may interact with your activities of daily living, how to store the drug, refills, and dealing with overdoses.

Are there any completely safe drugs?

No. There are potential problems with every drug. Both doctors and their clients are at risk of being lulled into a familiarity-breeds-contempt kind of attitude. If your doctor has prescribed a drug a number of times and no one has ever complained of any side effects, he may begin to assume it’s completely safe, and may no longer feel it necessary to warn people about side effects. But every person responds differently and you may have a side effect even though none of your doctor’s previous patients did.

Incidentally, this is an excellent reason for letting your doctor know about minor side effects of a drug you’re taking—if you don’t tell him, he might not think to warn the next person for whom he prescribes that drug.

What are the important differences between prescription and nonprescription drugs?

It’s a somewhat artificial distinction. There are a number of drugs, presently available only by prescription, that will soon be available over the counter, such as Benadryl (diphenhydramine hydrochloride), an antihistamine. The more potent or potentially dangerous the drug, the more likely it is to be available by prescription only.

I think that a number of drugs that now require a prescription could be made available over the counter—if the buyer was provided with good, clear information on how to use them.

I think the idea of increased access to a limited number of drugs is very exciting. The number of effective pharmaceuticals available is much smaller than most people think. We have thousands of drugs. But there are only about three or four dozen really widely used and effective therapeutic agents. The average physician prescribes only about two dozen on a regular basis.

I have no doubt that with an effective medical education program in our schools, we could have high school graduates with a level of drug expertise sufficient to safely use many, many drugs that are now available only by prescription.

You were saying that you felt we relied much too heavily on drugs. Why is that?

I think there are four main reasons. Number one is the huge amount of money spent on advertisements for over-the-counter drugs. Kids grow up thinking that pills and potions are the answer to health problems—a pill for your headache, a cream for your hemorrhoids. Just count the number of drug ads on television in one week. You’ll be astonished.

Number two is an even more intense effort by drug manufacturers to advertise their products to doctors. There are thousands and thousands of detail people who do nothing but go around to doctor’s offices pushing their companies’ drugs. Almost every major medical journal, including the most reputable ones, contains gobs and gobs of very impressive and expensively-done drug commercials. That can’t help but have a big impact on doctors’ prescribing habits.

Number three is the way health workers are educated. Prevention and nondrug treatment are either ignored or given lip service. The message we give health workers is that there’s a pill for every ill.

Number four is the pressure from the very nature of the clinical visit to give a prescription. The doctor has perhaps ten or fifteen minutes to see each patient. That’s not enough time to even begin to ask how the current problem relates to the rest of their lives. You can’t even begin to think about prevention. That’s barely time to take a brief history, check your blood pressure, and write a prescription.

And a lot of people will feel cheated if they get advice instead of a prescription.

Absolutely. A lot of the pressure comes from the client. We live in an “instant” society today—with instant hamburgers and instant checking. So when we’re ill, we expect instant relief.

There’s an economic pressure, too. The doctor who’s charging you fifty dollars for a fifteen-minute visit is going to have a lot of difficulty prescribing aspirin— even if that’s the best and safest remedy. The person could have done that much for himself.

How can we get away from these patterns?

I think that people have to learn some basic clinical medicine. 1 think that health workers need to help them do this—by stepping out of their authority roles and sharing their uncertainties and their doubts.

I think that medical education needs to stress nondrug treatments. If someone comes in with high blood pressure, most doctors’ first thought will be to prescribe a thiazide diuretic, but a much more appropriate first step might be to recommend that the person lose weight, begin exercising, quit smoking, cut down on salt intake, learn new ways of dealing with stress, or apply some combination of these self-care approaches. The drug should be used only as a last resort.

You were saying that our health workers are being trained in a professionally- and pathology-centered medicine rather than in a client-centered medicine. What would a client-centered medicine be like?

Some health workers are already practicing client centered medicine. For instance, someone seeing a person with an ailment might ask, ”What’s worked for you when you’ve had this problem before?” Maybe the person has used hot baths for menstrual cramps or an over-the-counter remedy for indigestion. If a person has strong feelings against pharmaceuticals, an herbal remedy or a homeopathic remedy may be more effective—for him.

I would think that one good local resource for information on drugs would be your local pharmacist. How can a person best use their pharmacist?

The pharmacist is probably the most overlooked and underused health professional. It’s a shame, because not too many years ago, the pharmacist was a respected and important source of drug information within the community.

One of the big problems is the way pharmacists are used in the big chain drugstores. The center of these stores is devoted to selling fishing tackle and cosmetics and motor oil, while the pharmacy is stuck in some little corner way in the back. The pharmacists are kept out of sight, filling ”scripts,” as prescriptions are called, as fast as their hands can move. They frequently receive incentive pay for the number of scripts filled in a day, and they’re not encouraged to spend any time giving people drug information.

This is a very sad misuse of talent, because the pharmacist is a well-trained pro who is perfectly capable of answering most questions on prescription and over-the-counter drugs.

This assembly-line approach allows the chain stores to charge less for prescriptions—which makes survival difficult for the old-fashioned pharmacist. With a small pharmacist who runs the store himself, you can develop a useful, personal relationship. Look for an individual who is good at communicating and is willing to take the time to deal with your concerns. Ask your friends about the pharmacists they use. And once you find a good one, let him know you appreciate his services.

So you’d advise trying to understand a particular symptom instead of just trying to get rid of it.

Sure. Symptoms are an early warning signal. Eliminating symptoms without paying attention to the underlying process that’s producing the symptom is like putting a penny in the fuse box when a fuse blows. The next warning is likely to be something a lot more heavy-duty.

That doesn’t mean I think we should all be masochists. If you’ve got a headache and you know it’s from stress and muscle tension, there’s nothing wrong with taking aspirin. If you have severe menstrual cramps, codeine may be very effective. If you have diarrhea, you may decide to take codeine or Lomotil even though you know that the diarrhea is helping to cure you of something else—because the inconvenience just isn’t worth it. And there are some cases in which a drug actually attacks the root of a problem instead of just removing a symptom. If I had a bad sore throat, I’d have it cultured. If the culture grew out strep, I’d be the first in line to get some penicillin.

It should always be a carefully weighed decision whether or not to use a given drug. And I think that it should be the informed consumer who ultimately makes those decisions.

What other kinds of products are available in drugstores that might be good self-care tools?

One very promising tool is the dipstick sets that allow you to test your own urine. They provide a number of easy, inexpensive, completely safe screening tests for excess sugar, blood, or protein in the urine.

Another device now being tested is a tampon which will allow women to collect menstrual blood and cell samples to be sent in to a laboratory and examined for evidence of cervical cancer. If the present testing goes well, it will be marketed under the trade name Ascend.

I highly recommend blood pressure cuffs for home use. Some of the new automated models make a stethoscope unnecessary. Having a cuff at home is particularly helpful if you have high blood pressure and are working on controlling it on a self-help basis— through such approaches as weight loss or exercise or stress reduction or quitting smoking or meditating, or a combination of these methods. The cuff provides a kind of biofeedback, rewarding you by letting you see the immediate results of your efforts. And people taking blood pressure medication can help adjust their own dosage of the drug if they can monitor their own blood pressure at home.

Another new kit allows you to test your own stool specimen for traces of blood. This test is highly recommended once a year for persons over forty. You just touch the fecal specimen to a piece of moistened test paper, and if blood is present, the paper changes color.

What drugs should be kept on hand at home?

If I could take only one drug with me to a desert island, I’d take codeine. It can be used to relieve quite a few common, distressing medical problems.

Codeine is good for pain—a toothache, a headache, or bad menstrual cramps that aspirin won’t handle. And codeine plus aspirin has an additive effect, so that both together are especially powerful. Codeine can also be used to control diarrhea.

Codeine is a prescription drug in most states, so you’ll have to get your doctor to prescribe it for you. You don’t need much, and if you ask for a whole lot, your doctor might start thinking you’re a drug addict. Ten 30-mg. tablets should be plenty. Take a whole tablet for serious pain, half a tablet (15 mg.) for a cough or diarrhea. At our house we go through maybe one or two tablets in a year.

While it is true that codeine can be abused, it is almost never habit-forming in the doses we’re talking about. Drug companies have made millions by playing on the fears of people and doctors by claiming that their expensive preparations are safer than the older and much cheaper codeine.

If your doctor resists prescribing this cheap and effective medicine, make sure that he does prescribe some Lomotil for potential traveler’s diarrhea and something like Capital with codeine or Tylenol with codeine for pain.

The one caution would be not to use codeine—or any other painkiller—for a pain of unknown origin. If you had an inflamed appendix, for example, a painkiller might make it hard to diagnose what was really going on.

What else belongs in a home medicine chest?

I always keep some Tinactin (tolnaftate) handy. It’s one of the best antifungal agents for athlete’s foot or jock itch and it’s available over the counter.

People troubled by motion sickness might want to include Dramamine (dimenhydrinate). It’s an antihistamine and may cause sleepiness. Another antihistamine, Phenergan (promethazine), available by prescription, is a stronger antidote for motion sickness, and has such a strong sedative effect that it can do double-duty as a sleeping pill. Don’t try to drive or operate machinery while taking this one.

For occasional indigestion, I use a little baking soda in half a glass of warm water, but that’s not for people with high blood pressure because of its high sodium content. For chronic indigestion I’d recommend any product with magnesium and aluminum hydroxide. Ask your druggist for the cheapest stuff that contains these two

Aspirin is a mainstay of any home medicine kit. I buy the cheapest aspirin I can find. You can also buy aspirin as a powder. Or you can crush regular tablets between two spoons. The crushed or powdered form may be a little less irritating to the stomach.

If anybody in your family has an acne problem, I’d recommend the cheapest product containing benzoyl peroxide.

If I had an allergy to bee stings, I’d definitely keep a couple of syringes with adrenaline around. You’ll need a prescription and your doctor will have to show you how to perform an injection. Some people don’t think they could ever do such a thing, but you’d be surprised how easy it comes when somebody’s life is at stake. More people die from allergic reactions to insect stings each year than do from snake bites.

There’s an excellent Emergency Insect Sting Treatment kit available from Hollister Stier Laboratories (P.O. Box 3145, Terminal Annex, Spokane, WA 99220). You’ll need a doctor’s prescription to purchase one. And if I lived in snake country, I’d have a snake bite kit around. These are also available by prescription from most drugstores.

If I had children in the house, I’d also have a poison antidote kit. The best one I’ve seen contains a syrup containing activated charcoal and syrup of ipecac. (But don’t use ipecac for all poisonings. It can be extremely dangerous in cases of corrosive or irritating chemicals or petroleum products.) The charcoal absorbs the poison, and the ipecac is an emetic—it makes the child throw up. The kit is available without prescription from Bowman Pharmaceuticals (Canton, Ohio 44702). I’d also want to have a poison antidote wheel. You dial in the poison that the person swallowed and it tells you what to do. There’s a good one available from SlideGuide (Box 241. Pacific Palisades, CA 90272).

For an occasional case of constipation, I’d have something containing either psyllium or methyl cellulose. Both of these work by increasing the bulk of your stool. They’re found in such products as Metamucil and Serutan.

For traveler’s diarrhea, I’d have some Pepto-Bismol. There’s good evidence that one of its ingredients, bismuth subsalicylate, really works for this annoying problem.

A lot of people report that thiamine, Vitamin B-1, taken orally, will keep away fleas and mosquitoes. There have been no controlled studies on this yet, but the existing evidence is impressive. If I had problems with these critters, I’d keep some thiamine around the house.

For preventing sunburn, anything containing para-amino benzoic acid is good. Pre-Sun is probably the best buy.

A paste made up of meat tenderizer and water is a good treatment for insect stings. And, of course, ice is the best emergency treatment for minor burns, bumps, sprains, and bruises.

To return to the doctor-patient relationship again . . . whose responsibility is it to make drug decisions?

I don’t mean that laypeople should never take drugs, but that the decision to take a drug should be their decision. Sometimes it may work the other way. Sometimes a doctor may not want to prescribe a drug that a person wants.

After writing a recent column in which I criticized the widespread use of estrogen for menopausal women, I received a letter from a woman who had been using estrogen.

“Mr. Graedon,” she wrote, “You have no idea what it’s like to have hot flashes. It gets so bad that sometimes I just can’t stand it. They’re so unpleasant and they upset my life so badly that I’m willing to take a risk and use estrogen for a limited period of time. And I don’t think you have any right to tell me not to.”

And she’s absolutely right. She’s looked into the available evidence about possible risks and weighed the risks against the benefits and has made the choice that’s right for her. She made the right choice because she went to the trouble of really informing herself.

Many doctors act as if choosing a drug is always the doctor’s decision.

And they’re taught to think that way. It’s not easy for doctors, because to support their clients to be self reliant health consumers, they have to unlearn some really deep-seated elitist attitudes. But some doctors are really working at it, they’re really trying to share their knowledge and their uncertainties.

I got a call the other day from a man who was in great distress. He had a skin condition that had been bothering him for three years. “It’s unbearable,” he said. “it’s gotten to where it’s preventing me from working. It’s really painful. I’ve gone the whole route of symptomatic treatment, and now my doctor’s suggesting that I consider going on methotrexate.”

Well, my immediate reaction was, “My God, you’re kidding! Methotrexate? For a skin condition?” Because methotrexate is a very potent antimetabolite with massive side effects. It’s normally used only in cancer therapy.

And he said, ”Well, my doctor explained it in great detail, and I’ve been reading up on the side effects. I think I understand what the benefits are and what the risks are.

”My doctor told me to take ten days and talk to anybody I could find—other doctors, anybody—to try to get any other suggestions or any other advice. That’s why I’m calling you, to find out what you think about the use of methotrexate for my condition.”

I’ll tell you, I was impressed by the way that doctor was taking the necessary time and giving the necessary information and support to help that fellow make his own decision about using a drug. I really had a sense that they were working as partners. And the doctor made it very clear that if the caller decided not to try the drug, he would not be insulted, and he would continue helping him in the best way he could.

We need more doctors like that.

Yes. And it doesn’t matter whether the drug under consideration is a very potent one like methotrexate or a widely used and relatively safe one. The doctor should supply the information and describe the alternatives, and the layperson should make the final decision.

Medical Self-Care Magazine’s women’s health editor Carol Berry listened to the tape, agreed that it would make a good article, and suggested that she conduct a follow-up interview with Dr. Witte and Heidi Bednar, a midwife who works with Michael. She did, and it broadened and deepened the original interview immensely.

Finally, I edited the two transcripts and dovetailed them together, so that somewhere in the middle Carol and Heidi appear and I disappear. I guess you could call it collaborative journalism.

TF: Michael, you were saying that many people are thinking and feeling differently about having their babies than they did five years ago?

MW: Yes. Many, many more people are actively looking for just the right person to attend their birth. People are much more concerned with the environment in which the birth will take place. The underlying concept seems to be that the mother, the pregnant woman, should command a lot of respect. Prospective parents are getting more assertive about wanting things done their way.

TF: Has that concern for people’s individual preferences been lacking?

MW: I think it has. Both I myself and the group I work with are constantly being approached by people who haven’t been able to find the kind of prenatal care and deliveries they wanted. They’re determined to create a way to have their own birth experience meet their needs.

People are becoming much more deeply involved with the birthing experience than they’ve ever been. They’re realizing that there’s an independent, benign force at work changing a pregnant woman’s life and her body in monumental ways, and there’s a widespread feeling that those changes need to be respected by health workers, by her man, by her friends, and by herself. She’s different than she was before she was pregnant, and she gets more different the more pregnant she gets.

TF: I certainly didn’t hear anything about any of that in medical school. We just learned about all the possible complications.

MW: Yes. The medical professions have focused almost exclusively on the technology. We’ve really approached childbirth as though it was a diseased state, full of potential complications. The technology of childbirth has been kept as secret and magical tools to be used only by physicians.
The technology has saved a lot of lives, but it’s been controlled by the obstetricians, nearly all of them men, which created a built-in insensitivity, and birthing got dragged into the hospitals. Human values were subjugated to the hospital routine, with delivery rooms modeled on operating rooms, even though birth is not really very much like surgery at all.

TF: All right, suppose you’re talking to a couple thinking about having a baby. What are the choices they should start taking into consideration? What are their alternatives? When should prospective parents start looking for someone to attend their birth

MW: When you’re planning a pregnancy is an excellent time. You have a lot more time to explore options. Certainly by the time you first find you are pregnant.

The first step is to find out what’s available locally. I would talk to your local doctor or a couple of local doctors. Another good resource can be the local public health nurse. Public health nurses are often pretty sensitive to people’s needs, and they should know what the local resources are.

TF: So you could just call the county health department and ask for the public health nurse?

MW: Right. Free clinics or women’s clinics are also good resources, if you’re lucky enough to have one in your community. If you don’t, you can get in touch with such clinics in the nearest big city. Two nationwide organizations can help refer you to a sympathetic doctor, too: the La Leche League and the International Childbirth Education Association You can write to both of these and they’ll send you the address of their nearest local chapter.

TF: Could you suggest some good books to be reading around this time?

MW: Yes. Commonsense Childbirth, by Lester Hazell and Birth by Catherine Milinaire are both good. The birth chapter in Our Bodies, Ourselves, also has a lot of good practical information.

Once you’ve really gotten along into pregnancy, some good books are Spiritual Midwifery and Immaculate Deception. Then there’s a super picture book, A Child Is Born, which has excellent color photographs of the fetus at the various stages of development. Pregnant women can spend hours with that one.

The midwives we work with have a library of books on these subjects which they loan out to prospective mothers. It’s a really nice service to be able to provide.

TF: What are the most important things to focus on in the prenatal period?

MW: The single most important thing is that the mother respect herself and take care of herself. Prenatal care is not something the doctor does. You can only do it for yourself. What we’re doing is monitoring the mother’s and baby’s well-being. It’s the mother who’s doing the real work.

TF: What can a couple do if they can’t find a local doctor that does things the way they’d like?

MW: I would hope that they would tell their doctor what they’d like. Impress on her or him that these requests are very important to them. Hang in there, and be prepared to negotiate.

If you’re assertive and persistent, you may find a great deal more flexibility than you expected. Ask the doctor what his reservations are about your requests. If the physician is worried about legal liability, you may be able to work out a legal waiver stating the things you want and the risks you’re willing to accept. For instance, you may want to try to deliver vaginally in the case of a breech presentation, instead of automatically going to a cesarean. It’s very important for you and your doctor to discuss these possibilities and choices in advance.

If you are negotiating with your doctor, it’s vital to get good counseling regarding risks and procedures. A good deal of this can be done by phone if necessary.

TF: What are the possibilities as to where the birth will take place and who will attend it?

MW: Well, the alternatives range all the way from having the baby at home and delivering it yourself, to home birth with a lay midwife, to home birth with a nurse-midwife, to home birth with a physician.

In the hospital, the alternatives might be an alternative birth-canter-type room, where you can have your friends and family in to witness the birth but have a doctor or midwife in attendance. Or you might choose to have your baby in a regular delivery room, again with a midwife or a physician in attendance.

TF: Could you say some more about alternative birth renters?

MW: Sure. They’re a good example of hospitals being responsive to people who want more control over their own birthing experience. The alternative birth centers are often scheduled months in advance.

The labor and birth usually take place in a room down the hall from the delivery room. The family has a good deal of control over this room—they can decorate it as they like, play their favorite music, and have their kids and friends and family members present. So on the one hand, there are many of the benefits of a home delivery.

On the other hand, if any complications develop—if the baby starts to come out feet first, or if the mother or the baby are having any difficulty at all—the parents and the doctor or midwife have the option of zipping down to the delivery room in a few seconds.

TF: An obstetrician friend said that he advises prospective mothers to pick the hospital first, then pick the doctor.

MW: If you’re planning a hospital birth, that’s not a bad idea. Most hospitals have regular tours of the labor and delivery facilities for prospective parents. If you pick a doctor first, you’re limited to the hospitals where he or she practices.

TF: You were saying that the changes in obstetrical practice here in Marin County over the last five years may foreshadow the kinds of changes we can expect in the country as a whole. How have things changed here?

MW: Five years ago the doctors here took a very interventionist, technical view of birthing. Deliveries were done in the hospital delivery room, period. Now we’ve become very family oriented. There’s much more concern for the quality of the birth experience. A significant percentage of babies born in Marin last year were born at home. This certainly reflects a change in consciousness among health workers and potential parents alike. It also indicates the power consumer demand can really have.

Probably the most important reason for this change is that the families have put on economic pressure. They’ve said, “If you don’t provide what we want, we’ll go elsewhere. We’ll do it at home, or in another hospital, or in another city.” We’ve had people from all over the state coming here to deliver because they couldn’t get what they wanted in their home town.

And what’s happened is that the health workers and the hospitals have responded to the economic pressure. Obstetrical units are usually real money-makers for a hospital, but not unless they’re active. When a few hospitals offered alternative birthing services, the staff at the ones that didn’t ended up sitting around twiddling their thumbs. They were forced to offer those services. Now you walk in the door of any obstetrical unit, and you’ll see this sign, “Family Birthing Experience.”

HB: Yes, they talk about it all the time, about losing patients to other hospitals.

CB: How should a family go about choosing between a home birth and a birth in an alternative birthing center in a hospital?

HB: It really depends on the family—especially the mother. Very few alternative birthing centers offer an atmosphere as supportive as being at home. If they went to the hospital, they might feel too out of their culture to really relax and have the quality of experience they want.

MW: Some women have a terrifying image of the hospital, or see it as a place very foreign and scary. Heidi and I have seen that lots of times—where a woman who’s in labor at the hospital has trouble because she can’t relax. On the other hand, there are plenty of women who wouldn’t be able to relax anywhere but in a hospital.

CB: How can women get in touch with their feelings about the hospital beforehand ?

HB: By all means, take a tour of the hospital. Talk with friends who’ve had babies there—and with friends who’ve had babies at home. I always encourage pregnant women to take the tour. The results are sometimes very striking—people who were definitely going to give birth at home may realize they’d rather have it at the hospital, or, just as commonly, the exact opposite will happen, and a couple who’s planned a hospital birth will decide to have it at home.

CB: What should a woman ask herself when she visits the hospital and takes the tour of the labor and delivery rooms?

HB: They should ask, “How do I feel about technology?” “How do I feel about being handled by competent strangers?” “How do I feel about mechanical things?” Sometimes the number of electric and electronic gadgets a woman has in her home will reflect her feelings about technology.

MW: Sometimes reading the right books helps people explore their feelings, too. It can make you aware that there are really more possibilities than you might have thought.

CB: Why do you think there’s been such heated controversy about home births in some places, while in other areas it’s just seemed to slowly evolve and be well accepted ?

HB: I think that some health workers are scared. They’re afraid that they’ll lose financially, or that obstetricians might be phased out completely. And some non-health workers have just turned their backs on health workers altogether and gone off to deliver their own babies at home.

My feeling is that both extremes are off the mark. A certain degree of technical training and experience is clearly helpful in figuring out the small percentage of women who are at higher than normal risk. At the same time, families need to be able to arrange a birthing experience that meets their needs, not the health workers’ needs. Birthing should be a collaborative effort, with input from both the family and the health workers involved. Neither party can manage as well without the other.

CB: What are the qualities to look for in the person you want to attend your birth?

HB: How you feel about a person is very important. When it came to choosing someone for my own birth, I passed up a number of doctors I knew and picked one I hardly knew at all because I had very good feelings about him.

MW: I would also want to check on their competence. Ask somebody they’ve helped to deliver, or ask other health workers who’ve worked with them. I’d ask a health worker friend whom he or she would go to. It’s also important to consider who has hospital privileges where.

HB: Another important thing is whether the person really listens to you. Birthing works best when both attendants and parents are really listening to each other and learning from each other.

Also, a doctor who delivers fifty or sixty times a month by himself is not going to have time to give you much personal attention. He’ll be forced to scoot you in and scoot you out. So be sure and ask how heavy a case load the person carries.

Finally, I’d choose a person who’s not locked into either a home birth or a hospital birth.

MW: Yes, the parents’ feelings may change at any point and they should be supported. The option to have a baby at home or to go to the hospital should be kept open as long as possible.

HB: To realize that you can change your mind, shift plans, and still have a positive birth experience is very important. Maybe you have been planning on a hospital birth, and once you get there, realize that it would have been better at home. Or maybe your game plan has been home birth and you feel yourself wishing you were in the hospital. It’s okay to say, ” Hey, wait a minute. This doesn’t feel right.” And change the game plan so that it does feel right.

CB: Heidi, you were saying that prospective parents should think in terms of having two birth attendants.

HB: Yes. There’ll be more than two at the hospital, and I personally don’t consider home birth safe unless there are at least two knowledgeable birth attendants there. It may be a nurse-midwife and a lay-midwife, it might be a midwife and a doctor. If all goes well, there’ll be one person to organize things and make phone calls, while the other stays by the bedside. If there are complications, it’s vital. After all, there can be two patients—the mother and the baby. The two health workers should not only be competent, they should work well together.

CB: What are the risks of home birth?

HB: Except for the mother who lives miles and miles from the hospital, I think they’re about the same as for being at the hospital. The important thing is who’s attending your birth. Are they monitoring the fetal heart tones? Do they have emergency equipment with them? If you have the right people, they can do nearly anything that could be done at the hospital—and in a less intrusive way. Competent attendants at home, with a good attitude, are much safer than less competent attendants in the hospital who are working at cross purposes. Technology is only a tool. It’s the people and the attitudes behind the tools that are even more important.

MW: I think that many obstetricians still believe that home births are less safe than hospital births. That may have been true at some time in the past, but with birth attendants who are well equipped and well trained, that’s simply not true any more.

CB: When people talk about the complications at home births, the most scary one is excessive bleeding. Can that be handled just as well at home as it can in a hospital ?

HB: Yes, it can. We have intravenous fluids and plasma expanders and oxygen and all the medications right there with us. We use the same technologies and techniques they would use at the hospital. The only woman I ever heard of who bled to death at childbirth did so in a hospital.

MW: The problem is more legal than technical, really. If a mother bled to death at home, the attendants might be charged with manslaughter.

HB: Yes. People assume that if a woman bleeds to death in the hospital, it’s justified because the assumption is that everything that could have been done was done. There’s a real double standard operating here. If a doctor delivered a woman in the hospital and she died, there would very likely be no recriminations. If a midwife delivered the same woman at home, provided exactly the same care, and the woman died, the midwife would undoubtedly be charged with murder.

CB: How about the risk of infection at home births?

MW: Well, generally speaking the baby comes out sterile and is immediately exposed to bacteria and viruses in the environment—he has to get used to them in order for his immunological system to develop. Babies born at home are exposed to the flora on the parents’ skin—and they have antibodies to these germs already. On the other hand, the germs in hospital nurseries are more likely to be the disease-causing kind, and therefore much more dangerous.

HB: In the hospital you’re at added risk of surgical intervention—episiotomies, invasive techniques— which increase the risk of infection. Hospital birth attendants are more likely to get tired of waiting and give a drug to induce labor. It may well be safer to wait—as we do when we deliver at home.

CB: How many home births have each of you done, would you estimate?

HB: Probably 150 over two years. And this doesn’t include the hundreds of births I’ve attended as a labor and delivery nurse in the hospital.

MW: I’ve been involved in about 350 births.

CB: Have you ever run into anything you felt you weren’t equipped to handle?

HB: No, not once. We can start emergency measures and get the woman to a hospital by ambulance in about the same amount of time it would take to set everything up in the hospital.

MW: And you have to remember that one reason for that is that we don’t try to deliver everybody at home. Any woman with a pre-existing illness or a disease of pregnancy is advised to plan for a hospital birth.

CB: What are the benefits of giving birth at home?

HB: I think that in many cases it’s safer. The home birth attendants I’ve worked with watch the patient more closely. I’ve seen complications arise in the hospital because there are six or seven women in labor at once, people are busy, and there’s a false sense of security because of all the technology. No machine can replace a birth attendant who’s totally there with you, so that if any little thing starts to happen, we can catch it right away.

MW: You can create your own routine at home— you’re not at the mercy of the hospital’s routine. This is your first chance to meet this new little creature, and it’s important not to have a lot of regulations getting in the way.

CB: It sounds as though a real polarity has developed between people doing home births and people doing hospital births.

HB: It has in some places, and it’s a real shame. My experience working both in the hospital and at home has been invaluable for me. In the places where things have gotten polarized, everybody loses. The hospital birth attendants have a great deal to learn from the people doing home births, and vice versa, and some of the home birth people could use more technical knowledge. In places like Marin, where there is a lot of communication between people attending home births and people delivering babies in the hospital, it’s been wonderful. Birthing doesn’t need to be divided into two warring camps. We need one whole flowing continuum with an emphasis on alternatives and individual choice.

I always find myself explaining Keith Sehnert as the George Washington of self-care. Keith graduated from Western Reserve School of Medicine in 1953. After working as a General Practitioner and later as Medical Director of Dorsey Laboratories in Lincoln, Nebraska, he joined the Reston-Herndon Medical Center in Herndon, Virginia. There, in 1970, he taught—and largely invented—the first of the modern breed of self-care classes, classes in which laypeople learned basic medical skills formerly reserved for doctors only.

The class drew wide media attention. In 1972, Keith became a visiting professor at Georgetown University and in 1974 founded the Center for Continuing Health Education at Georgetown.

The Center for Continuing Health Education did self-care research, taught health professionals from all parts of the country to conduct self-care classes, and prepared course materials for these classes. In 1977, Keith became Vice President and Director of the Health Promotion Group at InterStudy, a health-policy and health-futures think tank in the Minneapolis area, and joined the University of Minnesota School of Public Health as clinical professor.

It is in large part because of Keith’s efforts that there are now self-care classes in forty states. He is the author of How to Be Your Own Doctor (Sometimes).

TF: You were saying that you were a student of Ben Spock’s at Western Reserve.

KS: Yes, back in the early fifties. Spock was just starting out as a teacher there, and his book, Baby and Child Care (reviewed on page 207) was just out. Of course, no one had any idea then it was going to become so popular.

Did he have a big influence on you?

He did. He was very concerned that most patients were getting a great deal of treatment but very little teaching. He felt that was a mistake.

I don’t think there’s any doubt but that his book planted a seed for me. I’ve always thought of my book as a kind of Dr. Spock for adults.

Were there any other experiences at Reserve that nudged you in the direction” of self-care?

Yes, the influence of another very important teacher, T. Hale Ham. In those days the whole business of a doctor’s empathy for the patient and communication skills were spoken of as one’s bedside manner. We were all very concerned about our bedside manner. Dr. Ham used to say, “Keith, you just talk to your patients in whatever way is most comfortable to you—but keep in mind that if you’re a good teacher, your patients will think you’re a good doctor.”

How did you happen to end up teaching that first self-care class?

Well, you know, serendipity plays such a big part in these things. I’d just joined a family practice group in the Reston area of Virginia. The guy who’d actually planned the class was leaving to join the Family Practice Department at the University of Wisconsin. One day he just casually asked me, ” Look, as long as you’re going to be here, would you mind picking this thing up for me?” And of course I said yes.

How many students were there?

I think there were forty, maybe forty-two. About 80 percent women. Almost all of them were patients at the Medical Center.

What was the first class meeting like?

It was an interesting experience. Many of the people in the first class were women whose husbands had been recently laid off by a reduction in the Johnson administration space program. Some of them were living on unemployment insurance for the first time in their lives.

As we got to know each other better, a lot of anger toward the health-care system started to come up. Frustrating experiences. Times when they’d been treated insensitively.

The old authoritarian doctor image was hanging over our heads, even though I wasn’t the typical authoritarian doctor. There was a lot of asking, is this something that’s okay to talk about? Is it all right for me to ask this question? And when I made it very clear that it was, they really began to share their experiences and concerns. They began to express feelings they may never have expressed to anyone before—certainly never to a physician.

It soon became clear that they had a lot of health needs that weren’t being met by the health-care system. They’d been put down and ripped off. The women’s movement was beginning to be active around that time, and the women especially were beginning to look at their lives in some new ways.

Pretty soon people started saying, “Why can’t I take my father’s blood pressure?” “Why can’t I give my kids allergy shots?” “Why can’t I use an otoscope to look in my little boy’s ear when he has an earache?”

And I found myself saying, “I don’t know why not. Let’s do it.” So the whole course evolved out of the things people were asking.

Had there been any other similar classes up to that time?

No, to my knowledge, it was the first class of its kind. There had been orientation tours for new patients in certain clinics and patient education for some specific diseases like diabetes, but nobody had ever really gotten into this area before.

How would you define this new area?

1 think of it as directed toward a new kind of medical consumer, what I call the activated patient. In my Herndon class, their questions went well beyond the boundaries of what had been thought of as patient education at that time. They wanted to know why they couldn’t have their own black bags of medical tools at home. No one had ever thought of teaching laypeople to use such tools before. There weren’t any models for that. So we just had to go along and figure out how to do it as best we could.

What motivates a person to take a self-care class?

We’ve looked at that, and there seem to be seven basic reasons people give, over and over, for their interest in self-care:

1. wanting to save money on health expenses;


2. wanting to be able to take better care of their family’s health, to be able to make effective family-health decisions;


3. wanting to take more responsibility for their own illness care—like hypertensives who want to be able to keep track of their own blood pressure;


4. wanting to learn how to hook into the medical system like a number of older people who outlived their doctors and weren’t able to find a new one they were satisfied with;


5. wanting to learn more about their bodies and how they work;


6. people with illness in the family, wanting to feel more confident in dealing with it;


7. people who’ve gotten turned on to healthier life styles, wanting to hear more about jogging, nutrition, yoga, meditation, and whatever else there might be to this whole healthy lifestyle business.

So you include more than just traditional Western medicine in your classes?

Oh, yes. Of the really alternative approaches to health, yoga is the main one we’ve used—mainly because a neighbor of mine happened to be a fine yoga teacher. If I’d lived next door to a Thai chi teacher, we might have included that. The introduction to yoga has certainly been well-accepted by our students.

I think giving these kinds of alternatives is awfully important, particularly because through them people can learn to get the same kinds of things they might now be getting from alcohol and various other chemicals. And those are not ways I like to see people relieve their stress.

How long did the Course for Activated Patients go on?

We ran two classes a year for almost three years. Then, in February of 1973, Howard Eisenberg did a story on the class for Parade magazine, and I got over two thousand letters as a result. That made me realize that what we were up to might be something with a much wider appeal than I’d thought.

About that time I began getting inquiries from the federal Department of Health, Education and Welfare, from a number of foundations, and from several of the faculty and deans who were interested in doing something more in the way of self-care at Georgetown University.

Several publishers started wining and dining me and convinced me that there was a need for a book on what we were doing. So I took a six-month sabbatical and collaborated with Howard Eisenberg on How to Be Your Own Doctor (Sometimes). Shortly after that, the Center for Continuing Health Education was formed at Georgetown, and I became its director.

So you were there until 1977?

Yes. Then our grant ran out, and the functions of the Center were divided between the Health Activated Person Program at the Georgetown School of Nursing, where they’re continuing to give an ongoing self-care course for the Washington community, and the Health Activation Network (see page 268), who put out a newsletter, “The Health Activation News,” to train self-care teachers and help people establish new courses.

You know, Keith, I have a feeling that if it had been some other doctor teaching that class, it might have ended up as just a lot of boring lectures. Have you had special training in communication, or are you just good at it?

Well, as you know, one of my daughters, Cindy, is deaf, and that’s made me very aware of the importance of getting and giving feedback. It got me very interested in good communications, and when I was talking to a patient I would always give and ask for feedback to be sure we were understanding each other.

And then the other thing was how much I loved doing it. I discovered that I liked being a facilitator better than being an authority. There was a feeling of real partnership. It was wonderful to relax out of my professional role and, if somebody asked me a question, to say, “1 don’t know. How do you suppose we’d go about finding out?”

It was a very rare thing in my medical education to hear a doctor say, “I don’t know.”

Incredibly rare. We were taught we were supposed to know all the answers.

How have health professionals reacted to self-care classes?

I like to say, scratch a doctor and you’ll find a teacher underneath. Most doctors have been too busy with day-to-day practice to develop as teachers, but once they do it, they find that it’s fun.

I’ve brought a lot of health professionals into selfcare classes, and while at times I’ve had to more or less drag them kicking and screaming into the pit, once they take off the white coat, loosen the tie, and get their shoes off, they find they’re having a fine time. It’s a real relief to be able to show your human side, and the people in the classes are always so appreciative.

There’s a real sense of working together for a common goal. Most of us went into medicine for pretty altruistic reasons. We’re not all dollar-sign guys. And when you start relating to people as active partners instead of passive pawns, they really appreciate it, and they let the doctor know.

In my medical school training, except for a little bit in psychiatry, I didn’t receive any formal training in communicating with patients. Many people would say that medical education makes doctors less capable of communicating on a meaningful level. Are there any signs that this is changing?

Well, coincidentally, I just finished reading a report on self-care from the Association of American Medical Colleges. They’re getting together a major project in which they will begin teaching self-care communication skills in a number of medical schools. Dr. James Hudson is going to be the Project director.

The American Medical Students Association also has modest self-care programs going at a number of medical schools. And of course there are all kinds of new and fairly informal projects at individual schools—there’s something here at the University of Minnesota Medical School, the University of Arizona has one, as does Georgetown University. There’s a big interest at UC Berkeley, and you were just telling me about the self-care class you visited at Wright State School of Medicine in Dayton. There’s actually quite a lot going on in the medical schools already.

Any signs of health insurance companies being willing to reimburse policy holders for self-care education expenses?

Blue Cross of Montana has started doing this on a very small scale, and some of the other Blue Cross plans have been saying they’re going to get into this area— they’re putting on some prevention education programs now. Several other insurance companies are looking into self-care education. International Group Health in Washington has started several projects. IGP’s head guy, Jim Gibbons, is a real self-care advocate.

Could you comment on the kinds of people who are—and should be—teaching self-care classes?

I’ve always felt that the ideal teacher was the nurse. Certainly the greatest enthusiasm for self-care has come from nurses, nurse practitioners, and physicians’ assistants. Many of these allied health professionals feel much more strongly about prevention and self-care than about diagnosis and treatment—which continues to be the main concern of most physicians.

Do you think it’s important for the people teaching these classes to have clinical experience?

It certainly helps. One of the real dilemmas these days is that people hear this from Reader’s Digest, that from the National Inquirer, and something else from Prevention. They need to be able to ask someone who has done more than just read the books.

How about in the schools? Do you think it would be an advantage to include people with clinical experience as a part of health-education classes?

Yes. Not only are clinical workers more likely to have experience with these matters, but it’d be very valuable for kids to be able to talk to a health worker at some time other than when they’re sick or need shots.

Do you see a connection between the widespread popularity of running and the developing self-care movement?

Absolutely. Because as people start feeling better from jogging, and begin to sleep better and eat better, they’re going to discover they have more energy than they ever did before. Then they begin to realize that health is a resource to be conserved, not something you can waste and then discard like a cigarette butt or a wrecked car.

Yes. Your body is a temple. Why treat it like a motel?

Yes, that’s a good one. So when people increase their nutritional awareness, or start jogging, or get into stress reduction, they feel better. And taken they say, “Well, gee, maybe I can kick smoking and kick alcohol and practice a healthier lifestyle. And it’ll pay off.” And it does!

What other cultural changes are we likely to see?

One we’re already seeing is a change in men’s thinking and behavior. For so long we’ve had this macho male image about everything that’s harmful or illegal.

If I smoke and it’s bad for me, I must really enjoy it. It’s a sort of bad-boy mentality. To have fun, you’ve got to be destructive—driving too fast, abusing your body or those of people around you.

That tough-guy mentality is softening. As I go into groups of my peers—men in their late forties or early fifties—I find I seldom hear the sort of thing which was the rule not very many years ago. You know, ” Boy, did we have a good time last night. I bet old Fred and I drank a fifth of booze . . .” and so on. That kind of bragging.

Now I’ll more likely hear a guy say, “You know, I’m so proud of myself. I finally quit smoking after twenty-two years.” And everyone is very interested in how he did it. They’re talking about jogging and cutting down on their drinking.

I had some unpleasant experiences—before going to medical school—when I tried to find certain health information in a medical library. It would have been much easier to look for comparable information in just about any other field—engineering, physics, biology. But technical medical information—for someone who is not a medical professional—is almost impossible to come by.

I recently called the National Arthritis Foundation to ask how our readers could order copies of a book they put out. It covers arthritic diseases in depth, it’s comprehensive, and it’s cheap—one of the best available sources of information on arthritis. I was told that it wasn’t available to laypeople, ”because they might misunderstand it. ” A medical librarian at Yale told me that she had been taught to discourage laypeople who came into the medical library in search of information, “because it was probably somebody looking for evidence for a malpractice suit. ” Why is medical information kept so secret?

Until recently, the medical mystique was much like the religious mystique in the days of Martin Luther and the Protestant Reformation—the language of the laity was one world and the language of the clergy was another. They didn’t even say their prayers in the same language. It was a priesthood. There were things that the layperson wasn’t supposed to know about.

I think that what we’re seeing now, with the demystification of medical language, is comparable to the change Luther made in bringing Christianity into the language of the people.

That’s the most important thing that happens in these self-care classes. First, you let people know that it’s okay for them to step into this formerly forbidden area, and second, you guide them in their first steps. So the main thing is not the class itself, but the fact that it can get people started. It’s a perceptual door opener.

It should be the goal of every health professional to transfer useful and accurate tools, skills, and knowledge to his or her clients. To hide these “professional secrets” and keep them for one’s own aggrandizement is a malfunction of one’s professional role.

One last question, Keith. Would you look into your crystal ball and share your thoughts about the kinds of changes we’re going to see in the next ten years as a result of the growing enthusiasm for self-care?

When I first moved to Minnesota last year, I picked up a paper and saw that a man was considering running for governor on a health-promotion platform. I think we’re going to see mayors and governors and other political leaders picking this up—and probably in your state of California, too. I think self-care will be one of the big political issues of the next decade—in the way that education and agricultural reform and honesty in government have been hot political issues.

A second thing is that the business community is going to get increasingly involved in health promotion, self-care, and helping their employees become wiser buyers and wiser users of health-care services. The big corporations especially are feeling the pain of rising health-benefits costs. In fact, the guys bathe executive suites are hitting the ceiling. These decision-makers are suddenly realizing that health insurance premiums, disability insurance, early retirement, days lost from work due to illness, are all things they can do something about. Several companies last year paid more for health benefits than they did for any other product or service. So I think we’re going to see a lot of self-care promotion on the part of industry.

Third, I think a lot of leadership in this area is going to come from senior citizens. I think that women will continue to be especially active in self-care, and I think we’ll begin to see unions taking a major role.

Fourth, we’re going to see school systems putting in really high-quality self-care programs running all the way from kindergarten to high school. There are some exciting things happening along such lines in Maine, Montana, and Minnesota schools already.

And finally, I think we’re going to see a growing number of fitness/self-care/health-promotion groups, health-information centers, health clubs, self-care classes and study groups, alternative health centers, stop-smoking clinics, and exercise facilities, more widely available black-bag tools, and so on.

He is the author, with Alfred H. Katz and Erik Holst, of Self-Care: Lay Initiatives in Health, and is an Advisory Editor of Medical Self-Care Magazine.

TF: Lowell, you’ve probably school health education as extensively as anyone in the field. What do you think about the way health is taught in American schools?

LL: School health education is a real disaster area. Not only are we not teaching our kids much that is useful, we may be actively destroying their innate abilities to care for themselves.

Health is frequently taught by bored P.E. teachers who have little theoretical and no clinical training. It’s like studying auto mechanics with somebody who’s never picked up a wrench in his life. It’s a rainy-day activity. Few take it seriously.

We desperately need to transform our so-called health classes into experiences that genuinely promote increased self-care, self-discovery, and opportunities for increased control of one’s own life. In fact, that’s probably the single most important thing we could do to solve the so-called health crisis in this country. We need to give our kids a good solid education in clinical medicine, just like we do in reading and arithmetic.

How can a health class damage a child’s ability to care for himself?

By teaching children to conform to a very narrow, professionalized view of what health is all about. We’re teaching them that chiropractors and herbal remedies and homeopathy and other healing approaches are dangerous and harmful. In so doing, we’re prejudicing them against approaches that might be very useful tools.

We teach them that illness is a negative concept and not to be talked about. Health classes never talk about illness—though of course that’s exactly what children are most curious about. The message is that only health workers are capable of knowing about such things— which is absolute rot. These classes have been a real form of social control, and it’s no accident that organized medicine has had a very active role in determining the content of these classes

What do you think we should be teaching in the schools?

Some of the same things we teach in medical school basic human anatomy and physiology and the causes and treatment of disease. Use the school nurse or doctor as a teacher, and use the actual illness experiences of children and their families as opportunities to learn about illness.

We should teach them to diagnose and treat common minor health problems. We should also teach them which kinds of health problems really require professional help. We should teach them medical consumer skills, so that they’re not helpless pawns when they walk into a doctor’s office or go into the hospital. We should teach children to take a good medical history, and to understand the questions and what the answers mean.

Suppose you were a parent. How would you go about getting such a program started in your local school?

I’d start by talking with other parents, sharing my feelings and whatever information I had. I’d try to get parents and teachers together with people working in self-care, visiting some self-care projects. I’d try to give them an opportunity to experience some self-care education for themselves.

Then I’d put it on the agenda of the local PTA or welfare mother’s group or whatever kind of parents’ group existed—maybe invite someone working in selfcare to give a presentation. Then get the parents and teachers to come up with some specific proposals.

I don’t think you can have a good self-care program without the parents’ support, because what you have to do is really put the learners in charge. Give the students the initiative to invite people to come to class— physicians, dentists, alternative healers, runners, meditators, people from self-help groups. Give the kids a feeling that it really is up to them, that health is not just another thing they’re going to have rammed down their throats. You need parental support for that, because that’s a hard idea to sell to traditional educators.

There seems to be a real reluctance to discuss disease with children. A classmate of the children in a class I taught had a brain tumor. Our kids were very curious about what was going on with him. Why was he in hospital? Why was he being kept home? Why had he lost all his hair? What did it mean that he had cancer? Was he going to die? But they’d definitely gotten the message that it wasn’t okay to ask, that it was something so horrible you just didn’t talk about it.

I wanted to invite him and his parents and perhaps his doctor to come and talk to the class about what was happening. The other teachers were horrified. They felt that having him talk about his experience would be too scary for the children.

Yes, and it’s in large part this very pattern of treating such serious illnesses as if they were taboo—except for professional health workers—that makes being seriously ill such a frightening experience. Not only are you sick, but nobody will talk with you.

How did you first get interested in self-care?

It really grew out of my fascination with what was happening in the women’s movement in the early 1970’s Passing the speculum technology on to individual women seemed to point the way toward a much broader transfer of skills and responsibility in health. I got very interested in extending that kind of health empowerment to the population as a whole. Compared to what was happening in the new women’s clinics, most of what was being called health education was a pretty feeble effort.

The women’s clinics were teaching skills that really empowered the people who learned them. They were teaching laypeople to do things that had previously been done only by doctors. They were really transferring knowledge and power from the professional to the client.

Maybe you could describe the proposed adult selfcare project you’re working on in New Haven.

Our project is set up to allow four different communities to plan and carry out self-care programs that would meet their own needs. The four communities are very different in economic and ethnic composition. One is a blue-collar neighborhood with a good number of first- and second-generation southern European and Puerto Rican families. It’s served by a consumer governed free clinic. The second is a predominantly Black and Puerto Rican community with a strong community health center. The third is an economically depressed area which recently lost its textile industry. It’s a depressed working-class area, served by a community hospital and its clinics. The fourth is a university community—students, staff, and families—served by a prepaid medical plan on campus.

What’s the goal of your project?

We want to see what kind of self-care programs the four different communities will come up with. What kind of educational processes will they prefer? What content will they consider important? What outcomes will they want to use in measuring the success of the program?

The people in the communities will plan the program?

Right. We’ll let it be known, through the community, that there are resources available to set up some kind of a self-care or health-education program, but the organizing and planning will be done with the people in the community. They’ll decide how the program is structured, how long it will run, what will be included, and how it will be evaluated. I would anticipate that the four different communities will come up with four very different programs.

After the formal “program” is over, the people involved will continue to learn and to participate in meeting their own health needs. A good self-care program should include not only skill empowerment, but process empowerment. What’s going on in that community that affects people’s health? Maybe it’s environmental pollution. Maybe it’s lack of exercise. Maybe it’s on-the job stress. Whatever it is, it’s the people in the community who should be setting the goals.

Lowell, must lecture and speak about self-care as much as anybody. What kind of reception do you get when you go out to talk about self-care?

I guess the most difficult point to get across is that self-care is not just an extension of health education. We’re not just talking about creating some new, canned programs for professionals to run on the unsuspecting masses. We’re talking about big changes in professional roles, big changes in role for health consumers. We’re talking about shifting the initiative in health care from doctors and other health workers to the individual.

I am less interested in whether self-care will cut down on the use of services than I am in whether it will improve the quality of self-care practice, professional services, and the interaction between the two. Self-care may indeed save us money, but I don’t think that should be the main objective of these programs. For a self-care perspective, the enemy is not the disease, but ignorance and powerlessness.

So far, we’ve been looking at self-care from the point of view of the consumer. How are our doctors going to feel about it?

I think that physicians in primary care will be cautious. Once you empower people to make their own decisions, some people will make decisions other than the one the doctor would have preferred. An empowered consumer might also opt for some kind of care other than that offered by the traditional M.D.

Self-care-educated people will be much more assertive. Their questions will be sharper, they will demand more information, more education. They will ask health workers what they plan to do in much greater detail, and they will expect good answers. They will be more likely to seek different opinions or approaches.

Self-care offers additional degrees of freedom for both health workers and individuals, but it doesn’t mean that every individual will be on his or her own in health decision-making. The staunchest advocate of self-care, going in for major surgery, would want to be able to rest his or her trust in the surgeon doing the operation, to go to sleep trusting that everything would be all right. There are times when this parental, assuring role is very appropriate.

It’s less valuable, perhaps even harmful, when the parental attitude is used when somebody comes in with a stress-related illness. If the doctor just gives these people a Valium and a pat on the head, he or she may be doing them a disservice.

Doctors need to identify situations in which it is appropriate for them to say, “I can’t deal with this effectively,” and perhaps suggest that they make lifestyle changes or involve themselves with a self-help group.

You know, the basis of the whole problem of healthcare costs is that the provider almost always decides what the consumer needs. Health professionals make nearly all decisions about purchasing hospitalization, lab tests, drugs, physician’s services, and so forth. When these decisions are made solely by the provider, all economic controls go by the boards. It would be like going to the grocery store and having the checkout clerk tell you what groceries you had to buy.

A self-care-educated mother monitoring the health of her children can make very useful health judgments about her child—saving time and effort and minimizing the need for professional services. Family and friends can, in many cases, provide better health care than any hospital, because they share the client’s culture. So self-care offers some attributes far superior to what any professional could supply.

Some people in the alternative technology movement are calling self-care appropriate medical technology. Would you agree?

Very much so. Because we’re not talking about bringing in vast new programs, run from the top down. We’re talking about using resources we already have—and have been overlooking for years.

I wouldn’t want to overemphasize health workers’ resistance to self-care. A great many health workers are very excited about self-care, because it gives them an opportunity to get out of professional roles they find personally unsatisfying.

I couldn’t agree more. I’ve always felt that physicians who tend to be curt and abrupt with their patients—who show their stress in their patient relationships—do so because of the strain of having to deal with the patients who appear passive and helpless, who come in demanding that the doctor do things he couldn’t possibly do. If I were a physician, I’d much prefer working with assertive, educated clients who understand and believe they can and must participate in what’s going on.

I’ve been on the faculty of a number of workshops devoted to self-care for health professionals and I’ve been struck by the way that health workers, especially physicians, when they start to trust you and really start letting down their hair, will say that they feel at the mercy of their patients.

These doctors feel harassed by endless forms and paperwork, and on top of all that, now the public doesn’t love them any more. There’s a lot o f stress, a lot of anger. And there’s a wide-spread realization that they’ve gotten themselves into a role that’s not very satisfying.

That is very interesting. Those kinds of workshops are an extremely valuable resource, because we’re beginning to find more and more health professionals becoming—would you believe it—alienated.

Nurses have been feeling this way for a long time, and now alienation is creeping into other sectors of the health establishment. Medicine really is being demystified. The mystique is beginning to crumble—not only for consumers, but for the health workers themselves. They’re beginning to ask, Who am I? What am I doing here? Who needs us, anyway? Are there other ways of being a hearth worker that would be more useful to myself as well as my clients? And so on.

I would think that an important part of the workshops you’ve described would be an opportunity for health workers to meet in open dialogue with their clients.

One of the great gains of self-care is going to be to let us see our doctors as people. If you scrape the money away, you can see that doctors are insecure, beset by self-doubts, and under a lot of pressure—just like all the rest of us. But their training and society’s fantasies about their function have perpetuated a role in which they’re not able to admit their feelings, their fears, their uncertainties.

It’s encouraging to see that a great many medical students are excited about new career opportunities as educators.

Yes. I think that’s going to be the biggest future role for primary care physicians, nurse practitioners, and physicians’ associates. Health workers who are communicators and educators are going to be very much in demand. I think that the enthusiastic reception your magazine has received is a case in point.

I’ll have to admit, I’ve been stunned by the way Medical Self-Care Magazine has been accepted by health workers and health workers’ organizations. I got into this work very disillusioned with-conventional medicine, and I expected to be considered a real rebel, attacked by the AMA, the whole bit. It’s been absolutely the contrary. In fact, I’ve just been invited to speak to the AMA’s Annual Rural Health Conference.

It’s at these conferences, like the AMA Rural Health Conference you mentioned, that many health workers get introduced to these concepts—and so do other professionals- such as librarians, social workers, and agricultural extension workers.

In fact, that’s the stage self-care is in right now— networking. Getting the word around. Helping people connect with others with similar interests. Some of these networks are very informal communities with homey mimeographed newsletters. Some are more formal—some of the best national networking is being done by the National Self-Help Clearinghouse in New York.

What do you see ahead for self-care?

I would hope that we would see some changes on three levels: changes in our understanding of what self-care is, changes in government health programs as the result of an increasing awareness of self-care as a resource, and a gradual extension of the goals of the self-care movement.

Up to now, self-care has been thought of as an individual activity. I think we’re going to move toward a view that also takes into account the health-care-giving functions of nuclear and extended families, friendship networks, affinity groups, churches, mutual aid groups, libraries, groups of fellow-workers, and political groups. We’re going to broaden our notion of the nonprofessional health-care resource.

Second, I think that legislators considering new state and federal health legislation will have to be very sensitive to its effect on our lay health resources. We don’t want to professionalize these resources. We want to supplement and humanize professional health care by nurturing existing lay health-care strategies.

Finally, I think we’re going to see the self-care movement taking on some broader social and political goals—improving the environment, improving our communities. I would hope that self-care could build on its strong base of individual action and seek to improve our individual and community health by social action as well.

Named one of the top ten eco-heroes of the planet by the UK’s Independent and lauded as the “environmental messenger” by Vanity Fair, Simran has contributed numerous segments to Nightly News with Brian Williams, CNBC, the Oprah Winfrey Show, Today Show, Ellen DeGeneres Show, Martha Stewart Show and History Channel. She is committed to a redefinition of environmentalism that includes voices from the prairie, the inner city and the global community.

Simran blogs about sustainability and life cycle analysis for The Huffington Post and Alternet. She has been a featured guest on NPR and is the host of the Emmy-award winning PBS documentary, “A School in the Woods.” She has lectured at institutions ranging from the Commonwealth Club to Cornell University; keynoted conferences including Bioneers by the Bay, the Green Business Conference and the North American Association For Environmental Education; and moderated panels for the Clinton Global Initiative University, Demos and the Climate Group.

Simran is an associate fellow at the Asia Society and serves on the Sustainability Advisory Board for the city of Lawrence, Kansas. She holds an M.B.A. in sustainable business from the Presidio School of Management and graduated cum laude with a B.A. in Sociology and Women’s Studies from Smith College. She is the 2009 recipient of the Smith College Medal, awarded to alumnae demonstrating extraordinary professional achievements and outstanding service to their communities.

What first led you to engage so fully in learning about the environment and sharing what you learned with other people?

I took a course in college called “The Environment,” which was a real galvanizing moment for me. I studied sociology and women’s studies. What I have always cared about are communities. For me, how we use and abuse our natural resources is a really clear indication of where we need to go as a global community. When I worked for MTV News in Asia, and specifically saw what was going on in India, it was that the communities that were the most vulnerable, that had the softest political voice and the least amount of expendable money, were the communities where our most toxic industries ended up. I can remember seeing bodies of water that were a completely unnatural color because of the dye that had been dumped into them. Or the displacement of communities because of a large-scale dam that had been proposed, the Narmada Dam. I recognized that, for me, getting a better understanding of our ecosystem would be way to better understand social justice.

Which environmental issues are most urgent at this time and to what extent does the public, in the United States and elsewhere, understand the urgency?

If you had asked me that question a couple of years ago, I would have said climate change and I would have paraphrased one of my bosses, Robert Redford [founder of the Sundance Channel], who has said that climate change is the umbrella under which all environmental issues fall. But since I moved from New York City to Lawrence, Kansas, three years ago, I’ve had a real education in understanding how people feel connected or disconnected from the issue of climate change.

What I talk about now is understanding our water usage and the fact that our drinkable water is currently finite, that we really need to think about ways to conserve water. Over the next couple of years, 38 out of the 50 states in the United States will be suffering from water shortages of some degree. I think that we need to really consider, for the U.S. population and global population, our consumption. What’s often talked about is population, but what’s more significant is that the United States comprises about four percent of the global population but we use upwards of 20 percent of the world’s resources. Whether we’re talking about petroleum or paper, or generating greenhouse gas emissions, these are all things that the U.S. (now with China and India not too far behind) plays a huge role in. For me, being of Indian origin and recognizing the challenges around population growth, I think the biggest challenge we face right now is people trying to emulate a Western lifestyle. So what we need to do, as Americans, is take a leadership position in redefining how we consume and what we consume. I think that’s the real opportunity to reach people.

Climate change is an urgent problem but it’s hard for a lot of people to get their heads around. The information seems abstract. Carbon dioxide emissions are invisible. The time trajectory for sea level rise seems so far away. The melting of the icecaps is still not something that people hold in their consciousness as they face the challenges in their everyday lives. So I think focusing on the resources we use is perhaps a better conversation to have right now.

Returning to your emphasis on water, this is not just about rainfall, is it? It’s also about using up the water contained in the underground aquifers.

Absolutely.

And here in Kansas, that hits very close to home because the massive Ogalala Aquifer is being drained at unsustainable rates. What have you learned, living in Kansas, that you didn’t know previously about water?

I have learned that we are using too much of it. I came from New York City, where the carbon and ecological footprints are pretty small [per person]. But here, the conventional farming techniques that are employed are very water intensive. The crops we grow, ranging from corn to soybeans to wheat, are water-intensive crops. The push for corn ethanol has been really misguided. So yes, water is not just about rainfall; drought depends on how we use water. And there are certain things that we believe we need to have – like green lawns – that don’t make a lot of sense in certain climates.

We are starting to get a better sense of that fact that water is finite. Planning policies need to reflect that. But for the most part, local governments don’t seem to have taken too strong a stance on this. This is one of things that we addressed in the climate plan for the city of Lawrence, that we really need to look at how we’re using our resources and how we’re planning our cities. The Climate and Energy Project, the nonprofit that’s an offshoot of The Land Institute, has also started to talk about water in relation to climate change, which relates to conventional agricultural measures as well. I’m learning that this hits a lot closer to home here, and we’re not just talking about drinking water. It’s industry, it’s public health, it’s a host of issues that have not been considered as fully as they need to be. Especially in an ag state! We need to be concerned with how available these resources are.

In the United States, and perhaps elsewhere as well, we currently face converging crises in the health, environmental and economic spheres. Do you see these as being interconnected?

Absolutely. Environmental issues are issues of public health, economic prosperity, patriotism and more, because we rely on our natural resources to sustain us. When we abuse our resources, we suffer the health consequences of doing so. So, for me, these issues are not separate; everything falls within our planetary ecosystem.

The biggest challenge I have as a journalist is trying to help people make these interconnections. Media is notorious for trying to squeeze a little bit of information into a little bit of space and not providing a lot of context. It’s a real hardship to try to explain climate change in a 250-word blog post or a two-and-a-half minute news story. I have tried to do both and I can tell you it is not easy. I think these stories warrant a much deeper conversation. When it comes to talking about the environment, we see the schism in the January 2009 Pew Poll saying people feel the Obama Administration should focus on jobs, the economy and terrorism, while interest in issues like environmentalism and climate change have fallen precipitously. Those things are completely interconnected. If we don’t make those connections clear, then it’s understandable that most people won’t be able to.

You teach courses at the University of Kansas on the intersections between media and the environment. You’ve partially answered this already but I’d appreciate your going a little deeper, if you would. What do you think is currently lacking in media coverage of the environment? You’ve talked about the limitations of sound bites or 250-word blog posts., For someone seeking to get the message out, someone who is a journalist or aspires to be one, how can they accomplish what needs to be done?

I think that for starters, they need to do a lot more homework. Science is not an easy thing to understand and I’ve seen many reporters ask questions that indicate that they haven’t done much homework. I emphasize to my students, many of whom are budding journalists, that it really comes down to asking good questions and knowing what to do with that information. We are further challenged by the fact that scientists are not trained to work with media. Science is a journey whereas media asserts destinations, for lack of a better analogy here. Media wants you to know this is right and this is wrong, this is black and this is white, this is the truth and this is a falsehood. Science is based on hypothesis; based on past history, this is what we think will happen in the future.

I think a lot of communicators don’t know what to do with that uncertainty. We need to do a better job of making our own concerns clear, while also being clear that some of this has not yet been figured out. It is dynamic and changing information. I worked for media outlets that would say to me, “We already did that story. Green transportation, green jobs, done.” You would never say that you’ve “already done” the Obama Administration, or healthcare. But for some reason this issue, the environment, has been siloed in such a way that people feel that it’s not well integrated into the fabric of their lives. So my goal would be that we stop having courses on media and the environment because the information will become so much a part of the public discourse that the information will no longer be decontextualized and isolated.

To what extent should journalists, environmental or otherwise, seek to maintain an objective viewpoint? Also, to what extent must there always be two sides presented, or given equal time, even if one side has essentially all of the science behind it? How do you address this with your students?

I tell students on day one that I don’t believe in objectivity. Other courses that they take may assert that objectivity is very much available and necessary. But for me, particularly in any level of advocacy journalism, it is my belief that people make assumptions about what your orientation is, if you are simply reporting on the environment and that the truth of the matter is that we all have a vested interest in the environment continuing and sustaining. So we have an agenda – we want clean air, we want clean water and we want clean soil. To me, it was a great misstep to give equal time to climate skeptics and do this 50-50 split on what the skeptics believe versus what the scientists believe. And this is really reflected to this day in the skewed kind of support that we have, or lack thereof, for responses to climate change. According to the recent Yale study, roughly half the population believes that human activity is behind climate change. The other half does not or is somewhat skeptical along the continuum.

I think most people get their information from media. That’s how they formulate their opinions about the world. I believe it is possible to assert, to make clear, your agenda and move forward. Because to me, you are showing your bias from the moment you select an interview subject, the moment you ask a question, the moment you edit a news story and determine what sound bite you’ll leave in and what you will take out. That reveals some level of subjectivity. So to assume a detached voice is an objective one, is, I think, an illusion.

Speaking of having an opinion, are you optimistic about our avoiding environmental catastrophe?

Sometimes I am not but most of the time, I am optimistic. On one of the television shows I worked for, I interviewed a woman named Sylvia Earle. She’s a marine biologist in her seventies who was the first woman to walk untethered on the ocean floor. She was named one of Time’s heroes of the planet. I leaned in to her during one of the breaks and said, “Dr. Earle, 90 percent of our fish stocks are depleted. What do we do? I mean, how do you keep going?” She’s this spry woman with bright blue eyes, and she said, “Simran, it’s the 10 percent.”

Keeping our eye on the possibility and the hope of what we can do is not always easy but I think it’s always essential. That’s where I try to come back to and it’s what I try to inspire my students to do. There’s always that moment in the semester where they realize, “Well, gee, everything I eat, the car I drive, the clothes I wear, everything has this terrible impact.” For most people, it is not a viable solution to pull yourself off the grid and go live in a yurt. But it is possible to be conscious about the decisions you make and recognize that everything does have an impact, and to look at ways that your impact can perhaps be diminished.

To what extent is food production and distribution, and the choice of which foods we eat, an environmental issue? And I would ask you to specifically address that in the context of animal agriculture, since Kansas is one of the world’s centers for animal agriculture.

Exactly. Don Stull, a cultural anthropologist at the University of Kansas describes the area of Garden City, Holcomb and Dodge City as the Golden Triangle of Meat Packing. This year in my class on media and the environment, we used food as the lens. We focused completely on food and agriculture, which I don’t think are separate. But in some people’s minds, ag is different from food.

Food is a universal. We have to eat, we can’t get away from it. And the choices we make have varying impacts. For a lot of students, it was an awakening to realize the amount of land, water and greenhouse gas emissions (particularly methane) that are generated through the raising of livestock. You can think about a meat packing plant in the abstract and think that it isn’t very pretty, but we talked to farmers. We started to get a better sense of what it means to make that choice. A couple of people in the class are vegetarians and they were able to share their insights as to why that was important for them, in terms of a personal ethic as well as an environmental responsibility.

In terms of the research that you were encouraging students to do more of, did you look into the 2006 United Nations report, “Livestock’s Long Shadow”?

Yes, we read the summary of that report. This is information that we weren’t talking about just a few years ago. Everyone was talking about carbon dioxide emissions without really looking at methane and the concentrated nature of that greenhouse gas emission. For students, it has been a real awakening to understand this. But they tend to be on budgets so they face a struggle in which they say, “I want to eat better, but my pocketbook only allows this much, so what am I going to do?” There was one student who came in saying that he ate burgers every single day. By the end of the semester, he was eating fewer burgers, but more importantly, he was really clear on what the supply chain was that brought that burger to his plate. He was recognizing not only the animal that had given up his life but the resources that had been depleted, what the farmers had been paid, and how the workers had been treated in the factory. Hopefully that information will stay in his mind and he will make better choices.

The Leopold study that was done at the University of Iowa, indicating that our food travels over 1500 miles from farm to fork, was surprising to students. We live in an ag state, yet our food is still traveling these huge distances to reach us. Why is there this disconnect? Why is our food system so out of whack? Where can we look and what can we do as citizens to start to make a difference?

You’ve often appeared on various media outlets speaking about sustainable business approaches. Corporations seeking quick profits are often seen as the enemy of sustainability. Can corporations be part of the solution?

It goes back to the idea of doing the best we can and thinking critically about our choices. Corporations are corporate citizens and I think we really need to treat them as such. And as such, some will do better than others. But for me, it’s necessary to continue to encourage companies to go further and not allow them to rest on their laurels.

I’ll give you an example. I moderated a conversation between the heads of corporate social responsibility for Whole Foods and Wal-Mart last year in Boulder, Colorado. The conversation was about sustainability and how these corporations define it. There’s a definition from the Bruntland Commission, the UN commission on sustainable development, which defines sustainability as engaging in a way that doesn’t harm future generations. Whole Foods has this American pastoral vision, that Michael Pollan talks about, in which they paint a picture that lots of the food is local and the price premium is certainly worth it. I asked, “What does this mean?” Furthermore, there is a lawsuit in California about toxins in some of the products carried in Whole Foods, so I questioned them about that, as well.

On the Wal-Mart side, I asked what they were doing in terms of labor rights. We cannot underestimate the power of the world’s largest retailer shrinking packaging, demanding that their supply chain shrink packaging by 30 percent. Trust me, when Wal-Mart says you have to do it to stay in our club [laughter], that’s it! It is unequivocal. So I can’t in good conscience say that Wal-Mart is the devil. Personally, I don’t really shop there, but I recognize the power of that institution and I recognize that there are huge numbers of people who do. So for me to dismiss them out of hand means that I am losing an opportunity to galvanize a lot of support throughout the supply chain, through a number of other companies and throughout a consumer base.

So you’re more concerned about expanding our reach than about being accused of compromising too much.

As a journalist, my goal philosophically is to bring more people into the conversation. We can’t get there if it’s just the folks on the coasts, the people who are already engaged in permaculture, the folks who are riding bikes and buying Priuses. It has to be everybody. This is too important and it involves all of us. So we need to seek out ways to get more people involved in the conversation and not make people feel alienated or shamed or stupid. All of these things have happened and have caused some people to say, “That’s not for me. That movement doesn’t belong to me.”

This one belongs to all of us. It’s about striving every day to figure out how to do that. This has to involve getting corporations on board. At one point, I was vehemently against a number of corporations, which I won’t list now. But I had a friend talk to me, and he said, “Do you go through your day and not interface with companies? You use products, right? Your coffee comes from someplace. You didn’t make your own clothes.” That helped me to realize that whether I like it or not, I engage with companies from the moment I wake up in the morning and brush my teeth, until the moment I go to sleep and put my beeswax earplugs in my ears. Somebody made those things; I bought them from somewhere. So I need to figure out how to work within that model and encourage those companies, and other companies, to do more.

Coming back to health issues, the British medical journal, The Lancet, recently ran a major article which concluded that global climate change is the greatest health threat of the 21st century. Is that your sense and, if so, why is this not more widely recognized yet?

You know, climate change has needed a much better public relations company. I’m making a joke here, but someone needs to do a lot better PR for the planet than we’ve had. Climate change has been an extraordinarily divisive issue. Media didn’t do a good job, NGOs [nongovernmental organizations] didn’t do a good job. Some people have felt like if they are to believe in climate change, the next thing you’ll want is for them to support abortions and vote for Al Gore. It’s this strange polarity that has occurred. I can’t quite understand how this happened.

While I have not read that particular issue of The Lancet, I completely believe that climate change is an extraordinary health concern. It doesn’t get talked about enough because climate change, in general, has not been spoken about in ways that resonate with enough people. We talk about the number of degrees of the planet heating up, and we talk about sea level rise, but we have not made this tangible for people. If you say the temperature will rise here in Kansas and we will see increased rates of malaria because the mosquito population will proliferate, then that’s something that people can get their heads around.

But abstractions have not worked for people. We thought that maybe – when I say we, I mean environmental storytellers – that facts would really engage people. But I don’t think that people can tell the temperature difference between [global climate change of] one degree Celsius and two degrees Celsius. I’m not convinced that telling people that swapping out light bulbs will be the equivalent of taking a million cars off the road, or two million cars off the road, actually means anything to them. It sounds like a lot, don’t get me wrong. But speaking for myself, it doesn’t stay with me. I can’t discern the difference in those orders of magnitude. I think the more we can talk about public health, the better chance we have of actually engaging people.

From your perspective, what are some of the palpable public health issues that we can hang our hats on as communicators, to connect in a visceral way with people who may just be engaged in other activities and not thinking about this? What is there with people’s health that they might connect to? Not having enough water to drink, that’s one. Not having enough water to grow food with, that’s another…

See, you’re on a great roll. Not being able to breathe the air, that’s another one. The pollution. In the 1970s, when we galvanized around the Clean Air Act, seeing smog is what galvanized people. We have to make the invisible visible for people. Also, we can’t keep talking about everything over these long time horizons. There are some great reports that have come out for the state of Kansas, and for other states, about what will happen in response to climate change by the year 2100.

When we’ll all be dead.

Exactly. I want to know, what’s going to happen in 2010? Will I still have a job, will I have food to eat? It’s important to break some of this stuff down and say listen, this puts us on a certain trajectory. Here’s what happens to our soil, here’s what happens to our food, here’s what happens to the air that we all need to breathe, here’s what happens when we site another coal plant in our community. Here are the impacts that coal plant will have on drinking water. We don’t need to actually use climate change as the conversation starter because that’s where a lot of people have been turned off.

I can argue against a coal plant on a number of grounds that have absolutely nothing to do with the planet warming. I think that’s what we need to start do more, to build bridges to constituencies that are simply turned off rather than trying to convince them that climate change is real, which I think is a very challenging thing to do because it has become so politically and culturally loaded. I would start to talk about some of those common cares. And I think that what you just cited and what I just cited are the best ways to do it. Public health is so unifying. None of us want to be sick. None of us want our kids to be sick. A lot of us don’t want the animals to be sick or the plants to be sick either. That’s something that people can really feel.

Is concern about the Midwest turning into a Dust Bowl again a useful angle?

I still consider myself a bit of a transplant. I don’t know what the historical memory is around that. I mentioned it in class but I don’t really think that a lot of my students got it; they don’t seem to have any recollection of what that meant.

Aside from food, what did they identify with most?

For the whole course we used food as a lens, so the conversation was about food. But I would say water, jobs, the economy. We have to tie it into what people assert they do care about. That, to me, is just the clearest way to do this. If Pew tells you that the top three concerns for people are jobs, the economy and terrorism, well, I can figure out ways to talk about the environment in ways that address those concerns, rather than talking about them in ways that fall to the bottom of their list of concerns.

So if we say the conversation is about climate change and sea level rise, well, that just dropped to 20 in the list of 20 concerns. But if I can tie these to all the workers that have been laid off from Boeing in Wichita, and that the skill sets they have translate really well into creating wind turbines, and that Kansas has the third highest wind capacity in the country but we’re tenth in production, there’s really a tremendous business opportunity here. That’s going to get some people listening. That’s going to bring dollars into our state. I mean, those are the kinds of connections we need to make.

If we are concerned about terrorism and this whole idea of energy independence, what are the sources of energy we can use that would be good for us? Okay, we have a lot of coal here. What can we do to clean it up, because at this point clean coal is really a fallacy. What can we do to make that real if we’re not going to get rid of it? What other sources can we move toward? How can we educate our consumers? How can we get the government on board? We have a real opportunity right now because for so many years under George Bush, it was really hard to have these conversations.

So that space has opened up now?

Absolutely, from the inside out. We are no longer fighting to get these conversations held and policy changed. These things are happening in real time, since January. We have an extraordinary opportunity. There’s momentum. So where else can we direct our efforts? In my opinion, and I’m working on a book about this very thing, we need to address the people who have felt maligned or unaddressed by this movement. I would that say that’s a lot of folks who politically have identified as Republicans and who culturally have engaged in some of the same activities that the most ardent environmentalists do, but who would absolutely refuse that label because it doesn’t feel like a good fit for them. We’re trying to find out what would make it a good fit.

I read that your forthcoming book focuses on eco-elitism, which seems to be what you were just talking about. I was going to ask you to speak about how reasonably well-off people can recognize and avoid it. But I realize that eco-elitism may not be so much about whether one is well-off, but perhaps more about a kind of cultural elitism.

It’s more of an attitude that separates us. I received an email from a woman and I was describing the book, talking about how the contemporary American environmental movement was founded by hunters and anglers and so I’m interested in talking to them. She said she was vegan and that she wouldn’t have anything to do with this book. Now, absolutely the most environmentally friendly individual change you can make around food is become vegan. There’s no question. But, if we’re only going to get vegans on board with this movement, then we’re not going to get a lot of traction.

I’m curious to understand a community that values natural resources and has been instrumental in preserving large tracts of land. And as someone who eats meat, the people who hunt and then clean those animals and put those animals in their freezers and eat them all year round, they’re far more noble than I am when I go to the grocery store and look for some free-range chicken. I have a tremendous amount of respect for people who do that. I’m not a big fan of hunting as a sport but I think that there’s something we completely miss when we say that we don’t want to engage in dialogue with them. That’s philosophically where I come from.

So we need to find the places where the circles intersect?

Absolutely. And there are a number of them when it comes to natural resources that we share and depend on for our sustenance. I think there are a lot more ways that we are connected and we need to be a lot more creative about figuring them out. That’s what I mean by eco-elitism.

Is there any other area or issue that you feel passionately about that we haven’t touched upon?

Environmental justice. I really feel that people have been left out of this conversation for a number of reasons – because they’re disenfranchised, because they’re poor, because they have no political clout, maybe because they’re people of color, or because they’re Republicans.

There are just a host of reasons that we determine that someone is not like us. What I am trying to do is to help to make it clear that we are the same, that we have shared concerns and we need to figure out shared solutions. When it comes to environmental justice, Robert Bullard, the sociologist, did a study 23 years ago, looking at where toxic industries are sited. They’re sited in low-income communities of color, disempowered communities. That hasn’t changed in 23 years, despite EPA having an environmental justice arm, despite many of the big environmental organizations having an environmental justice arm. We have not reached those constituents.

I created a series for The Sundance Channel, for their website, called “The Good Fight,” that looks at how these issues – water usage, access to food, housing – how these effect disparate communities and what we can do. I think the first step is becoming informed. In order to do that, we need to seek out really good journalists, we need to encourage them and we need to become our own storytellers. And to recognize that this is the one movement that we cannot say belongs to someone else. It belongs to all of us.

1. 1. From internal AMA documents introduced into evidence by the chiropractic plaintiffs at the Wilk v. AMA trial. Data from the federally-mandated study study was to be used to determine whether chiropractic should be included in Medicare, the government-sponsored health insurance program for older Americans. Passage of the Corman-Stone bill in 1973 brought chiropractic services into the Medicare system.
   

   
   

2. 2. Eddy, David M. Quoted in Chiropractic: A Review of Current Research. Foundation for Chiropractic Education and Research. Arlington, VA. p.1. Dr. Eddy, a medical physician, is Professor of Health Policy and Management at Duke University.
   

   
   

3. 3. Eisenberg, David et. al.”Unconventional Medicine in the United States: Prevalence, Costs and Patterns of Use.” New England Journal of Medicine. January 28, 1993. 328: 246-252.
   

   
   

4. 4. Leach, Robert. The Chiropractic Theories: A Synopsis of Scientific Research. p. 24. Leach cites as his source an article by Elizabeth Lomax called “Manipulative therapy: a historical perspective from ancient times to the modern era,” which appeared in The Research Status of Spinal Manipulative Therapy, published by the United States Government Printing Office (1975), pp. 11-17. This monograph contains the proceedings of a conference on spinal manipulation, convened by the National Institute for Neurological and Communicable Diseases and Stroke (NINCDS).
   

   
   

5. 5. Copland-Griffiths, Michael Dynamic Chiropractic Today. pp. 119-120.
   

   
   

6. 6. Ibid. pp. 121-122.
   

   
   

7. 7. Leach. op. cit. p. 25
   

   
   

8. 8. Gibbons, Russell. “The Evolution of Chiropractic: Medical and Social Protest in America.” in Modern Developments in the Principles and Practice of Chiropractic, edited by Scott Haldeman. p. 23.
   

   
   

9. 9. Sharpless, Seth. “Susceptibility of Spinal Roots to Compression Block.” In Goldstein, Murray (editor): The Research Status of Spinal Manipulative Therapy. Washington, DC, Government Printing Office, 1975, pp. 155-161.
   

   
   

10. 10. Kirkaldy-Willis, W, Cassidy, J. “Spinal Manipulation in the Treatment of Low-Back Pain.” Canadian Family Physician 31:535-540. 1985.
    

    
    

11. 11. Meade, T.W., Dyer, S., et. al. “Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment,” British Medical Journal, June 2, 1990. Vol. 300, pp. 1431-1437.
    

    
    

12. 12. Dr. T. W. Meade, interviewed on a Canadian Broadcasting Corporation (CBC) program, as quoted in Chiropractic: A Review of Current Research. Foundation for Chiropractic Education and Research. 1992.
    

    
    

13. 13. Koes, B.W., Bouter, L.M., et. al. “Randomised Clinical Trial of Manipulative Therapy and Physiotherapy for Persistent Back and Neck Complaints: Results of One Year Follow Up.” British Medical Journal. March 7, 1992, Volume 304, pp. 601-605.
    

    
    

14. 14. Ebrall, P.S. “Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Managment Within the Victorian WorkCare Scheme,” Chiropractic Journal of Australia, June 1992, Volume 22, Number 2, pp. 47-53.
    

    
    

15. 15. Jarvis, K.B., Phillips, R.B., et. al. “Cost per Case Comparison of Back Injury Claims of Chiropractic versus Medical Management for Conditions with Identical Diagnostic Codes,” Journal of Occupational Medicine, August 1991, Volume 33, Number 8, pp. 847-852.
    

    
    

16. 16. Wolk, S. Chiropractic versus Medical Care: A Cost Analysis of Disability and Treatment for Back-Related Workers’ Compensation Cases. Foundation for Chiropractic Education and Research, September 1987.
    

    
    

17. 17. Boline, P.D. Chiropractic Treatment and Pharmaceutical Treatment for Muscular Contraction Headaches: A Randomized Comparative Clinical Trial. Proceedings from the 1991 International Conference on Spinal Manipulation. FCER. Arlington, Virginia.
    

    
    

18. 18. North American Spine Society’s Ad Hoc Committee on Diagnostic and Therapeutic Procedures. Spine. 1991. Vol. 16, No. 10.
    

    
    

19. 19. Davis, H. AV MED Medical Director. Miami, Florida. 1982. The chiropractor was Mark Silverman, D.C. This evidence was presented as part of the Wilk v. AMA trial.
    

    
    

20. 20. Cherkin, D., MacCornack, F. “Patient Evaluations of Low Back Pain Care from Family Physicians and Chiropractors,” Western Journal of Medicine, March 1989, Volume 150, pp. 351-355.
    

    
    

21. 21. Gilbert, J.R. “Clinical Trial of Common Treatments for Low Back Pain in Family Practice.” British Medical Journal, 1985, Vol. 291, pp. 791-794.
    

    
    

22. 22. Curtis P, Bove G. “Family Physicians, Chiropractors and Back Pain.” Journal of Family Practice, November 1992, Vol. 35, pp. 551-555.
    

    
    

23. 23. The Gallup Organization, Demographic Characteristics of Users of Chiropractic, 1991.
    

1. 1. Copland-Griffiths, Dynamic Chiropractic Today, p. 159
   

   
   

2. 2. Bourdillion, J.F. Spinal Manipulation. pp. 205-206
   

   
   

3. 3. Copland-Griffiths, op. cit. p. 162
   

   
   

4. 4. Mazzarelli, Joseph, D.C. (editor). Chiropractic: Interprofessional Research. pp. 69-76.
   

   
   

5. 5. Yates RG, Lamping DL, Abram NL, Wright C. “Effects of Chiropractic Treatment on Blood Pressure and Anxiety: A Randomized, Controlled Trial.” Journal of Manipulative and Physiological Therapeutics, 1988; 11: 484-488.
   

   
   

6. 6. Kokjohn K, Schmid DM, Triano JJ, Brennan PC. “The Effect of Spinal Manpulation on Pain and Prostaglandin Levels in Women with Primary Dysmenorrhea.” Journal of Manipulative and Physiological Therapeutics, 1992; 15: 279-285.
   

   
   

7. 7. Thomason, PR, Fisher BL, Carpenter PA, Fike GL. “Effectiveness of Spinal Manipulative Therapy in Treatment of Primary Dysmenorrhea: A Pilot Study.” Journal of Manipulative and Physiological Therapeutics. 1979; 2: 140-145.
   

   
   

8. 8. Brennan PC, Kokjohn K, Katlinger CJ, Lohr GE, Glendening C, Hondras MA, McGregor M, Triano JJ. “Enhanced Phagocytic Cell Respiratory Burst Induced by Spinal Manipulation: Potential Role of Substance P.” Journal of Manipulative and Physiological Therapeutics, 1991; 14: 399-408.
   

   
   

9. 9. Klougart N, Nillson N, Jacobsen J. “Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases.” Journal of Manipulative and Physiological Therapeutics, 1989; 12: 281-288.
   

   
   

10. 10. Falk, JW. “Bowel and Bladder Dysfunction Secondary to Lumbar Dysfunctional Syndrome.” Chiropractic Technique, 1990; 2: 45-48.
    

    
    

11. 11. Borregard, PE. “Neurogenic Bladder and Spina Bifida Occulta: A Case Report.” Journal of Manipulative and Physiological Therapeutics, 1987; 10: 122-123.
    

    
    

12. 12. Masarsky, CS and Weber M. “Screening Spirometry in the Chiropractic Examination.” ACA Journal of Chiropractic, February 1989; 23: 67-68.
    

    
    

13. 13. Masarsky, CS and Weber M. Chiropractic and Lung Volumes A Retrospective Study. ACA Journal of Chiropractic, September 1986; 20: 65-68.
    

    
    

14. 14. Hewitt, EG. “Chiropractic Treatment of a 7-Month-Old With Chronic Constipation: A Case Report. Proceedings of the National Conference on Chiropractic and Pediatrics (International Chiropractors Association), 1992; 16-23.
    

    
    

15. 15. Bachman TR, Lantz, CA. “Management of Pediatric Asthma and Enuresis With Probable Traumatic Etiology.” Proceedings of the National Conference on Chiropractic and Pediatrics (International Chiropractors Association), 1991: 14-22.
    

    
    

16. 16. Browning, JE. ” Mechanically Induced Pelvic Pain and Organic Dysfunction in a Patient Without Low Back Pain.” Journal of Manipulative and Physiological Therapeutics, 1990; 13: 406-411.
    

    
    

17. 17. Goodman R. “Cessation of Seizure Disorder: Correction of the Atlas Subluxation Complex.” Proceedings of the National Conference on Chiropractic and Pediatrics (International Chiropractors Association), 1991: 46-56.
    

In this interview with Dr. Daniel Redwood, Dr. Brehony describes the motivation behind these extraordinary acts of compassion, discusses the role of challenge and pain in times of transition, and addresses the need to be both creative and secure.

A clinical psychologist in Virginia Beach, Virginia, Brehony is also the co-author (with Robert Gass) of the recently published book Chanting: Discovering Spirit in Sound (Broadway, 1999).

DANIEL REDWOOD: To write Ordinary Grace, you sought out people who had gone the extra mile, helping others in situations where no one would have criticized them had they not performed these acts of service. Is there something that these people have in common that sets them apart from the rest of us?

KATHLEEN BREHONY: Great question. Really, that’s the theme of the book, to explore if there is something different. I think they have something that they manifest that the rest of us also have but don’t always manifest. There are a number of characteristics, but one of the major ones is this absolute felt connection to other people. In all the people I’ve talked with, there wasn’t a single one who cited pity. It was pure compassion, a lot of, “There but for the grace of God go I.” The other characteristic that immediately comes to mind is that everyone I spoke with seemed to think that to help somebody else was a blessing to them. It wasn’t something that they did expecting a reward. They didn’t say, “Look how great I am because I got to help.” There was a sense that it felt good to them to give somebody a hand.

REDWOOD: Did they all come from families where this sort of altruism was encouraged and inculcated?

BREHONY: Absolutely not. You’d like to think so, it would make it a little more predictable in some ways. But one of the guys I interviewed, named Tony, was born to a 13-year-old mother in a state mental institution. He was shuttled from foster home to foster home and taken away from his father because his father physically abused him. He was working in the lumberyards and sawmills from the time he was 11 years old. As soon as he was old enough, he went off into the Marines and did two or three tours of duty in Vietnam. This is not somebody you would think would easily come to compassion, and yet he did. He’s this great big guy, from the Virginia Beach area. And he, his wife, and a number of his friends, all motorcyclists, on every non-rainy Sunday afternoon they do something to raise money for a trailer park, kids with muscular dystrophy, adults with multiple sclerosis. He’s known locally as “The Motorcycle Santa.”

REDWOOD: I was especially moved by the two stories you told of people who decided to donate kidneys to individuals who were neither relatives nor close friends. Could you relate a short version of those stories and share with us your own personal response when learning what these folks had done?

BREHONY: I read an article about the power of prayer, I think it was in Time or Newsweek. One of the women in it said that she had prayed for her sister, who needed a kidney. She had an unusual last name, and it said that she was from somewhere in Pennsylvania. So I called information and found her father. Because I wasn’t yet sure that he was related to her, I said I was an old friend of hers from college and asked how I could reach her. When he said he was her father, I explained who I really was and I eventually tracked her down in California. She was in her mid-30s, her kidneys were shutting down, and she was going to die in spite of dialysis. She comes from a large Chinese-American family. She has tons of relatives, it’s a close family. They all were tested to see if anyone could donate, but none was a match, not even her sisters and brothers.

She walked into the bank one day, looking sad because she had just learned this news. The bank teller, a woman named Mary, said, “Boy, you look down in the mouth today. What’s wrong?” And the woman, whose name is Mickey, said, “I just found out I don’t have anybody who can give me a kidney.” And Mary said, “What is your blood type?” Mary told me later that at that exact moment, “I knew that I would match”and that I was going to give her a kidney.” She said, “Something came over me.”

Then I meet up with these two guys in Detroit. One is an Italian guy from New York City, and the other is Larry Wynn, originally from Mississippi. They both work as executives for General Motors, but they were not close friends. They had gone with a number of other co-workers to some baseball games and things like that, but that was about it. Larry told me that on the very day that he discovered that his sister could not donate a kidney (which was only three days after his father had died), he went from Pontiac to Detroit, and for some reason he had a strong feeling that he wanted to see his old co-worker, Sal.

He went to Sal’s office, but Sal was not there. So he went and did whatever other business he was there to do. On the way out, he pushed the up button, even though he was intending to go down and leave the building. He said to me later, “I’m not quite sure why I did that.” But he went back to Sal’s office, and by this time Sal was back from lunch. Sal said the same kind of thing to Larry that Mary had said to Mickey, “You look kind of down today.” And Larry said, “I just learned that my sister doesn’t match and can’t give me a kidney.” And Sal used the exact same language as Mary had. He said, “Something came over me.” And at that moment, he said to Larry, “I’ll give you a kidney.”

REDWOOD: What is this “something” that came over them?

BREHONY: It depends on your point of view in terms of the language you might use to describe it. Larry talked about it as being the Holy Spirit. I think it can be the Self. It can be that place in each of us that is connected and knows it. Most of us can understand, as your question framed, that we would give a kidney to a beloved child, or even a very good friend, or somebody that we loved. All these people have done is expand that outward.

REDWOOD: You are a psychologist who specializes in transitional periods of life, such as midlife and death and dying. What led you to this focus? Do more people seek out therapy at these times?

BREHONY: Very often, yes. I am one of those therapists who doesn’t particularly believe in diagnoses. I think it works in many other areas of medicine and healing, but in the area of psychiatry and psychology I think it doesn’t work. I’m in private practice, and it might be different if I worked in a state hospital, where many people truly have profound psychiatric disorders that I think are probably as biological as they are anything else. But mostly, that’s not who I see. Mostly, I see normal, functional, everyday people who are going through a hard time in life, and maybe don’t have some of the resources they need in order to cope with the problem. The book I just finished, which is as yet untitled — I sent it to my publisher under the title, A Big Old Book about Suffering, by Kathleen Brehony — in a way it’s an exploration of that question, of what we need to deal with the inevitable changes and transitions and struggles in life.

REDWOOD: Aren’t we always in periods of transition?

BREHONY: If we really think about it, sure. We’re transiting as we sit here and speak. But the big ones sometimes jump up and knock the wind out of people in a way they’re unprepared for. One of my chapter titles is “Straw Houses.” I use the metaphor of the three little pigs, and ask, “What kind of house have we built for the inevitable blowing of the wolf?” Some people, many of whom come from dysfunctional families and hard backgrounds, do have houses of straw, though not all, because I’ve met lots of people who you would expect to have very little resilience, and they have plenty. Then there are other people who seem to have had a lot of things that we think go into making a person strong and able to deal with challenges in life, and they’re not as good as somebody who had a hard time.

REDWOOD: Is growth possible without pain?

BREHONY: I’d like to think so, but I’m afraid I’d be wrong. Here’s why. Most people don’t come home on a Friday night and say to their spouse, “You know what I’m going to do this weekend? I’m going to grow.” Very often it is exactly those events that knock the wind out of us that cause us to say, “Okay.” It’s an initiation. I like the alchemical metaphor of having to be broken down sometimes, to fall into the abyss. Then I think we come back differently, and that’s the hero’s journey. We can come back differently if we only allow ourselves to be open to the experience.

REDWOOD: In your own life and those of people you have worked with, do you find that the drives for security and creativity are often in conflict?

BREHONY: Quite often. It’s funny you should ask.

REDWOOD: How does one, and how do you, deal with that?

BREHONY: I think you hold the tension of the opposites. I just wrote a 4000-word letter to my 23-year-old nephew. For Christmas, I wanted to give him a couple of books that would matter to him. He’s a musician. He’s 23, and in love for the first time in his life, with a young woman who has a 14-month-old baby. The family has always been very supportive of Madison pursuing his love of music. He’s very good at it and works hard at it, too. It’s not just, “I want to be a rock and roll star.” He really writes beautiful music and lyrical words with a depth that you wouldn’t expect of a 23-year-old. But his friends — not the family, but his friends, non-artist friends — have said to him, “When are you going to grow up, man? You can’t support a family and take care of this baby if you’re going to be out until three o’clock in the morning playing music, making $100 a week.”

So I wrote him a 4000-word letter. I told him I wished I were the kind of auntie who wrote with a fountain pen on handmade paper, but it would be all smeared and I don’t think my thoughts would come out as quickly as they can on computer. I told him that I thought what had to happen was holding the tension of the opposites, which is to do both/and, as opposed to either/or. To say yes, my life is going to be creative and this is what I’m here for, this is part of the natural talent, the natural reason for why I exist. To bring that out and share it with the rest of us.

On the other hand, there are the pragmatic realities of rent to pay, food to put on the table, and particularly if you have other people riding in your boat with you, children or other people you’re responsible to. So one of the things we’re going to be doing over Christmas (he also teaches music) is that we’re going to sit down over a nice glass of Merlot, and we’re going to brainstorm all kinds of creative, good marketing ideas to making his teaching business work. And if he has to work part-time at a 7-11, that’s what he’s willing to do in order to make his music happen.

REDWOOD: I was struck when reading your biographical sheet that it contains an unusual combination of pursuits. You’re a clinical psychologist, but you have also been director of marketing and later president of an independent video and film production company. You co-wrote the recently published book Chanting: Discovering Spirit in Sound with Robert Gass, one of the great spiritual music pioneers of our time. You also seem to have a great love for animals. Is there a common thread here that helps explain how you became the person who you are?

BREHONY: Because I’m a Gemini [laughter]. I have a lot of varied interests. I think we all have certain innate directions that our personality and our type pull us in. Mine is always to not take on too many different things, but to have enough depth in the ones that matter to me. There’s just a lot of things I love. I see this whole existence as a kind of buffet. And now that I think of it, that’s kind of the way I eat at a buffet too – I take a lot of things in order to see what I like. And there is a thread, there’s certainly a thread in all my nonfiction work, and that is always consciousness. Whether it’s about midlife, or goodness, or this new one about growth through pain and suffering. They all follow a theme that says, “What can each of us individually, and all of us collectively, do to help each other to become more conscious, awake, aware, and alive?”

There is a story that I love that I included in Ordinary Grace, about St. Francis and the almond tree. According to the old legend, it’s the middle of winter and the ground is frozen. St. Francis looks out to this almond tree and says, “Speak to me of God.” And the almond tree blooms. Even when I say that now, I start to feel myself become very emotional because it’s such a powerful image of what I think is simply what we’re here to do.

REDWOOD: I’m remembering a few years ago when an intense storm came through here, with strong winds and pounding rain. There’s a tree – crabapple, not almond – just outside the office here. Shortly after the storm, half of the tree went into bloom a second time, something I’ve never seen before. Perhaps these special blossomings often come after a storm.

BREHONY: You know, they do. I don’t watch much TV, but I love documentaries on the Discovery Channel. There’s a series called “Wonders of the Weather,” and if it’s on, I’ll watch it. One was a documentary about the earth after wildfires go through. And while you can still see these burning embers of trees, there are tiny tendrils, green shoots, coming up right next to them. In nature, I think that’s one of the purposes of those kinds of clearing out, to make room for new growth. And I think we often have to do that as human beings, too. We don’t like it, particularly. We don’t have to like suffering or pain, but I think that if we make a commitment to ourselves that we’re going to use it to grow, to become more of who we can be and who we really are deep inside, then I think somehow suffering doesn’t hurt you quite the same way. Not that we don’t grieve; I think we should grieve.

REDWOOD: So that if we handle it right, what doesn’t destroy us does make us stronger.

BREHONY: That’s my first epigram in the new book! In fact, my aunt Theresa, who I adore and who died two years ago, and who the book is dedicated to, told me that so often that one of my clients did a hand calligraphy of it, and attributed it to “Aunt Theresa.” It was only years later that I read that it was from Nietzsche.

REDWOOD: He did have a few powerful things to say in his time.

BREHONY: Oh, yes. [laughter]

REDWOOD: Do you find that there are differences in how men and women experience midlife?

BREHONY: Yes. While I think that underneath it all it’s really the same thing, sometimes the expression of that transition can be different. With women, there are other very profound physiological things going on that cause people to say, “Oh, this is not about midlife, it’s about menopause.” I personally don’t believe that hormones cause feelings, I think they amplify feelings. That’s something that, as far as we know, men don’t go through in quite the same way.

But in some ways, I think men have it harder at this transition, because in our culture (though it is changing), men don’t have a language for feelings. And for many men, they haven’t known how to express feelings all their lives, and here they’re having powerful feelings and they lack the experience to express those feelings. Again, I don’t want to add to stereotypes, and I’m not saying this applies to all men or all women. But in general, it’s true. In fact, when I first came up with the idea for this book, the first agent I had said I should focus it only toward women, because women buy many more books of this type. Even as a lifelong feminist, I refused. I said, “I think this is about everybody.” I said I would certainly put in different kinds of examples because people of different genders might resonate with different stories. But do you know, I have received more letters from men than women, which shocked me and shocked my publisher. I continue to get emails and letters, and many of them are from men who say, “I’ve never even read a book like this before.”

REDWOOD: What effect are they saying it has upon them?

BREHONY: A lot of people have said it inspired them to make changes. A couple of different guys said, “After I read your book, I thought you’d been following me around for the past few years.” Some have said that they always wanted to do X and Y, and after reading the book they registered to take a class to realize that dream. I even got an email from a guy writing from a pub in Dublin, writing on his laptop. He said, “I grew up in England, and for almost all of my life I never really claimed my Irish roots, because there’s still a lot of prejudice in England. And here I am in Dublin, thinking about my beginnings.”

REDWOOD: What was it in the book that elicited this response?

BREHONY: The idea of being who you’re supposed to be, claiming the sense of self that I think we’re all endowed with. I don’t think we have to go out and look for it. It’s there! It’s a question of uncovering it. So quickly and so easily that essence can get covered up with conformity. Our mother and father, gender role and religion. Society says we’re supposed to be this, and you realize that it may not be authentic for you. But a lot of people are trapped, stuck in how to get out of that.

REDWOOD: Do we need an inspirational example in order to bring out our potential?

BREHONY: I think that’s one of the ways. I think there are lots of ways to get it. Some people, as Paul did on the road to Damascus, have an epiphany. The Buddha found it sitting under the bodhi tree. He was looking, but a lot of people find it whether they’re looking or not, if they’re open to it. I really do believe that the universe gives us every opportunity to know it, to move in the direction of the self and the soul. But we get busy, and we get stressed out, and we live in such a linear-thinking society that many people tend to think that if you can’t see it or touch it or taste it or smell it, then it doesn’t exist. I think that’s very wrong and it keeps people on a track for what oftentimes is a person’s whole life.

REDWOOD: For people who are living in such a linear-focused society, what are some tools they can use to expand their experience and perspective?

BREHONY: I think that a lot of it is taking time. Meditation, prayer, even just silence. You know, how many of us sit in silence? Even here, in your nice quiet office, if I were to sit simply I’d hear noise. That was one of the things that Robert Gass talked about in the Chanting book, that there are very few places in the world to really find that silence. And yet we can. I think the world would have less problems in it if everyone would take ten minutes a day to sit quietly. I really do. I think it could be as simple as that, because I think that’s where the Self appears. Meister Eckhart said, “There is nothing so much like God as silence.”

That’s one way. I think another way to wake up, which is a major theme in Ordinary Grace, is to get out and do something for somebody else. It expands our view of what our own life is. I make that same point in my new, as yet untitled book – that your suffering should be acknowledged, and it should be grieved and felt and experienced in the depth that it is. But even in the midst of it, to go out and give a hand to somebody else changes your point of view.

Daniel Redwood is a chiropractor, physician acupuncturist, and writer who lives in Virginia Beach, Virginia. He is the author of A Time to Heal: How to Reap the Benefits of Holistic Health and Contemporary Chiropractic. A collection of his writing is available at http://www.DrRedwood.com. He can be reached by e-mail at danredwood@aol.com

© 2000 by Daniel Redwood