Didi Pershouse’s book, The Ecology of Care: Medicine, Agriculture, Money, and the Quiet Power of Human and Microbial Communities has just been published and so we are re-posting this interview from 2012 with Didi about her work and the vision behind her book.
From 2012 Interview with Ann Armbrecht
We tend to make different demands of medicine than we do of other commodities. Instead of focusing on how these products are made, we focus on whether and how they work, assuming that the two are unrelated. But they are related. Once while undergoing chemotherapy treatments for breast cancer, a friend was warned by her doctors to be careful not to let her urine splash on her body because the chemicals from the chemotherapy made the urine toxic to the body. The disconnection at the heart of this warning stuns me. We not only have developed a system of medicine that assumes you can cure one part of your body while poisoning another, but we have been told to accept that disconnection as a precondition for getting well.
Didi Pershouse is part of a growing movement challenging this disconnection. She founded the Center for Sustainable Medicine in 2006. She has run a sliding-scale clinic providing both standard and alternative care in Thetford Center, Vermont since 1995, and teaches classes on peer-counseling, resiliency and leadership.
Ann: You’re writing a book called “Sustainable Medicine.” Tell me about it.
Didi: The question at the heart of this book is: How do we get close enough to each other so that we can really look out for each other? More specifically: how do we create resiliency in the ways we take care of our bodies, our relationships, our communities, and the natural world that we depend on to be alive? People are discouraged about relationships, disconnected from each other and from nature, and it’s blatantly obvious in the way we approach health care. We have figured out all kinds of cool things to do with modern medicine and other technologies, and there are thousands of human cultures on earth today that are about to go extinct, that could all be helping us come up with elegant solutions to the problems at hand. But we have a long way to go towards figuring out how to actually support each other in making good choices about what to do with both the old and the new technologies.
Our health care system, like all of modern society, is hard on the environment and unsustainable economically and socially as well. Hospitals, pharmaceutical companies, ambulances, even doctors—these days they are mostly owned by corporations, which exist not only to provide healthcare but also to make money. To expect corporations to continue to take care of people in an economic crisis when they are losing money is naïve and dangerous. When it gets too expensive to provide care most of them will simply close up shop and go elsewhere to make money. It’s already happening in many places. So we need to start planning now on how we will look out for each other’s health and well-being as that starts happening more and more. We can do this. The solutions are there. Sometimes it’s just hard to see them.
Ann: What led you to the work you are doing?
Didi: I’ve been working as an acupuncturist and health care provider for almost 20 years, and for many of those years I shared clinic space with physicians, psychologists, and other healers. I love cross pollination of ideas. It is what fuels me as a systems thinker. After a trip to Cuba in 1999 to research their “post-petroleum” medical system, I started thinking about the links between sustainability and alternative medicine, and started trying to define what “sustainable medicine” would mean. I have been writing about, thinking about, and talking about the intersections between sustainability and health care ever since.
I saw the film “The End of Suburbia” around the same time, then discovered the Transition Town movement, which is a worldwide movement encouraging communities to build resiliency in the face of rising oil prices, climate change and uncertain economics. They were doing great work in the areas of transportation, housing, and food, but not much at all about health care. I already knew our health care system was very vulnerable to this triple threat of oil, climate change and economics, and I started giving talks at Transition Town initiatives.
Ann: Have you noticed a change in awareness since you started working on this?
Didi: When I first started, there were only a few other people in the world that I could find who were working on this issue of building resiliency in our health care system. So I decided it made sense to write a book for people who know something better is possible and is about to happen. I want to help them in the process. I don’t have all the answers, though I think I have some of them because of my experience as a bridge person. For 20 years I’ve been listening to people’s stories about what has and hasn’t worked for them in the medical system, and I’ve studied many different alternative medical systems and seen what does and doesn’t work in those. My book serves partly as a toolkit of ways we can figure this out together. What I have noticed is that once people start thinking about it, they are very eager to hear more.
My book makes the point that there is no such thing as “human health” apart from the rest of the planet. There is only health. We are part of a whole system. I encourage people working in health care to see the natural world as part of their patient base, to start working on climate change, to choose the forms of technology they use with that in mind, and to help patients see the links between their life choices and the changes that happen as a result of them, not just in their own bodies, but in the body of their community and their world. Otherwise we are all just practicing palliative care on a dying planet. Palliative care takes care of symptoms, and relieves the suffering but doesn’t focus on curing the problem. It is often used on people who are expected to die: like giving them pain medication, antidepressants, playing harp music, etc.
There is absolutely no reason this particular patient needs to die. We can dive into the pain, act right now and the earth can live. If we think of the earth as our beloved child, or the love of our life, how much attention would we give that situation? What would we drop in our lives to make sure they would live? We have about five years to turn things around in terms of climate change, which is already having a huge effect on the health of the natural world, and is starting to have an effect on our health—like the spread of Lyme disease in New England, and the flooding from hurricanes as more moisture gets into the air from warmer temperatures. Are we going to do something? Or just take medication so we don’t have to feel how hard it is?
There are hard but wonderful choices we need to start making now in terms of how we take care of our own bodies and the earth’s body. My book shows ways we can support each other as we make those choices, even when they are difficult.
Ann: There is so much that is discouraging, especially around the unsustainability of medicine and the fate of the earth. What gives you hope and inspires you to keep up the effort?
Didi: Once you understand that all discouragement is old, and that hope is not just rational and useful, but also a moral imperative, it kind of changes the way you operate. Discouragement is not about the current situation, it’s about things that happened long ago that the current situation reminds us of. We don’t know the outcome of the current situation, and we have a lot more experience and insight, having gone through the past, so it makes sense to be hopeful. The pattern of discouragement runs deep enough that most of us think it is just a normal outlook to be kind of cynical. I can go there at times, but most of the time I feel very hopeful. At our core we are all quite hopeful. We are also cooperative, brilliant, loving, and all kinds of other great things.
If you put a bunch of people in a room and gave them enough attention and support, and let them cry about all the old places they got discouraged, there would be enough wisdom in that room to solve any problem facing the world right now, including the problem that we haven’t done a very good job of figuring out how to take care of each other in modern medicine. The most interesting part of my work right now is figuring out all the ways to keep myself and other people from getting discouraged so that we can see the opportunities that are right there, waiting for us to notice them.
Ann: What does that look like in your life?
Didi: I have groups like that in my life where we are doing just that. I describe this process in detail in my book. We shed dump-trucks full of discouragement every time we get together to laugh and cry and put our minds together to think really clearly about what is needed. I have a good cry at least a few times a week. It helps to clear the decks and keeps me from bringing old discouragement along with me. I think much more clearly since I started allowing myself to cry. I have lots of people in my life I can do that with, in a number of areas: deep friendships, peer counselors, colleagues, a contemplative prayer group of fellow mystics, and some very wonderful family. It’s a little tricky in a rural landscape where people are so spread out, and in New England where people have such habits of wanting to be independent of each other and being afraid to get close to each other because it seems too messy.
I’ve been working on getting closer to the people in my life no matter how uncomfortable I feel. It’s pretty amazing what happens. It has been really hard and really, really, fruitful. I have relationships with my kids, with friends, with ex-partners, my siblings and parents that I never thought were possible.
I’ve always loved deep relationships, but I was more comfortable having them with people where there was a chance of escaping: like people who lived on other continents, or people who were about to move away, or long conversations with people on a greyhound bus that I would never see again. Now I’m holding myself to a new standard of permanent loving relationships with those who are right around me, and it makes me squirm like crazy but there is tremendous growth.
That’s a much better way to change things. The same is true whether you are with your friends, working with patients, or trying to change the medical system. You have to get close enough to really feel the heat of the places that aren’t working, and close enough to have the trust of the people who are going to be relying on you to lead them to a better place.
This is actually the core of my work in creating a sustainable health-care system—this thing of creating permanent loving relationships instead of people being a bother to each other. We need to get over that if we are ever going to enjoy taking care of each other in a deep way. So I talk about this to my patients, my students, and my friends. I get asked to give talks about building deep community in churches, and I taught workshops about it after the flooding from Hurricane Irene in 2011. I’m trying to make it a conscious practice for me and everyone around me.
Take a look at Didi’s new book, The Ecology of Care to learn more about her work and her ideas.