If ‘It Takes A Village’, Do We Have What It Takes?
More than a decade ago, I was a “doc in a box” in solo practice; alone in holding my patients’ stories of sexual assault, alone in feeling the fragility of patients restricting their intake, alone in guiding patients along the tightrope of harm reduction and risk awareness.
One evening as I raced home from the office — feeling the whiplash of my need to quickly switch from attuning to my patients to attuning to my young children — the limbic drain and isolation hit me hard. I called a friend who I knew would understand, deep as she was in the sleep deprivation throes of new parenthood.
During our conversation she scoffed as she invoked the popular proverb, “It takes a village”.
“Where is that proverbial village? When does grandma arrive? I’m ready,” she half-joked.
I laughed, but felt an internal pang. Here I was, holding and attuning to other people in so much pain, only to go home to uphold HIPAA, care for my children, and wake up to do it all over again. Time to connect and offload with other providers was limited. Time to care for myself? Practically nonexistent.
Caregivers are profoundly impactful. Society would simply cease to function without the individuals stepping into these healing roles and yet, who is caring for the caregivers?
The village should….
But how many of us have ever experienced the care of the mythical village? We are neurobiologically wired for interdependence and connection, yet we are more isolated than ever — as parents, as mental health providers, and as biological beings who co-regulate our nervous systems by being in community.
Author Beth Barry sums up the concept of community eloquently:
“By village…I’m referring to the way of life inherent to relatively small, relatively contained multigenerational communities. Communities within which individuals know one another well, share the joys, burdens, and sorrows of everyday life, nurture one another in times of need… and feel fed by their clearly essential contribution to the group that securely holds them.”
“A group that securely holds them.” So few of us — at least those of us in modern Western society — have experienced or will experience that type of community. And we struggle without it.
Social connection, in addition to being a basic psychological need, is one of the biggest (some would argue the biggest) determinant of emotional and physical wellbeing. The body of research in this area, thoroughly explored in the works of author and Scientific American contributor Lydia Danworth, concludes that not only do social bonds just plain feel good, but a lack of social bonds can be dangerous. For example, an oft-cited 1988 study suggested social isolation rivals cigarette smoking and obesity in their association with illness and death. A 2007 study found that social isolation increased susceptibility to inflammation and viral infection. Most recently, a study from earlier this year discovered that (accounting for demographic variances) communities with a strong sense of connection have experienced fewer and less severe cases of COVID-19.
Research outcomes like those make our nation’s difficult but crucial task of balancing the spread-stopping benefits of social distancing with the immune-boosting benefits of social connectedness even more precarious.
As Mandy Len Catron wrote recently in the Atlantic (“There is so much more than the nuclear family, even now” June 2020):
“Disasters have a way of illuminating our human capacity for care and connection, but a pandemic is a cruel messenger: It reminds us of our essential interdependence while amplifying the isolation of our modern lives.”
I found two particularly interesting takeaways from Catron’s article:
Firstly, her thesis that the so-called nuclear family is no longer the dominant living arrangement or source of refuge for most Americans, and that we need to extend our definition of family to include alternative infrastructures of care. I’ve certainly noticed this trend among patients. Have you? Family Therapy is something we hold in high value at True Life Center and it is therefore an integral part of our IOP. But this work often necessitates a patient’s chosen family. Recently we’ve included many members of the family in to support a patient’s care, such as a trusted aunt and a longstanding supervisor at a family business.
Secondly, her thoughts on the relationship between care and belonging. Particularly, her conclusion that the act of caregiving fosters a sense of belonging, and that this connection could be intentionally activated as a tool to establish community.
What would that look like? If we legitimized and supported these alternative infrastructures of care? If we leaned into and prioritized cultivating community around systems designed for giving and receiving care?
Just the other day my team and I discharged a patient whose complexity poignantly highlighted the need for a village. This patient is on the Spectrum, with co-occurring substance use disorders, eating disorders, and a lifestyle of total isolation. During her time at True Life Center she thrived as a member of our community. Now, as she “graduated” from our IOP and is launching out of sober living after many years, there is no ready-made community for her to launch into and celebrate with.
My vision for True Life Center has always been to care for the caregiver by cultivating a securely-attached community for providers, who in turn care for patients and their families, whatever form that takes. Rather than being given what Elizabeth Markle, Ph.D. calls a “behavioral prescription to nowhere” (telling patients to support their treatment by eating better, moving more, or being more mindful, but leaving them to their own devices to find such support); a team of ‘well-cared-for’ caregivers can likewise offer their patients a community of care, as well as the implementation tools to achieve their goals.
I know for certain that True Life’s sense of community, in addition to our approach and our team, is a main reason that patients often find success here after struggling to achieve their goals at other competent programs. And I believe that it is our role as treatment providers to foster that sense of community.
Because if — as Markle and many others assert — community is medicine, then our task as healers is to help fill that prescription for as many people as possible.
