Where the River Meets the Sky

landscape view of baltimore's inner harbor

Some days I sit, staring out at the Chester River which flows to the Chesapeake Bay, which empties into the Atlantic. It’s beautiful here. There is room to think, room to dream, room to reflect. It is not Baltimore. It is not Hong Kong. 

The Institute for Integrative Health is on Fleet Street in Baltimore, Maryland and, in many ways, this is our town. But our work has taken us around the world, with many stops including Hong Kong, visiting and collaborating with our colleagues at the Chinese University of Hong Kong.

There’s a headline in last week’s Washington Post which reads, “We don’t get justice” and the story comes from Baltimore. It details the death of the youngest victim of COVID-19 in the region – a 15-year-old, whose race and place on the economic ladder left her particularly vulnerable. She lived and died in southeast Baltimore, her home, less than four miles from our office on Fleet Street.

I would like to be in a world where George Floyd was not murdered by a policeman. Or Freddie Gray. I would like to be in a world where Dar’Yana Dyson didn’t have to die from a virus she made every effort to avoid. I would like to live in a world where the voices of freedom in Hong Kong are not silenced, and my friends do not have to live in fear.

But this is our world.

A poem I read recently by Lynn Ungar says, “The fact that you are swept along by the river is no excuse. Watch where you are going. Lean in toward what you love. When in doubt, tell the truth.”

I wake up in the morning with options – and I know I have to lean in. We have spent decades striving to broaden the view of medical care through an integrative approach. We have cross-pollinated – connecting the dots between science and sociology, nutrition and wellness, clean air and healthy communities. We have helped disseminate information, funded projects, and supported the work of brilliant thinkers who are seeking to change the status quo. But it is not enough.

The incredible inequities in America which have been laid bare by COVID-19 and by the unwarranted death of black men have been brought to us by a broken system that is upside down. Simply put, racism and social injustice is a public health crisis that puts the entire community’s health at risk, not just those of color. This must change.

We cannot sit idly by as communities that have been historically under-served in every way, suffer at a disproportionate rate. We cannot pretend that this problem will go away. And we must address the bigger issues.

Healing is not about writing prescriptions. Healing is about listening. Wellness is a daily practice – it’s food, and sleep. It’s clean air and water, it’s hope and dreams. It’s freedom.

Around the world, people are marching for justice. In the poorest neighborhoods, people are fighting for their lives. The courageous voices of teenagers are ringing out to remind us that the earth is struggling. There are throngs of people protesting in the streets of Hong Kong, London, New York and Washington, DC.

There is an urgency, an opportunity for change, and this change is not incremental. We cannot go back to normal, now is time to bounce forward to a new normal.

At the Institute for Integrative Health, we have always been dedicated to envisioning a world that values wellness, that treats people with dignity and listens, that recognizes healthcare is not just about medicine, but also the interconnected web of everything in our lives, our communities, our planet. The work of our Scholars, Fellows and programs is raising awareness about inequities – the challenges being faced by primary care providers during this time of COVID-19, the undue impact of COVID-19 on communities of color – and is helping people and communities to heal from trauma and thrive – through art, time in nature, healthy eating. Now, at this moment where evolution meets revolution, our work is adjusting and growing. . . we choose to lean in.

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. 

When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) 

“When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” 

Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”

 In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” 

  • Helping Others: We find meaning in helping others. “Understanding that suffering gives the strength and experience to help others in similar situations.”
  • Hope: We begin to have hope that we will not always feel this bad. A Crohn’s patient said, “I think gradually I realized that I was going to feel better. I did have days when I actually didn’t vomit, when I did feel better. And I think gradually I came to believe that maybe I could have a normal life again.”
  • Self-Acceptance: We see our inherent value and understand that we are not to blame for our suffering. A participant living with HIV said, “I’m really proud of myself. I think that now I still want to live. I don’t want to die, and I really love myself a lot. I have a lot of comfort in myself.”

Suffering is the ongoing pain from wounding. 

There is some debate about whether people always experience suffering on the path to healing.

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. 

“The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”

Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.

Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.

Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.