This week I had the pleasure of getting to know two amazing people from Ummeed Child Development Center, a narrative therapy center in Mumbai. Narrative therapy is a technique to separates a person from the problem they are experiencing while encouraging them to rely on their own skills to see the problem in a different context.
DLR Prerna CHHIP Broadleaf has been piloting a Behavioral health intervention that trains lay community health workers to identify unhealthy behavior patterns in students and work with them individually to address these behaviors. We invited Ummeed to bring narrative practice up to Darjeeling and conduct an introductory two-day workshop for NGO workers, community health workers and teachers.
Narrative ideas and practice provide tools for shifting from dominate stories about a person into preferred ones, by finding and highlighting behaviors outside of the dominant story. When a negative dominant story is formed it can be damaging to a person’s self of sense, the way they are perceived and treated. It is easy to start believing a dominant story about oneself and lose perspective on one’s actions that counter this story. Narrative practice aims to find and affirm the actions that someone is taking to counter the dominant story.
During the narrative practice training I thought about a friend, Sonam,* who I’ve become close to through our field visits. On one such visit, Sonam was coughing up blood. TB is a shrinking but serious problem in Darjeeling. She described coughing up blood before but vehemently denied that it might be TB. There is a lot of stigma around having TB so people often hide the fact that they are ill from others. For more information about the factors around TB stigma check out this article.
Sonam said that she consulted a doctor one year ago; the doctor said she had a lung infection and prescribed her medicine. She stopped taking the medicine once she felt better and did not complete the course. If this had been TB the fact that Sonam did not complete the course could complicate her case, as drug resistant TB is significantly more difficult and costly to treat.[1]
I was worried that Sonam might have had or have TB and asked her to return to the doctor. She refused saying that her in-laws would accuse her of being lazy and trying to get out of housework. Also, they would claim that she was drawing unnecessary attention to herself and wasting the family’s resources.
Narrative practice would say that the dominant story within her home is that she is lazy, attention seeking and financially irresponsible. From my perspective none of these qualities matched her schedule of waking up at 5 am and working all day to care for everyone in her multi-generational home. Her preferred story was that she was a hardworking mother, housewife and daughter in law that did not indulge in new clothes, going into town or even watching serials at home. Her life revolved around doing her absolute best to care for the many members of her family, even if it was detrimental to her health.
Although she did not internalize the dominant story, fear of reinforcing it was pushing her to make potentially very dangerous choices for herself and her family. As Sonam shared her story, I felt frustrated by the stance that my friend was taking. Now, having completed an introductory training in narrative practice I have a structure for how I could have helped strengthen the preferred story while weakening the dominant one.
Find activities and skills that challenge the dominant story.
I could have asked Sonam for examples of when she was a hardworking and thrifty mother. I could pinpoint skills, activities that she used in example that she shared. Sonam might share a story like how carefully she schedules leaving the house for shopping. She would cook quick dishes for lunch so that she could do all of the house cleaning and laundry faster to create time for her trip out of the house.
People make stories stronger; involve them in the preferred story.
Especially as Sonam’s in-laws were creating an “us against her” mentality it would be important to help her identify people in her life that believe her to be hard working. I could do so by asking about people involved in this grocery-shopping example. For instance, the butcher that gives her a good deal on meat or that her friends in town are always surprised to see her out of the house.
Everyone is the expert of his or her own lives.
Highlighting the skills that Sonam was already using to save the family money and the people who already saw her as a hard working mother challenge dominant story. Narrative practice would highlight the activities that represent the preferred story and amplify them. In Sonam’s case, far from being a “bad” daughter in law and mother she was actually managing an incredible amount of work.
Everyone makes their own meaning; do not enforce judgments on others.
As Sonam’s preferred story becomes stronger, the dominant story would become weaker. We could brainstorm ways for her to build her narrative as the family caretaker to see keeping herself healthy as vital to her family’s well-being. To me, Sonam’s health matters not because she is someone else’s mother or daughter but because she is her own person. I do not agree with Sonam’s image of a good mother being self-sacrificing and not leaving the house unless the outing will benefit her family. In my preferred story of Sonam she would have time to herself and with friends while her husband and other family members stepped up to help with housework. But narrative practice stresses that my judgments are irrelevant to Sonam finding her own path to making her preferred story a reality. She is the expert of her life and is already working to counter the dominant story that her in laws have created.
At the time, Sonam did not go to the doctor. Instead she took the year old medicine to a pharmacist and purchased the same medicines with borrowed money. Her resourcefulness is evident in how she went about solving her problem even if she did not solve it in the “correct” way. I’m looking forward to seeing Sonam during our upcoming field visits, I hope she will be in better health and that we’ll have some time to strengthen her dominant story.
*Sonam is a pseudonym.
[1] “Treatment for TB Disease.” Centers for Disease Control and Prevention. CDC, 11 Aug. 2016. Web. <https://www.cdc.gov/tb/topic/treatment/tbdisease.htm>.
