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FOUR YEARS REMOVED from his position as director of UPMC's (then
called) Center for Complementary Medicine at Shadyside Hospital in Pittsburgh,
Lewis Mehl-Madrona, MD speaks on the record for the first time about
his 1997-2000 tenure at the region's leading health care system
and the controversial native ceremonies that earned him the "sweat
lodge doc" moniker. He also shares meanderings on  the essential
role of faith in the healing process, the field of psychiatry and the
future of integrative medicine.
Mehl-Madrona's self-assumed identity as Coyote - the bringer
of constructive chaos - is apropos, as I learned during the interviews
for this piece. As our phone talks ensued over several weeks, I felt
at times like a storm chaser in pursuit of a tornado. When I was able
to track him down - 10 minutes here: on an elevator, in a copy shop;
20 minutes there: flying to Chicago, driving a U-Haul cross country
- the content of our discussions was captivating. I knew that
controversy ran parallel to Mehl-Madrona's career ever since the
1970s, when his research on home births being safer than hospital births
landed him on the Today Show. As evidenced by his responses,  below,
he's still inclined to speak with candor. When the dust finally
settled after our whoosh of interviews, I understood his true coyote
nature: intelligent yet amusingly derisive, a true survivor and, beneath
the irascibility, quite benevolent.
Over the years, Mehl-Madrona has been prolific - authoring four
books, 18 book chapters and more than 50 papers in scientific journals;
and holding various academic and research positions at some of the most
prestigious university hospitals in the US. He is a Stanford-educated,
board-certified family physician, psychiatrist and geriatrician. Part
Cherokee-Lakota, Mehl-Madrona has studied native traditions for 25 years.
He is currently Coordinator of Integrative Psychiatry and Systems Medicine
for the University of Arizona's Program in Integrative Medicine.
Mehl-Madrona is author of the best-selling Coyote Medicine,
Coyote Healing and Coyote Wisdom.
As it relates to medicine, the unpredictability of coyote "cautions
us to realize that it's impossible to fully analyze and apprehend
the world," Lewis states. "By the same token, it encourages
us to expect a miracle, and to prepare in all ways for it."
The UPMC Years
GMH: Tell me your fondest memories of Pittsburgh.
LMM: City lights exploding through the Fort Pitt Tunnels. Attending
the symphony, especially since I had patients who played in it. I worked
most of the time, so many of my memories are of Pittsburghers themselves - people
who came to weekly healing circles at the hospital, or to talks I gave
around town. I remember meeting roomfuls of enthusiastic individuals
who wanted to explore ideas related to alternative medicine. And there
were memorable patients.
GMH: Now that you have some distance on Pittsburgh, how does it compare,
in your opinion, to other cities of comparable size in terms of level
of cooperation between allopathic and complementary medicine?
LMM: Shadyside Hospital was extraordinarily better than any other place
I've worked in terms of integration with other medical specialties.
GMH: Shadyside officials brought you on board precisely because of
your combined credentials in complementary and conventional medicine.
Yet when you set forth to integrate those two worlds at the hospital,
you met with resistance.
LMM: There was never a problem with Shadyside Hospital. The issue was
with UPMC administration. I was recruited by Shadyside when it was still
a private hospital. My contract was with them. It became a UPMC hospital
after I came on.
GMH: How did Shadyside's transference to UPMC impact the Center
for Complementary Medicine?
LMM: I don't think UPMC even knew about the center for the first
two years. It didn't hit their radar. Technically, I was employed
by the Department of Family Practice as a psychiatrist, family physician
and geriatrician. I was doing regular medicine as well as running the
center.
GMH: What caused the center to hit UPMC's radar screen?
LMM: UPMC became aware of the existence of me and the center through
different talks I was giving around the city. Then deans changed at
the University of Pittsburgh School of Medicine. The new dean (Dr. Arthur
Levine, since November 1998) felt [strongly that only proven therapies
be offered] at the center.
GMH: Were you surprised by this?
LMM: A little, because I thought we were [aiming to answer larger questions]
such as: How do we help patients get better by combining the  best of
alternative and conventional therapies? What works for who, and why?
What's this all about anyway? There are so many treatments that
we ought to be looking at that aren't even that "alternative."
For instance, it's known that making friends with a schizophrenic
yields better results and is more powerful than the drugs being administered
to treat this condition - this is still the case after many years
of progress in drug development. But here's the thing: making
friends with a patient calls into question the whole issue of the doctor-patient
relationship, the power of that relationship and the power of intent.
These are serious questions to be addressed... I think the role of
a medical school is to explore the frontiers, to continually discover
what medicine should be, what it should look like.
Sweating the Details
GMH: In Coyote Healing, you speak eloquently about the powerful role
of ceremony in the healing process, and you define a sweat lodge as
a Native American way of worship during which you pray for the patient's
highest health outcome. Why do you think much of the controversy during
your time here focused on your sweat lodge activities?
LMM: The concern was that some of my patients sometimes participated
in these sweat lodges.
GMH: You didn't perform them on UPMC time and didn't charge
a fee for them. Did you ever flat-out ask UPMC administrators, "What's
the harm in this if it's helping and not hurting patients?"
LMM: I don't think the UPMC hierarchy ever got clear that sweat
lodges were a separate, non-UPMC spiritual activity that involved the
Native American community.
GMH: You never clarified to them that a sweat lodge is a form of sacred
prayer in the Native tradition?
LMM: No, we never had a direct conversation.
GMH: Did you ask for a meeting to clarify this?
LMM: Sure, sure.
GMH: And their answer was?
LMM: I didn't get an answer. They never spoke to me directly.
The closest UPMC and I came to having a dialogue about this was through
the media. After the Pittsburgh Post-Gazette article came out [February
6, 2000], there was actually a lot of support from Pittsburgh's
faith community [regarding patients attending sweat lodges]. Rabbis
came forth and said that sometimes patients attend temple with their
doctors. Catholic priests came forward and stated that doctors and their
patients pray together at mass.
GMH: Do you feel the Pittsburgh media accurately portrayed your work?
LMM: They sensationalized it a bit [because] they didn't view
Native American as a bona fide religion. They really should have presented
it in the same way they would present the Jewish faith. You know, you'd
be nuts if you said anything derogatory about the Jewish faith in Pittsburgh.
Well, they didn't have that same sensitivity to the Native American
faith.
GMH:
Have you been able to actualize your vision of integrating native and
mainstream medicine with hospitals you've worked at since leaving Pittsburgh?
LMM: I've not been able to do the full integration I thought we could
have done in Pittsburgh. At Beth Israel's Center for Health and
Healing in New York [Mehl-Madrona served for two years as clinical program
director], we did clinical work but research was difficult because we
were a hospital and not a research institution. Now, at the University
of Arizona, the research is fine but clinical work is difficult.
The Spirit of Healing
GMH: You say in Coyote Medicine that all healing is fundamentally spiritual
healing. Define "healing."
LMM: To make whole again, to achieve a sense of integration. We have
to differentiate between healing and curing. People want both. Healing
is always possible, curing is less controllable. Sometimes a cure happens,
but not always.
GMH: You've also said that people don't make mistakes - they
make unsuccessful attempts to heal. What's required to achieve
wholeness?
LMM: We don't know what's required, frankly. Systems transform
themselves every day and even doctors don't know how it happens.
I don't know how it happens. I'd like to, but I don't.
GMH: I was struck by your comment in Coyote Healing: "our belief
in medicine is so strong that we usually turn to alternatives or to
God as a last resort when conventional treatments have failed."
LMM: It is kind of crazy, when you think about it.
GMH: Is our post-modern society moving towards recognizing that the
spiritual is ultimately as important as technology?
LMM: We have a long way to go, but things are changing. The concept
of spirituality is more acceptable. As recently as the 1980s, for a
physician to even mention the spiritual would make him so unrespectable
it's not funny. That's changing, which is great.
GMH: The CAM movement has been largely consumer driven. As someone
on the periphery, it appears to me that, increasingly, people want to
actively participate in their own healing processes. We want to know
our options, including but not limited to invasive procedures. What
is your view as someone inside the medical field?
LMM: Actually, on the inside what I notice is that patients are being
driven, out of doctors' fears, to do or not do more and more things
that may or may not be good for them in the long run. Here's an
example: recently, a doctor recommended a biopsy to a patient based
on a mammogram. This patient happened to be a nurse. She refused the
biopsy. As it turns out, her condition should have been biopsied. The
nurse-patient then sued the doctor for not making her have a biopsy.
Who wins?
GMH: In other words, you're seeing situations where patients
are taking matters into their own hands and, in some cases, not making
the best choices then blaming the medical establishment?
LMM: Right, and it's causing the medical system to run scared
and attempt to more aggressively get patients to do more procedures.
In medicine, you're almost never sued for over-treating, but you
can be for under-treating. Take the whole cholesterol craze. We've
lowered the numbers - now you're supposed to have numbers
below 100. Is that good? Is that bad? I don't think we know for
sure. What are the long-term side effects of cholesterol lowering medication?
Don't know. But clearly, everyone's being pushed to do it.
The Age of Miracles
GMH: Sure, ads for Lipitor and Zocor now share airtime with Diet Pepsi
and Chevy trucks. But clearly, you advocate for patients taking an active
role in their recovery and wellness. You believe in the possibility
of miracles and the power of a patient's faith in the healing
process.
LMM: People do have to somehow show up. In some cases, they show up
having already made the decision to heal, and they just need me to make
what's already occurred for them on a psychological level manifest
on the physical level. Funny thing, it appears to be true that a significant
percent of healing is the person's decision to be well.
GMH: When a patient comes to you, are you able to recognize, based
on the strength of their personal faith, that one person has a better
chance of succeeding with their healing goals than another who's
disillusioned about their ability to be well again?
LMM: Oh yeah, so much comes from the person. The story that you're
living is so important in what happens to you. What you believe makes
such a difference. It's huge.
GMH: As Jesus said, "your faith will heal you."
LMM: Exactly, that really says it. There's also a Bible passage
about faith moving mountains. So much of what I do is getting people
to believe in something. It really does matter.
GMH: Can you place a percentage on the number of people you've
worked with who don't have a spiritual foundation or concept of
a greater force guiding their lives?
LMM: Probably 20 percent.
GMH: And do they find God?
LMM: They find something. They might call it God. They might call it
nature. They might call it life. They're changed in some way.
GMH: You mention that curing requires the soul's permission.
Are most patients able to grasp this spiritual concept? Again, people
are coming to you, at least initially, wanting to be cured of their
illness.
LMM: One of the first things I do [with new patients] is disavow them
of the notion that "doing everything right" will cure you.
It's my sense that curing involves a state of grace, and grace
is defined as a favor granted by the divine without your having done
anything to deserve it. It's really a mystery, still, who's
cured and who isn't. All we can do in the face of this is cultivate
actions that we know will improve the quality of life and which are
associated with the possibility of a cure - then leave the rest
up to divine will.
GMH: You've been working with Dr. Andrew Weil's group in
Tucson for several years. Any healing stories you'd like to share?
LMM: Oh, sure. Some really amazing people have come through. We had
a woman from Greece who had two metastases in her brain from a tumor.
She was with us for a couple weeks and when she went home, both metastases
had disappeared. Another woman from Iowa with metastatic ovarian cancer
spent a couple of weeks with us. Her physicians had planned to do a
surgical intervention but when she returned home from Arizona, they
didn't find anything to operate on. She's still doing well.
GMH: You discuss such medical miracles in Coyote Healing.
LMM: Miraculous healings such as these are the home runs, but there
are no strike-outs in this work. What I do for some people is help them
to have a better death, to die with peace and dignity. That's
a success, too, just a different kind. With cancer patients, what's
more frequently the case is that they live longer and die better.
GMH: In working with people on such a personal level, the care becomes
complementary in the truest sense of the word - a real patient-physician
collaboration.
LMM: Yes. I rarely tell people what they should do. I believe our role
as physicians - whether the treatment is alternative or conventional
- is to give people menus that come with benefit analyses then
say "here's what you COULD do, here's the evidence
to support it, here are the risks and possible benefits - now you
decide." I've seen conventional physicians torture people
for a one-percent improvement in survival at one year, and the patients
were never told that the data only supported this one-percent. To me,
that's unconscionable. [It's an example of] conventional
medicine doing something when sometimes we should do nothing. Sometimes,
we should just say to the patient, "here's what we've
got, here's how good it is, and probably the best thing going
for you right now is the power of your mind. If you believe in any of
these [alternative or spiritual approaches to healing], maybe you'll
be one of the home runs."
Healing through Storytelling
GMH: Tell me about narrative therapy and what you refer to as the "third
wave of psychology."
LMM: In the native tradition, healers use stories to cultivate ideas
of faith, hope and the possibility of healing. Narrative psychology
contends that we organize our lives through the stories we tell ourselves
to help us make sense of the world. Some of these stories lead to self-destructive
results. Narrative therapy is about helping people become aware of the
story they're living. And I wonder with them about other possible stories.
For example, you probably know someone who always talks about their
life in terms of how terrible it is. What if she didn't do that? What
if she instead could say, "Hmm, maybe there's another way to perceive
the events of my life - what if I'm taking this too personally? What
if it's really not about me at all? What's a sounder way to see this?
What would those other ways be?"
GMH: The person has to be willing to rewrite their story. They have
to be aware that the story they're telling isn't working
for them. Or do they come to therapy not even aware of that?
LMM: Everyone believes that what they think is true, right? We don't
say "I'm creating my world view and I realize that it's
all relative and none of it could be true." Here's another
example: a woman I know is convinced that every problem in her life
is because of her husband. He seems like an average guy to me with good
and bad points. In narrative therapy, we might wonder, "no one
is all good and no one is all evil; maybe Mother Teresa is the exception,
but probably even Hitler was nice to kitty cats or something."
What I often find out is that people are raised in families to believe
certain things to be true and they can't stop seeing the world
that way without intervention.
GMH: Anything else you're involved in right now that you'd
like to talk about?
LMM: I'm really interested in the notion of revisioning psychiatry.
We need a different kind of mental health system, one that pays attention
to different aspects of the person - which is the way indigenous
cultures have done it for thousands of years. So I'm interested
in bringing [ancient teachings] into a modern medical culture based
on biological determinism and saying, "Maybe it's about
more than genetics. Maybe everything matters." For example, we
know that miracles can happen. The question becomes, why do they happen?
I've heard it said that some people are genetically primed to
have miracles. It's an interesting notion but probably not true.
It's another example of determinism. I'm suggesting that
we open ourselves to listening to the story without claiming that we
know what it means yet.
GMH: Give me an example of rewriting a patient's story.
LMM: This week, I worked with a fellow who came to us catatonic. How
they got him on an airplane is a miracle in itself. He'd been
in a state hospital for a year, hopelessly lost in a catatonic state.
His story was this: nothing could or would ever get better and that's
how it was going to be for the rest of his life. We gave him a context
in which to believe that he didn't have to be this way. He wasn't
doomed to being a seriously mentally ill person in a state hospital
forever. He actually had a world of possibilities. Now, this man is
no longer catatonic. In fact, as we speak, he's on his way to
Hawaii - we found an environment for him where he can recuperate.
We'll see what happens.
GMH: So your contribution to revisioning psychiatry is through the
storytelling aspect, helping people to comprehend a larger personal
vision.
LMM: Right, because we get what we expect. I'm not saying that
we ALWAYS get what we expect but if we don't expect something,
we probably won't get it. That's really what it's
about, whether you live in a culture of pessimism or a culture of optimism.
We don't really know the extent to which our thoughts and feelings
affect our physical bodies, but they appear to. In certain cases, it
appears to have a dramatic impact.
The Future of Integrative Medicine
GMH: Do you think the middle ground between allopathic and alternative
medicine is lessening?
LMM: Actually, I don't. It's puzzling because a lot of what
used to be healing is sort of being co-opted. Take the things that are
becoming acceptable and codified, like acupuncture; instead of it being
part of a broader healing view in which that's one tool to be
used, it's being brought into this compartmentalized world of
medicine in a way that reduces it effectiveness and renders it a "procedure."
GMH: You're saying that when the scientific community sets out
to identify an alternative practice, then research it, codify it, have
outcomes based on it, something gets lost in the translation?
LMM: Right. It would be better to say "Let's go to where
this practice really takes place and see what's happening there.
Let's speak with elders or sages of certain healing art forms,
see how they put it together, how they came to understand it."
GMH: Is it a matter of one world attempting to usurp the other?
LMM: I don't think the spiritual-shamanic world has tried to usurp
the biomedical world. It's more the case that biomedicine tries
to bring everyone into its domain. What worries me is that biomedicine
can make something seem ineffective. You can set up a study to make
something not work that does work in its own context.
GMH: Example?
LMM: I performed a study comparing acupuncture and craniosacral therapy
to see if it impacts asthma. I did the study according to biomedical
standards, but if it doesn't show effectiveness, I don't
know what that means. We used 6 acupuncture points in 12 sessions. If
the study shows nothing, the conclusion drawn is that acupuncture isn't
good for treating asthma. Now, is this how I would treat someone? If
a patient came to me with asthma, I wouldn't just do acupuncture.
I'd sit and talk with him, get a sense of the context of his life,
do imagery, consider different herbs he might want to try. It's
more than a procedure, it's a process.
GMH: Maybe we shouldn't try to assimilate the world's healing
systems into biomedicine?
LMM: They need to explore each other in preparation for integration.
One shouldn't destroy the other. Integration isn't the same
as assimilation.
GMH: From your vantage point as an MD and PhD, you see the shortcomings
and ultimate potential still waiting to be realized in the world of
healing. You make comments like "doctors are the third top cause
of accidental death in the country" and these statements -
whether proven or not - aren't endearing you to the medical
community. It's fascinating that you work in this world yet articulate
an outside view of if. Do you meet other physicians who share your view?
LMM: Oh sure. Even if they don't practice the way I'm practicing, there
are plenty of people I meet who are sympathetic to these ideas because
they're meeting with the same challenges. In some cases, we see patients
not getting better. And the bottom line is that we genuinely want them
to. After all, that's why we're in the business of healing to begin
with.
© Gina Mazza Hillier, 2006
Special thanks to Diane Gleason for connecting me with Lewis.
Photo of Lewis © Bob Hitchcock, 2006 |
