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Sustainability in Healthcare: From independent to interdependent modes of care

Pillars of Our Shared Work #16

Author: Danielle Smith (RMT, Artist, Healer)

I have offered much of my life to massage therapy, and have been practicing for over 20 years. Through these years of experience I have learned, as a healing practitioner, that there is a deep rooted and intentional need to also find strategies and tools to sustain myself. Thinking through this article on sustainability as a healthcare practitioner has provided me an opportunity to reflect beyond the care of self, into a care of community, and the resilience practices embedded within. In addition to the real and tangible benefits of receiving care, I have also witnessed some challenges in seeking this care. In this article, I will share some of the self-care practices that I’ve learnt over the years, and perspectives on resiliency which I’ve gained from being involved in communities and movements.

My Practice

My practice has provided a lens for life by studying the complexity of the soma (i.e. the body, not independent of the soul). In my massage work I facilitate several complex physiological processes that occur in the body. It is clear that these processes do not occur independently from the surrounding environment. More and more, the concept of self-care reinforces the inaccurate notion that the soma, within a healing context, creates physiological changes solely within itself based on what we do for ourselves. It is clear that we have personal responsibility for ourselves. However, I wonder how we can shift our concept from independent to interdependent modes of care to sustain ourselves. In reality, the body’s physiology is constantly being impacted by a myriad of external forces. This is relational knowledge. This is Indigenous knowledge. It is the relationship between ourselves and nature; ourselves and the land; ourselves and the elements; ourselves within time and space; ourselves and each other; and ourselves and all our relations. These relationships are a huge part, if not the greatest part, of what sustains us – ourselves in healthy environments, however we may define that. This is especially prevalent for those of us who are living at intersecting oppressions.

Having said that, some self-care practices are powerful and crucial, and may be exactly what folks need at specific points in their journey. The concept of self-care itself has been considered radical in supporting many of us to believe that we actually do deserve care. As a mixed-race Black womxn, I deeply identify with the statement by our late leader, visionary, sacred teacher, Audre Lorde: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.” To build on that well-known statement, what I have been in long-term deep contemplation about with regards to sustainability in life and practice, is how we define caring for ourselves, and specifically how “self-care” is not conclusive in meeting our needs in order to sustain us in whatever work we do. Self-care as a solo endeavour can too often be promoted, co-opted, and marketed within capitalism and the medical industrial complex as a wise and right thing to do. Yet in these frameworks it often focuses on an individual’s behaviour and choices without considering one’s social conditions and systemic barriers that are faced. As a method, it can maintain a deep sense of isolation that we feel when we are burnt out or unwell.

The problem of isolation is often invisibilized in our society and therefore so prevalent. Particularly in social movements, so many of us suffer from insomnia due to loneliness, isolation, and PTSD. And these conditions all prevent and block our ability to access the medicine of sleep for body system renewal, regeneration, and soul-visioning through our dreams. Many say they only finally get a good sleep with the return of a partner or when a trusted friend stays over. #Rest4Resistance This simple example illustrates some of the limitations of the idea of self-care, and asks what is beyond this model.

“Change-makers are dying as a result of spiritual and physical deprivation from trauma, stress and unrest in our movements.”Needs assessment by Kindred Southern Healing Justice Collective

On Community-Care

There have been several recent articles that are shifting the conversation of sustainability from self-care to community-care. These articles are usually in reference to activist and political movements, which I consider my vocation to be an important part of. It is so because of my social location and intention in healing justice, and knowing the healing potential that exists individually and collectively within somatic wisdom amidst the daily violence of racism, sexism, patriarchy, classism, ongoing intergenerational trauma, and more. Unfortunately, ableism still shapes much of our healing and movement work. I, as a self-employed person, sole proprietor, had a serious wake-up call a few years ago when I hit a health impasse caused by a storm of events that debilitated me physically, mentally, emotionally, and spiritually. My own unconscious ableism, perceived expectations of self, and “super-person syndrome”, were significant aspects that contributed to my isolation in this broken state, and the slow rate of that part of my healing journey. It was through that time that I was able to reflect on my own sustainability practice through the framework of Disability Justice, which is leading the way in teaching us that we don’t have to keep doing our work at “full steam ahead”, despite the sense of urgency we often face in our movements; nor that we need to do it alone.

All of this has led to reflections on community care, and recognizing that there are deep complexities involved in this framework. Canada is a colonial nation state that has not gone through a Civil Rights movement like our neighbours to the south, whom we love to compare ourselves to in our false altruism. Toronto’s tired dominant narrative of its diversity still likes to identify itself with a positive and benign multiculturalism. As a result, there is no institutional accountability to racist practices that get to hide behind politically correct language. This, along with all other intersecting oppressions, shapes and impacts what it means to develop community-care practices. For instance, what would it take to create community care practices that center Indigenous Sovereignty and Black Liberation? What if we implement a calling-in culture rather than calling-out, all the while assessing how much emotional labour (particularly that of femmes) we are able to do, want to do, and for whom, based on our social locations? Moreover, how do we treat ourselves and each other with care, with our coping mechanisms to deal with experienced traumas, even when we’ve outgrown those coping mechanisms and need to develop healthier resiliency practices?

My Community Care Vision

I continue to envision how to transform support and care systems on a broader level by contemplating resiliency practices as another form of sustainability. For instance, I consider my arts practice over the last several years as a resiliency practice because it facilitates mental and emotional health; and I consider it contributing to community care by providing and engaging collective reflection, creating alternative and broader perspectives taking into deep consideration the intergenerational trauma experienced by racialized community members, and by inciting and supporting movements centralizing Indigenous resurgence and Black freedom.

How can communities create structures in which self-care changes to community-care, where we receive care and are able to care for others within the organizing and movement work that we do? I am continuously unlearning ingrained notions of overachievement that is patriarchal and isolating. I move towards healthy, supportive, reciprocal connections while navigating the complexities of social locations, privileges, and oppressions of members in our communities that I relate to, call on, and who call on me. I am finding new balance in my life as I – and my practice – refine and evolve.

Recently, I have been collaborating with a colleague who practices and provides Generative Somatics, a holistic methodology providing a transformational path for healing. That is personal work that has been monumental in my community work, both in the healing arts and performance arts. Because I haven’t done any of this work alone, nor without support, I want to acknowledge and thank the following for sharing their knowledge and care with me:

Nazbah Tom Lamia Gibson Susanda Yee Alvis Choi Tuku Matthews Afrikaren Kyla Farmer Honor Ford Smith Anique Jordan d’bi anitafrika Lana Kouchnir-Kachurovska Jamaias DaCosta nisha ahuja Erin Howley Ann Musset Leah Lakshmi Piepzna-Samarasinha Other dear friends and community members Clients who continue to show me and teach me so much about strength in vulnerability, and the body’s potential to guide and heal.

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