I spoke last week at a retreat for the Financial Planning Association in Georgia, and told them this wasn’t a great time to be in their business. The recent recklessness, and some frankly criminal behavior of bankers, Wall Street financiers, and “institutions to big-to-fail”, nearly sank the world’s economy, and besmirched the entire financial services industry.

We are living in volatile, divisive political times; there is a global epidemic of mistrust. Building relationships based on truth-telling has become a myth of yesteryear; what’s right and wrong in our culture is decided by what you can get away with, and it breeds an atmosphere of greed and self-interest.

Today nobody knows what the truth is because “facts” have just become alternative points of view. What you say doesn’t have to be what you mean or believe, and as a result we are drowning in bullshit.

Your greatest asset In these volatile times I told them, had nothing to do with their familiarity of changing regulations, computer savvy, or knowledge of new products. It had everything to do with their integrity, their honor, and character. Their success now, and always, will be based on whether their clients like, believe, and trust them.

I told stories from my work with American Indians….the Navajo word for truth is “Hozho” it is also the word for health, beauty, harmony, balance, and the Great Spirit. In the language of mind/body/spirit medicine I talked about the importance of maintaining our own balance so that we become exemplars of the kind of relationships we like having with others.

Those are sacred relationships, and I have one with my financial planner. We have a real sense of each other, I trust him. Who he says he is, is who he is, it’s the authenticity I am desperate for, and those are the only relationships I want to have.

I challenged them to use their influence to set the standards in the financial industry.  They had a critical role and enormous influence as their clients are living longer and needing financial guidance. People will give you their most treasured possessions, forgive your mistakes and shortcomings, if they believe in you, and trust you will make decisions based on what’s in their best interests not yours.

I love my financial planner and the older I get, the more I depend on him not to go broke before I die.

I’ve previously written about an annual clown trip to Peru that I make with my friend Patch Adams, MD, and 100 other humanitarian clowns from all over the world. We have been going there for a decade to spread cheer, and revitalize the impoverished community of Belén, which is situated in the Amazon floodplain in the city of Iquitos. We conduct workshops, perform street theater, create community art installations, visit hospitals, and work with local grass-roots organizations. For the last 5 years, we also have been conducting mental health clinics in the streets.

To provide a brief overview … we go to a neighborhood, set up our space, and walk the streets with a bull horn. We announce our presence – “we are mental health professionals, and we’re meeting over at” … and we talk with anybody, young and old, who wants to discuss health problems, family issues, or other concerns.

We sit in a public place and speak to individuals/couples/families for 20 minutes, while around us, support clowns entertain the kids. We neither make diagnoses nor give drugs; we come with a clown nose and an open heart, and we listen actively without judgment and focus on solutions. We help people identify their strengths and resilience, and give them practical advice. This is community psychiatry disguised as “clown therapy,” which is just another phrase for solution-oriented therapy/ positive psychology/reality therapy/resilience-based therapy, logotherapy, existential psychotherapy, or kitchen table wisdom. These street clinics have had a profound impact on patients and clinicians.

Three years ago, I met a middle-aged woman who was suicidally depressed, and together we negotiated a successful intervention. In summary, she emerged from a church that happened to be across the street from where we were setting up our clinic. A clown saw her weeping and approached her, and after talking with her assured her that there was somebody here right now – a mental health professional – who would talk with her.

Maria sat down and told an unbelievably painful story that was happening within her family. On that day, after 8 months of prayer and receiving no sign from God, she had decided to kill herself. After listening to her, I actually believed she could do it.

There are no treatment centers or emergency shelters for the poor in Belén, so at our closure, I made her promise that she would not try to kill herself until I could see her again at our next clinic 2 days away, and close by. I gave her an amulet that was blessed and told her it was a reminder of her promise, and that my smiling face would be with her until she saw me again. She returned with her daughters to the next clinic, and together, they found a way to take a step forward.

Last year, I made my first home visit, and met with Maria, her daughters, and new grandson in their “new” home where they were happily sustaining themselves . When I left, the love and appreciation was so overwhelming that I told them as long as I returned I would come visit every year.

I just got back from this year’s annual visit, and was again greeted with passionate tears of joy. We sat and talked, and Maria told me her story. It seems that people in the community were now coming to her as a resource when they were deeply depressed. People know that she had walked a similar path and moved beyond it.

Dr. Carl A. Hammerschlag receives assistance in announcing that the clowns are back in Belen, Peru, for their annual mental health clinics.

Dr. Carl A. Hammerschlag receives assistance in announcing that the clowns are back in Belen, Peru, for their annual mental health clinics.

She is a warm, good listener, and tells them a story about walking out of church and deciding she wanted to kill herself, and meeting with a tall gringo, a clown/doctor who miraculously saved her life. She gives them simple, practical advice, tells them how important it is to stay connected to their children, speak your truth with them openly; to pray for miracles and recognize them when they occur. She tells them to reach out for help, and people will reach out to them. She is a credible, inspiring friend who gives hope.

For those who remember when community psychiatry was actually a subspecialty, this is my vision of community mental health: People talking to credible witnesses/healers/resources in their community, whom they respect, who will listen without judgment, and maybe even say something that inspires a light in the darkness. It’s at least as effective as psychotropic drugs, and all its benefits come without side effects.

Once a year we come together, listen to each other’s stories, and continue our healing work together. Maria tells me her friends want to meet me. “They want to steal you away,” she says, “but I tell them I am not afraid.”

Maria, a lay therapist of sorts, is the community mental health consultant. Once a year, she consults with her gringo, the clown/doctor, to compare notes. We laugh and love, hug and cry, and give each other hope. No matter how divisive and polarizing the times, it is possible to come together in community and promote healing.

Dr. Hammerschlag is chief of community mental health of the Gesundheit! Institute and a faculty member at the University of Arizona, Phoenix. He is the author of several books on healing and spirituality, including “Kindling Spirit: Healing from Within” (New York: Turtle Island Press, 2010) and “The Dancing Healers: A Doctor’s Journey of Healing With Native Americans” (San Francisco: Harper, 1988). Dr. Hammerschlag’s website is healing-doc.org.

Humanitarian clowns mobilized the community’s healing resources: All the established providers came (dentists, nurses, doctors, hospitals, hospice); and the often untapped and underused resources also came (bodyworkers, art/dance/music/pet therapists, energy workers, traditional healers, and clowns). All of them shared their healing stories to inspire people to actively participate in living healthier lives.

The fest was held in a lovely, green public space Feb. 26-28, 2016, in downtown Phoenix and featured speakers, panels, interactive demonstrations (including CPR, injury prevention, exercise). There was massage, Tibetan gong players, a theater/choral group comprised of developmentally challenged adults, yogis, mask makers, Native American blessing ceremonies, and an area reserved for the Truth Clinic staffed by Truth Fairies.

The Truth Fairies were health care professionals who had completed a workshop on clown therapy the day before. We explored the clown/fool/jester archetype – that universal character in the unconscious mind whose purpose it is to lighten the mood, diffuse anxiety, and help us look at the familiar landscape with new eyes. In many cultures, the clown also is the keeper of sacred wisdom and healing. We participated in interactive exercises designed to promote heartfelt connections, active listening, and opening the intuitive mind.

Clown therapy is just another manifestation of solution-focused psychotherapy, resilience-based therapy, positive psychology, existential psychotherapy, and logotherapy that happens in brief encounters. The focus of those solution-based approaches always is about helping people identify their strengths rather than focusing on the problems. It’s about asking the question: “What do you want, and what’s keeping you from getting it?” It’s active and involves listening to people talk about their dreams and imagining that they have the answers within to solve their problems. They all focus on people’s strengths and getting them to think about what they want to change (1-4).

The Truth Fairies sat in a wide-open space, with chairs facing in such a way that participants would be out of listening range of anybody else. People were invited to talk to a health professional for 15 minutes about any health-related issue or personal questions that they might have. The Truth Fairies did not make diagnoses or prescribe drugs.

Courtesy Dr. Carl A. Hammerschlag Dr. Carl A. Hammerschlag says the Clown Town Healing Fest in Phoenix included health professionals, yogis, mask makers, and people who performed Native American blessing ceremonies.

People signed in (first names only; there were no release forms). This statement appeared at the top of the sign-up sheet: “To Our Friends in the Community: we come to you with open hearts and our talent as health care professionals; we will never do anything intentional to hurt you and know that you come to us with the same understanding.”

A critical element in all treatment is the therapeutic relationship. If a patient likes you, trusts you, and believes in the system you practice, he or she will get better faster. When you help people focus on their strengths, resilience, and dreams rather than their problems, it actually allows them to imagine that they hold the solution to whatever they are facing. People waited in line to visit with the Truth Fairies; here are some of their observations:

• “It’s amazing how much people will share when you wear a red nose. After I introduced myself, I had a woman tell me a secret that she never shared with anyone in her life. I hardly said anything, and at the end of 15 minutes, she thanked me for listening and said: ‘I don’t know what came over me to tell you my secret, but I’m glad I did. I feel good!’ ”
• “This woman sat down in the chair looking at me with tears rolling down her cheeks. She said to me, ‘I have a terminal brain cancer, and I want to die now.’ I was taken aback and didn’t say anything for a moment, and then spontaneously blurted out, “You know we are all terminal; none of us is going to get out of here alive.’ She laughed out loud and asked me if she could use the line. It was an amazing connection.”
• “I didn’t even wait until I got to the Truth Fairy grounds. For me, it started during the opening Clown Parade. A young man walked up to me and started talking (where are you from? what are you all doing here?). I told him, and then he told me his story: that he’d just been released from jail and had shared his dream that he wanted to be a chef. He stayed with me for the whole parade, and when we entered the festival grounds, he was welcomed by a Native American woman who was blessing all the clowns. She waved fragrant smoke over him with an eagle feather, [and] said she was happy to see him here and that good things would be happening for him. He told me afterward he was an Apache Indian and that being with me this morning has changed his life.”

This is how we heal in community, open ourselves to making heartfelt connection with someone who can be with you, listen empathetically, help you look at what’s familiar and see it from a new perspective. Let’s get away from today’s cultural imperative that if you are feeling anything other than wonderful in every moment that you’re suffering from a disease for which there is a pill that can cure you. Let’s listen more and prescribe less. Connecting in this way reminds us not only of our therapeutic skills, but of our shared humanity.

REFERENCES

1. “When All Else Fails: Some New and Some Old Tools for Doing Very Brief Therapy,” United Kingdom: Crown House Publishing, 2014.

2. “Solution-Focused Interviewing,” University of Toronto Press, 2013.

3. “Hypnotic Realities,” New York: Irvington Publishers, 1976.

4. “Man’s Search for Meaning,” Boston: Beacon Press, 1959.

Dr. Hammerschlag is chief of community mental health at the Gesundheit! Institute. He is also the author of several books on healing and spirituality, including “Kindling Spirit: Healing from Within” (New York: Turtle Island Press, 2012) and “The Dancing Healers: A Doctor’s Journey of Healing With Native Americans” (San Francisco: Harper, 1988). Dr. Hammerschlag’s website is healing-doc.org.

Clowns conduct dozens of workshops (from the art of trapeze to puppetry); they paint murals, create art projects, and visit hospitals, prisons, and orphanages. In addition, for the last 4 years, clowns who also are health care professionals conduct mental health clinics in the streets.

I have described the street clinics previously. We walk the streets announcing our presence with a bullhorn and tack up flyers as we go, inviting people to come and talk to us about any problems they are struggling with. Clinicians talk to people in a tight circle, in a public place (school yards, ball fields, wharves, markets), and spend up to 20 minutes with them. Twenty minutes is not a long time, but it’s more than most people (especially women) get to spend with somebody who is actively listening to their story.

The clown clinicians listen empathically. They have the ability to stand in patients’ shoes and convey an understanding of their situations, and they have a desire to help. Clinicians do not make diagnoses or prescribe drugs; they focus not on people’s traumas but rather on their resilience and strengths. They give advice, make recommendations, tell a story/parable, and sometimes bestow blessings and sacred amulets. In that short a time, you can make a profound connection with another human being.

Dr. Carl A. Hammerschlag transforms into a clown clinician at the Belén Festival in Iquitos, Peru.

Last year, I shared the story of Maria, a middle-aged woman who the very day I saw her had decided to kill herself. Suffering severe emotional and physical abuse, she went to church that morning and asked for gift lists for what she was about to do. After leaving the church, she bumped into a clown announcing the arrival of our mental health clinic, which brought her over to us.

For the first time since doing these clinics, I believed this patient had the potential for taking her life, but hospitalization was not an option and the best I could do was to get her to agree not to kill herself until I could see her again at the next street clinic in a couple of days. I gave her an amulet and suggested she hold it during her morning prayers. I also encouraged her to remember how we found each other so miraculously that day and the promise she made to me to come back and see me in 2 days.

Maria did come back, and this time brought along her 16-year-old daughter and 18-year-old pregnant daughter. For the first time, Maria and her girls told each other their whole story. Then we talked about choices, and before leaving I gave each girl an amulet and a blessing telling them that together they had the strength to find a way through these hard times.

This year, I asked our street clinic coordinator if she could find Maria and her daughters. It took a while because they’d left the abusive home they were in and were living in their own “house.” I visited the three of them (and their now 1-year-old baby) in their home, a single room built on a wooden platform lashed onto an abandoned water tower, and partly covered with a tin roof.

The success of the mental health clinics in Peru show just how quickly humans can make intimate connections.

I brought along some nonperishable grocery items, and we greeted each other joyfully. They proudly showed me their amulets; we put some chairs together, and talked about what had happened over the last year – how, with the help of neighbors, they found this place and were able to move out of their abusive home, and were living happily together.

When we left, they thanked me effusively. Their gratitude had far less to do with the groceries than for having remembered them and the specialness of our miraculous connection.

We are psychiatrists; we know about transference and how quickly people can make intimate connections. An active listener who comes to the relationship with an open heart can practice this kind of clown therapy. As psychiatrists, imagine how much more fun we would have if instead of doing the 15-minute medication reviews that focus on side effects, we listened to people’s stories and shared some of our own wisdom. Not only might we prescribe less medication, but it would also remind us of why we came into the profession.

In late February 2016, Patch and I will be conducting a clown therapy workshop at the Clown Town Healing Fest. If you want to stimulate your creative juices, launch your intuitive wisdom, and learn about clown therapy, join us and reconnect with the joy of your healing soul.

Dr. Hammerschlag is chief of community mental health at the Gesundheit! Institute. He is also the author of several books on healing and spirituality, including “Kindling Spirit: Healing from Within” (New York: Turtle Island Press, 2012) and “The Dancing Healers: A Doctor’s Journey of Healing With Native Americans” (San Francisco: Harper, 1988). Dr. Hammerschlag’s website is healing-doc.org.

The clown/fool/jester is a recognizable fgure in every culture. The clown is an archetype, a universal image that’s embedded in the brain. These images dwell in the unconscious mind. They can be animals, people, gods/goddesses, or objects (a tree, a house, a cross, or mandala) that are a staple in many myths and legends.

The clown lightens the mood; encourages us to laugh at ourselves (and the ridiculousness of life), pokes fun at convention, provides social commentary, and can get away with revealing that the emperor has no clothes. The clown is irreverent, faunts taboos, and difuses anxiety; in many cultures, the clown is a sacred healer, wisdom keeper, and serves as the community’s psychotherapist.

This also is the purpose of psychotherapy; we psychiatrists help patients look at their In many cultures, the clown is a sacred healer, wisdom keeper, and serves as the community’s psychotherapist. The clown’s purpose is to help us look at the familiar from another perspective. old landscape with new eyes, and in so doing help them create new endings to their old stories.
It took me until midlife to embrace myself as clown healer, and I took this step only after many years of working with Native Americans as chief of psychiatry at the Phoenix Indian Medical Center. I went fnally went public after meeting Dr. Patch Adams, perhaps the world’s most recognized humanitarian clown, more than 20 years ago.

This is the third year we have been conducting mental health clinics in the streets of Iquitos, Peru, which I have described before, most recently last year. These street clinics are stafed by clowns who also happen to be health professionals representing many disciplines (doctors, nurses, psychologists, social workers, counselors, body workers, chaplains). They’re also part of a humanitarian clown trip that I make every year with Dr. Patch Adams and the Gesundheit! Institute in Hillsboro, W.Va., along with more than 100 clowns from around the world.

The impact of the clinics and on both ”patients “ and “therapists” has been profound. These encounters remind us that even in the presence of unimaginable sufering, connecting in this heartfelt way and remaining actively present in every moment makes sufering more bearable. They also remind us of the value of incorporating culture into treatment plans.

What is clown therapy?
Our clown-therapists will talk to people about anything that’s troubling them and work with them in open spaces (football felds, storefronts, loading docks, markets), sitting in a tight circle (with an interpreter for non–Spanish-speaking therapists) wearing a clown nose. We listen intently and are acutely present in every moment. We see people for 20 minutes and do not make diagnoses or prescribe pills, although we sometimes hand out amulets and give blessings.

As clown-therapists, we welcome the opportunity to get out of their heads and connect with people at the heart level. We delight in spontaneity, which facilitates opening channels into our unconscious minds, trusting that we will come up with something to say or do that will be helpful.

These clinicians can acknowledge sufering without becoming consumed by it … in the midst of crisis and/or pain they don’t “awful-ize” or “catastrophe-ize”; instead they have the capacity to identify people’s strengths and resilience and get a sense of what gives meaning to their lives. In a short time, such heartfelt connection can have a profound impact on not only the recipient but also the provider.

A case study
As a rule, we see people only once, but this year, I saw Maria, a 42-yearold woman twice. She was acutely suicidal, and after her morning prayers, decided today was the day she was going to kill herself. After 6 months of unbearable torment, she’d reached the end of her rope; she told me that her 20-year-old daughter had been raped 6 months earlier and was now pregnant. Maria’s family blamed her, saying that if she hadn’t divorced her husband 15 years earlier, this would not have happened. Maria knew she was not to blame, in which I concurred, but alas, she could not (as her family suggested) get over it and move on.

After listening, I told her I thought today was a miracle; this morning, she was ready to die, and this afternoon, we happened to show up on her street. I also said I believed the seriousness of her suicidal intent and told her she had two choices; I could hospitalize her, although I had no idea if that was even possible, or she could make me a promise – at least for today – that she would not kill herself.

I gave her an amulet that had been blessed by Navajo and Huichol shaman and said I wanted her to hold onto it during tomorrow’s morning prayers; she would feel our blessings and remember this miraculous day that we found one another. Perhaps tomorrow she could promise herself to also live for another day.

After the clinic, I couldn’t get her out of my mind, so after dinner I asked my clinic coordinator to check in on her the next day. We were going to be conducting another clinic not far from her home in a few days, and I asked her to invite Maria to the next clinic and to please bring her daughter, too.

Maria showed up not only with her 6 months’ pregnant daughter, but also with her younger 18-year-old daughter. Together, they told me the rest of the story. Both girls had been raped (the younger more than a year ago), and both by diferent maternal uncles. They had never spoken about it to anyone outside of their family, and although Maria had confronted her brothers, she refused to press charges. This is not a culture in which women prosecute their rapists.

Before we ended, I gave both girls an amulet and blessed the family; whatever they faced, they would face it better together; their love for one another would be showered on this new baby, and they would carry our blessings with them and those of many relatives all over the world.

In most Latin cultures, there is a strong belief in the power of spells, curses, and witchcraft, as well as in traditional healing practices and the power of faith. A critical element for successful healing in all cultures is the patient’s belief in the practice and in the practitioner.

As mental health professionals, we magnify our power not only with the pills we prescribe, but also with the blessings and amulets we may bestow. And it doesn’t take a long time to connect at the soul level if you are actively in the moment, and it is in those miraculous moments that we are reminded of our shared humanity. Imagine if we used our 15-minute medication reviews to actually connect with people at this heartfelt level and talked about what’s really important to them. I’m thinking we could reduce our prescription writing by half and be reminded of the joys of psychotherapy.

Dr. Hammerschlag is chief of community mental health at the Gesundheit! Institute. He is also the author of several books on healing and spirituality, including Kindling Spirit: Healing from Within (New York: Turtle Island Press, 2012) and The Dancing Healers: A Doctor’s Journey of Healing With Native Americans (San Francisco: Harper, 1988). Scan the QR code to read more commentaries at clinicalpsychiatrynews. com.

The Clown archetype is a character that lightens the mood, pokes fun, is irreverent, provides social commentary, flaunts taboos, diffuses anxiety, and embodies healing wisdom. The Clown stands at the threshold between reality and imagination, and in that space allows us to see the world from another perspective.

The literature is filled with both anecdotal and research evidence about the therapeutic efficacy of humor. Laughing in the face of tragedy seems to shield a person from its effects; it even seems to have a buffering effect against physical pain. It’s abundantly clear that the central nervous system, cardiovascular and immune systems are all strengthened by laughter and joyful connections.

The Gesundheit! model of clown therapy is to have clown-clinicians, healthcare practitioners all of whom make their living working with people with problem’s…(doctors, nurses, counselors, social workers, body workers, nutritionists, traditional healers). What distinguishes these clinicians is their willingness to get out of their heads and connect with people at the heart level. Clown therapists trust their intuition, are willing to open channels into their unconscious minds and find something to say or do they might be helpful.

We see people for short periods of time (15-20 minutes), and in public places. We wear clown noses, and are active listeners, which means we are acutely present in every moment. We talk to anyone about anything that’s important to him or her. We do not make diagnoses or prescribe pills. The clown-therapist can acknowledge suffering without becoming consumed by it. In the midst of crises they don’t “awful-ize” or “catastrophe-ize”, instead they can identify what gives their patients meaning in their lives and find a way to reveal to them what they still have inside that his not been lost.

My own journey into clown therapy came late in my career as a psychiatrist. I was middle-aged, and traditionally trained psychiatrist, before I met Patch Adams MD, perhaps the world’s most recognizable humanitarian clown. We were both speaking at a dental convention. I watched him get 40 dentists to dress-up and parade in public. Patch asked them to find things in their rooms to dress up in, and they appeared in bathrobes and lampshades, he gave them a clown nose and led these usually meticulous, exact, measured, detailed, organized doctors through the streets of a Colorado ski resort town. It made such an impression on me that I sought him out afterwards and that led to the start of a close family relationship.

A decade ago, at our annual family reunion at the Oregon Country Fair, I emerged as The Truth Fairy (see pictures), a pink ballerina in tights and tutu who invited people to talk with him for 3 minutes about an important question/issue/problem that they wanted answered…if they were ready to hear the truth. I sat in the middle of a meadow filled with hundreds of people, in a 10 x 10 roped off enclosure, with an empty chair facing me. People stood in line to spend… 3’ With The Truth Fairy; it turns out people will share the most intimate things because it’s completely anonymous, and you can choose to ignore whatever you hear. It gave me the opportunity to listen intently and trust my intuition to see something that was often funny and helpful.

We’ve expanded upon this model in the streets of Iquitos, Peru at the Belen Project where clown-clinicians from a dozen countries invite people to come and talk to them for 20 minutes about whatever concerns they might be having. In soccer fields, storefronts, and schoolyards, and marketplaces we have set up chairs, and seen people who want to talk. Often speaking through interpreters, we find these encounters have been profoundly impactful on both the people and the clinicians. They remind us that in the presence of traumas and disasters people can connect in ways that remind us of our shared humanity.

We have repeated these street clinics again and again, and find that making the heartfelt connections, and actively listening is an intimate therapeutic connection…and those are moments that make suffering bearable.

Carl A. Hammerschlag M.D.

Chief of Community Mental Health, Gesundheit! Institute

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References:

Psychiatry and the Art of Listening, Clinical Psychiatry News, Nov. 2012

Global Outreach Project, Clinical Psychiatry News, Nov. 2013

3” With the Truth Fairy, Schlagbyte, Aug. 29, 21011

I appreciate the invitation to address my Arizona colleagues on the psychiatric care of Native Americans. Generally, when we hear the words psychiatric care and Native Americans, it immediately conjures up a symptomatic population rife with substance abuse, domestic violence, high suicide rates among the young, and educational underachievement; because the literature focuses on these aberrations. The underlying psychological explanations for these problems are attributed to internalized anger, and the powerlessness resulting from their subjugation and political disenfranchisement. These ongoing symptomatic manifestations are attributed to the transgenerational transmission of their historical trauma.

There is not much in the literature about the transgenerational transmission of resilience among Native Americans; how did some tribes survive the assaults on their culture while others fade away? I have spent much of my professional life working with Native Americans, and would like to tell you their story from that perspective. The tribes who thrived were the ones who maintained a connection to the values and cultural systems (language, myths, rituals and ceremonies) handed down from generation to generation. Resilience is rooted in the nurturing soil of knowing who you are in the world. If you have a sense of yourself as unique in a positive way when you are young you greet the world as equal when you become an adult.

First, a brief history of how I came to work in Indian Country. It was the mid-60’s, and I didn’t want to go to Viet Nam; so after completing my internship I served my military obligation in the Indian Health Service. I thought it would be a 2-year experience but it turned into more than 20. Shortly after my arrival at the Santa Fe Indian Hospital in 1965 I was introduced to an old man on morning rounds who would be my patient because I provided the aftercare in his village. He was admitted in acute congestive heart failure, and was resting comfortably since he’d been digitalized, given a diuretic and oxygen.  I introduced myself, and then he asked me “where did you learn how to heal?” I assumed he was asking for my academic credentials so I tell him where I went to medical school and completed my internship, and when I finished he looked at me smilingly and asked “do you know how to dance?”

I was touched by his whimsy, thought I’d humor him, and said I knew how to dance and shuffled my feet at his bedside. The old man laughed, so I asked him if he knew how to dance, not knowing at the time he was a renowned medicine man. So he got out of bed the oxygen running and did the steps to a Corn Dance at the bedside, When he got back into bed he said to me “you must be able to dance if you are going to heal people” so I asked him if he would teach me those steps and he said “I can teach you my steps, but you have to hear your own music”.

I learned from Native healers that there were many ways to do the healing dance and what it meant to be healthy. Health was never defined in medical school, other than if you weren’t sick then you were healthy). And I learned about how many ways there were for people to get sick and how many ways to do the healing dance.

Most of us in Western medicine (especially in psychiatry), learn to do our healing dance one way; we become proficient in whatever our preferred methodology (psychopharmacology, neurobiology, psychotherapy, behavioral therapy, cognitive therapies, psychoanalysis), and then spend most of our professional lives refining the steps to that familiar tune.

The Navajo word for health is HOZHO… the same word also means harmony, truth, beauty, balance and the Great Spirit. Being healthy is when what you say with your lips, is the same story you’re telling by your actions, and what you truly believe in your heart; that’s when you are in balance, in truth. In the language of modern medicine this is the science of psychoneuroimmunology.

From Native healers I learned the importance of rituals, ceremonies, and sacred objects in setting the stage in opening ones heart, which is critical in healing; and that people heal better in community because the more people you have helping you/pulling for you, the more likely you’ll have a positive outcome. I was also awakened to many ways of altering human consciousness, and helping people see the familiar with new eyes that included the use of powerful psychoactivating substances has been used to heal the mind/body/spirit for thousands of years. The current explorations in the use of psilocybin mushrooms, and the Schedule III drug Ketamine for use in depression and end-of-life anxiety have been part of the indigenous therapeutic armamentarium for millennia.

I learned that no matter how much we know about the brain (its neurobiology and chemistry), that it will always have a mind of its own and some phenomena can’t be satisfactorily explained.

Those Native people who maintained a credible connection to their psychohistory, to the wisdom stories and ceremonial practices of their tribes, survived the vagaries of assimilation psychically intact, because that’s how we learn who we are in the world. It turns out that our survival as a species is not transmitted through our DNA, but through our stories. The road to resilience is in rediscovering old wisdom…stay connected in community, trust the truth of your heart, and keep your mind open to new ways of seeing, hearing, and doing the healing dance.

References
Hammerschlag, Carl A. The Dancing Healers, Harper/Collins, San Francisco, 1988
Hammerschlag, Carl A. The Theft of the Spirit, Simon and Schuster, New York, 1993
Hammerschlag, Carl A. and Howard Silverman. Healing Ceremonies, Putnam/Perigee, New York, 1998
Hammerschlag, Carl A. Kindling Spirit: Healing From Within, Turtle Island Press, 2013

We are in the midst of enormous changes in health care delivery. Implementation of the 2010 Patient Protection and Affordable Care Act will make health care accessible to more people than ever before, and ushers in a cultural shift from a prohibitively expensive interventional health care model to one based on prediction and prevention.

Instead of waiting to get sick and seeking expensive urgent care, we are moving toward identifying vulnerable patient populations early and encouraging them to become active participants in maintaining their health. Whether you like it or not, the Affordable Care Act (or some modification of it) is here to stay, because we simply can’t afford the 20% of our gross domestic product that health care costs us, and it’s not making us any healthier. Psychiatry is not well positioned to respond to this cultural shift, because as a specialty, we are moving in the opposite direction, creating more illnesses and prescribing more drugs. Patients only come to see us now as a last resort because they know we will label them with a disease and prescribe drugs.

Twenty-five percent of all Americans are now diagnosed with a mental illness, and with the recent publication of the DSM-5 and its record-breaking number of mental illnesses, soon 50% of the population might have a diagnosable mental illness. We are perpetuating the myth that if you are feeling anything other than wonderful in every moment, you might be suffering from a mental illness. We are “psychopathologizing” the ordinary ups and downs of the human experience and promoting pills for whatever ails the patient. I believe we would reduce the incidence of mental illness in this country by 90% if we prohibited direct-to-consumer advertising by pharmaceutical companies.

The message to the patient: Are you anxious, shy, sad? Can’t stay focused or can’t stay awake? If so, you could have a disease for which there is a drug (nowadays often more than one). Such messages are good for business, because we’re reimbursed better if we see four patients an hour for 15-minute medication checks than we do for an hour-long psychotherapy session. We are spending less time listening and establishing an intimate rapport, even though this is what most of us like best about what we do and understand as an important aspect of our healing power. Can we do both? Is it possible to make a soulful, human connection in a short time, and could this reduce an epidemic of overprescribing? I believe we can if we expand the ways in which we engage people – and in doing so, move into the new prevention paradigm.

In addition to my degreed credentials, I also am a clown and proudly serve as chief of community mental health at Gesundheit! Institute in Hillsboro, W.Va. The clown/fool/jester/trickster is an archetypal human characteristic that has served the purpose of lightening mood, diffusing anxiety, helping patients look at the familiar from a new perspective. The character can serve as a sacred healer. I clown all over the world with Dr. Patch Adams, perhaps the world’s most recognized humanitarian clown and founder of Gesundheit! Last year, I discussed a 20-minute mental health clinic in which I participated on the streets of Iquitos, Peru.

We did it again this year in Iquitos, and people lined up to see the clown-clinicians; they sat in an open space and talked for 20 minutes to someone they knew was listening to them. Clinicians heard gut-wrenching stories of suffering and challenges, helped people identify their strengths, applauded their resilience, gave advice, and blessed them. Patients felt better, and the clinicians felt better, because it doesn’t take long to make an intimate connection if you are truly present. It is in those moments that we are reminded of our shared humanity and that dreams are possible.

I’m thinking of bringing the Gesundheit! Global Outreach or (GO!) clowns to a mall in America and conducting such mental health clinics. Clowns would play, perform, sit in silence, and talk to anybody who wanted to right out in the open without charge. There would be neither signing of HIPAA compliance forms, nor making diagnoses, nor prescribing drugs. The idea would be to provide clown healers who might inspire people to see their lives from a different perspective.

This would be a community-based, mental health promotion program in which clowns would be supported by local community health agencies; self-help groups of every description (from survivors of violence, burns, and addictions, to parents with attention-deficit/hyperactivity disorder kids who found a way to help them without drugs). There are many untapped resources in communities, and these “clinics” can mobilize them to connect people. By doing this work publicly, we would destigmatize the concept that having ordinary problems of living is the equivalent of being mentally ill, or disabled, and needing only drugs.

You don’t have to be a clown and do this in the street (although you are welcome to join us). Try this approach in your office; use 15-20 minutes to make a heartfelt, therapeutic connection with patients; and remind yourself why you do this work. It will make you feel good and intensify your healing power.

Dr. Hammerschlag is affiliated with the Arizona Health Sciences Center at the University of Arizona, Phoenix, in addition to his role at the Gesundheit! Institute. He also is author of several books on healing, spirituality, and other topics. To get in touch with him, e-mail him at [email protected]. Those interested in the work of Gesundheit! and clown trips should go to patchadams.org.