Decolonizing Pathways towards Integrative Healing in Social Work

Kris Clarke, Michael Yellow Bird

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781351846271
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Taking a new and innovative angle on social work, this book seeks to remedy the lack of holistic perspectives currently used in Western social work practice by exploring Indigenous and other culturally diverse understandings and experiences of healing.

This book examines six core areas of healing through a holistic lens that is grounded in a decolonizing perspective. Situating integrative healing within social work education and theory, the book takes an interdisciplinary approach, drawing from social memory and historical trauma, contemplative traditions, storytelling, healing literatures, integrative health, and the traditional environmental knowledge of Indigenous Peoples.

In exploring issues of water, creative expression, movement, contemplation, animals, and the natural world in relation to social work practice, the book will appeal to all scholars, practitioners, and community members interested in decolonization and Indigenous studies.

1
Grounding modern social work

In the United States, the social work profession is seen as having two foremothers: Jane Addams and Mary Richmond. A Quaker deeply immersed in progressive social movements of the early twentieth century, Jane Addams was best known for founding Hull House in Chicago. Hull House was a ‘settlement house,’ a residential community that engaged university graduates with the urban poor through cultural and educational activities aimed at social uplift. Mary Richmond was a largely self-educated woman who started as a bookkeeper and eventually became the first female general secretary of the Baltimore-based Charity Organization Society (COS) in 1900. She focused on professionalizing the knowledge of caseworkers through the development of scientific methods. The COS was one of the first umbrella organizations that brought various groups together with the aim of making charity consistent, efficient, and preventative (Franklin, 1986, 508). The legacy of Addams and Richmond still informs how social work is conceived and implemented throughout the world.

These two women embodied distinct approaches to social work that have continued to roil the field: Addams with her community focus and Richmond with her emphasis on professionalization. Both represented many of the complexities and contradictions of a privileged and charitable approach to the structural social problems of extractive capitalism, operating in a system fully in support of white supremacy and patriarchy. Richmond sought to professionalize social work by using evidence-based methods to find and solve problems within the individual, often not taking into account the many structural systems of oppression (Jarvis, 2006). Though proclaiming appreciation for the contributions of immigrant cultures and a progressive political agenda, the settlement movement used the language of eugenics in the quest to ‘civilize’ newcomers by improving the education, hygiene, and orderliness of recent immigrants (Bender, 2008). Viewing assimilation as the main route to achieving acceptance by the dominant (white) American social order, settlement activities utilized an Anglo-American Christian model of social work (Schwartz, 1999). Settlement houses were also often closed to people of color. Charles Hounmenou (2012) points out that Black migrants during the Great Migration did not find Chicago settlement houses welcoming. Few donors would give to settlement charities aimed at African Americans, and whites opposed the influx of people of color to their neighborhoods.

From their earliest initiation, social programs have been framed by discourses of race, civilization, and settler colonialism (Bullard, 2015, 131). Despite the contemporary emphasis on diversity and oppression in social work education and requirements for cultural competence in social work practice, challenges remain in the way that the social welfare structures continue to be understood and operationalized through expertise that often embodies professional imperialism. Social work (discussed in the following story in the form of medical social work casework) has not always advanced or championed the values of ‘outsiders’ and has, in fact, continued to be locked into the colonial legacy that seeks to maintain the structures of white settler society at the expense of those that are non-white. In this respect, social work still has a long journey towards decolonizing practice and policy.

KRIS SHARES A STORY

At the turn of the millennium, a weary middle-aged woman named Yer arrived in Central California from a refugee camp in Thailand. Short and stout with strong hands, Yer wore the struggles of her life on her face. She had grown up in the midst of a US-launched imperialist war against the people of Vietnam in the mountainous regions of North Vietnam and Laos, the native land of her Hmong people. During the Vietnam War, Hmong society was completely disrupted as thousands were killed while the region became one of the most heavily bombed areas in history. The Hmong were military allies of the United States and lost 20% of the male population in combat (Vang, 1979). After the war, the Americans retreated, and the Hmong were persecuted by the Communist victors: Villages were destroyed, and people took great risks to secretly cross the dangerous Mekong River at night, escaping to huge, overcrowded refugee camps in search of safety. Yer had faced all of the travails of living through war and then fleeing the aftermath of destruction, survived the process of becoming a refugee, and relocated to Central California, blown by the winds of war from one part of the globe to another.

Living in California, far from everything she knew and held dear, Yer felt terribly lonely and restless. The climate was different, her home was surrounded by a sea of asphalt, and she could not see the stars at night amidst all of the flickering streetlights and police helicopters. Her husband had died in the refugee camp before their family of six children was granted permission to come to the United States. Yer did not understand the language or ways of her new land. Managing bills and navigating bureaucracy were left to the eldest children, who at a young age became students of the maze of American social institutions. She spent most of her time in the small apartment with her family sharing cooking and cleaning but lost in the memories of home, both good and bad. The children quickly adapted to the foreign culture and spent a good deal of time away from home with their newfound neighborhood friends who represented the diversity of the impoverished Central Valley. Yer felt that her soul had not followed her on the long, painful journey to the new country, and she felt bereft of all support, especially when night fell on her restless neighborhood and her memories welled deep in her chest.

Soon after Yer was settled, during a routine exam, local health officials discovered that she had multidrug-resistant tuberculosis (TB) which required a long course of oral antibiotic treatment. The disease is highly contagious, and officials wanted to ensure that she would comply with taking all of the medication so that she would not infect others. The health department used directly observed therapy (DOT), a strategy common in disadvantaged communities, in which a caseworker supervises the patient to ensure that she completes the full course of medication. The aim of DOT is to identify factors that prevent patients from completing their courses of treatment and to provide support for compliance that is context-sensitive and patient-centered. By addressing cultural, financial, social, and physical barriers, DOT improves access to treatment. However, for DOT to be successful, culturally appropriate health and social workers capable of partnering with vulnerable patients are key.

Yer believed that the cause of her illness was that her soul was still lost in her homeland and did not accompany her to the new, inscrutable country. In the animist Hmong belief system, human beings have several souls, which are a source of strength and spiritual energy. If a person is separated from one of her souls, she runs the risk of becoming ill, growing depressed, or dying. “Soul calling” is a ceremony performed by Hmong shamans to reunite souls with their person, thus restoring spiritual integrity. Before embarking on the DOT medical regimen, Yer wanted to hold a soul-calling ceremony, which she believed would heal her. Public health officials and social workers, unfamiliar with the Hmong community, were unsure what to do because their mandate was simply to ensure she take the medication.

A few years earlier, there had been a similar case. In that instance, a slight Laotian woman in her forties named Sunya was diagnosed with a multidrug-resistant form of TB. Sunya had been in the United States for a few years, but her family was spread out across the country. She had found it difficult to find work and, separated from her husband, had to rely on welfare benefits to get by. Sunya was given several medications to treat her TB, but the side effects were not properly explained to her, and she soon stopped treatment because she felt that the medication made her ill. There was an occasional interpreter with the caseworker, but his ability to interpret in Lao had never been tested, and young family members often ended up having to translate the physician’s instructions to Sunya. A sense of distrust began to form between the health officials, caseworkers, and Sunya as her TB worsened. She began to avoid the caseworkers and hid from them with various family members.

Eventually, the health department labeled Sunya noncompliant and deemed her a risk to public health. The health department placed her in jail as a means to ensure her compliance with the medical regimen. Realizing that Sunya came from a culture in which many family members often lived closely together, health officials thought that they were being proactive to prevent others from being infected. For many months, Sunya was remanded to a small cell with no furniture, just a bed and toilet. She was housed with people who had serious mental and physical illnesses. She lost weight due to the unfamiliar food, and she was attacked by a fellow inmate. Sunya told the indifferent authorities that she was suicidal and suffered from the side effects of the strong medications, but her pleas fell on deaf ears. There was no interpreter in the jail to explain her rights or why she was incarcerated. Sunya’s family also did not understand the reasons she was in jail and sought help from other community members and social workers to advocate for her release. The head public health physician wanted to detain her for two years, until the full course of her treatment was completed, so that the safety of the public could be ensured.

Sunya’s family finally managed to retain an attorney from a legal assistance group that challenged the detention order of the public health department. The attorney discovered that health officials had routinely detained people of color for TB treatment, though the length of Sunya’s stay at the county jail was certainly exceptional. The health department requested incarceration when there were fears that DOT would not be successful. After a lengthy court case, the county was ordered to pay over one million dollars in compensation to Sunya for unlawful incarceration, as well as emotional and physical distress. After the suit was settled, Sunya’s family chanted prayers outside the county jail together with a shaman, who performed a soul-calling ceremony to heal Sunya of the trauma she had endured.

When Yer’s case came up some years after Sunya, the health department paused to consider how to respond. While their heavy-handed approach to Sunya’s TB had achieved the goal of ensuring she took her medication, it also resulted in a great deal of personal distress for her and a large financial settlement from the county.

Yer told public health officials that she wanted a soul-calling ceremony before starting any medical treatment because she believed that the cause of her illness was the separation of her soul from her physical body. By reuniting her soul and body, Yer felt that she could heal. A soul-calling ceremony generally costs approximately 400 dollars for the shaman’s honorarium and other necessary items. Public health officials recognized that forcing DOT on patients without their full understanding and cooperation was futile, and forced detention was punitive, traumatic, illegal, and costly. Yet they could not think of alternative ways to ensure medication was taken. Officials tried to find a way to pay for the shamanic ceremony, but the county budget would not allow for such expenses. There were no line items in the budget for culturally appropriate services nor were there discretionary funds for frontline workers to pay for such activities. Only a certain range of medical interventions could be supported by the system. At a meeting on Yer’s case, the attending physician felt frustrated by the lack of options. She threw 200 dollars on the table, with social workers and nurses each ponying up twenty-five dollars until the total sum of 400 dollars was reached. With these funds, they were able to arrange a soul-calling ceremony for Yer so she could feel whole in her new country and be ready to embrace the treatment offered through DOT. Shortly after the ceremony, Yer agreed to take all of the medications and was successfully treated for multidrug-resistant TB.

Lessons on pathways

Many contradictions lie at the heart of human service interventions. These women had complex sociopolitical and transnational migration and personal histories, yet they were reduced to cases of noncompliant patients that needed to be isolated from the community and managed through force. State institutions remain largely guided by many of the white supremacist aspects of settler colonial processes of being, knowing, and acting, despite the rhetoric of empowerment and respect for cultural diversity. In the story, the social and health care system was only geared toward controlling individual behavior, largely devoid of context – in this case, the culture, history, and trauma of diaspora and being a war refugee. When Sunya did not follow the medical protocol, she was detained. Officials initially did not seek to understand the context of her reasoning for not following the treatment plan. Rather, their focus was solely on ensuring she took the medication to treat the infection. Years later, officials recognized that detention was a detrimental way to act, not only due to the sting of an expensive lawsuit but also because it ultimately harmed Sunya.

A key principle of settler colonialism is that settlers forge a new identity and system after they have invaded and replaced the population of Indigenous Peoples. People who migrate to this new society are expected to leave all of their ‘foreign’ trappings and culture behind to support the growth of the empire, both ideologically and materially. In Yer’s case, although the public health and social work team came to understand that she needed a more holistic and culturally congruent approach to managing her illness, they were nonetheless restricted by the limitations of narrow definitions of treatment to provide care and support in any way other than compulsory compliance with the medication regimen. It was only by breaking the rules of settler society that the team could work with the patient rather than work on the patient.

Many of us go into the human services because we want to join in solidarity with vulnerable people and work toward a more equitable and just society. We may have had positive experiences with social workers who helped us, our families, or our communities, and we want to be a similar catalyst for support. But why is it that our systems of care and professional practices often force us to act in ways that we know do not support the best interests of community members or individuals? How can it be that the logic of the system and our evidence-based interventions may even exacerbate problems, human suffering, and costs? Who are we, as human services experts, really helping, and who are we hurting? Are there other ways to think about healing the individual and the community? Have we social workers become so enamored of the rhetoric of helping in social work that we do not see that our interventions are many times complicit with settler colonial state power rather than truly empowering the people (Margolin, 1997)?

This chapter considers how the self, knowing, and acting – in the contemporary Western sense – have transformed historically. Through this framework, we ponder the relationship between the development of social work and the historical, ideological, and material bases of settler colonialism that have undergirded and shaped social policies, practices, and care systems. How did social work come into being, what is its knowledge base, and how does it practice? We ask: How have contemporary welfare societies emerged from their settler colonial origins of Indigenous genocide, African slavery, and industrial capitalist exploitation to construct complicated and sometimes inflexible systems to support human well-being? To understand where we have arrived in the human services, we must examine the road traveled to get here and how it has fundamentally altered our understanding of ourselves and others and our interactions with our communities and environment.

Whether we approach social work from the perspective of Jane Addams’s settlement movement or Mary Richmond’s social diagnosis, we must consider how our collective ways of conceiving the good life and a just society have roots in the complex legacies of settler colonialism. These legacies include particular understandings of being, knowing, and acting that shape our ideas about distress and support, which in turn define the models that specify appropriate social work practices. Though social work explicitly calls for challenging oppress...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Acknowledgements
• Introduction
• 1 Grounding modern social work
• 2 Postcolonial trauma and memory work
• 3 Confronting professional imperialism and moving towards integrative healing
• 4 Water
• 5 Creative expression
• 6 Movement
• 7 Quiet and contemplation
• 8 Fellow creatures
• 9 Mother Earth
• Epilogue: dreaming a decolonized futurity
• Discussion guide
• Index