[Scpg] Designing Care Article from Permaculture Activist Newest Issue on Medicine and Health #45

[scpg-admin at arashi.com]

hi Everyone
         Just got permission ("""from Peter Bane publisher thank you""") to 
email out this most amazing article Designing with Care from the most 
recent Permaculture Activist #45 on Medicine and Health. This Conversation 
takes you to the heart of permaculture and why designing using permaculture 
principles are so important. “In Permaculture, everything works both ways.” 
Yes we need to design with care for all interconnected life on this planet.
         My reason for posting this article is to remind everyone if they 
can to subscribe to the Permaculture Activist to help support and allow the 
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FUTURE ISSUES
#46Good work and Right Livelihood
#47 Watersheds
#48 Making Changes.

A Conversation between Susan Parenti and Patch Adams
DESIGNING CARE
“...a theory of permaculture that shows care for people as well as the
biosphere...But the dynamics of an ecosystem are not that of a social
system, or are they?”
Rob Scott, student, School for Designing a Society
PA: Susan Parenti and I work together on two distinct but connected
projects: The Gesundheit! Institute in West Virginia, and The School for
Designing a Society in Illinois. Both are based on premises foreign to
the current social system; thus,we consider these projects
revolutionary.
For a long while I spoke, publicly, of creating a social system “based
on peace and justice.” Now, for the past year, I’ve added “and based on
care.” This is because care—medical, social, political,
environmental—has long been ignored as a requirement for humane life.
In the following article we present our projects—their premises, their
hoped for consequences—and our attempts to design care.
         “I ain’t gonna study war no more
”

SP: In the past eight years I’ve been an organizer and a teacher at the
School for Designing a Society, as well as a performance partner with
Patch Adams. The School, located in Urbana, Illinois, is an on-going
experiment in making temporary living environments in which the
question, “What would I consider a desirable society?” is given serious
yet playful discussion. This discussion then forms the basis for a
variety of creative projects. Rather than orienting participants to find
a comfy spot in the current social system, the School offers tools,
time, ambiance, and company in which people can imagine and design a
system they would prefer.
Participants live together cooperatively, discuss, write, take and give
classes, make performances, and do experiments. Through these means they
explore the consequences of making their desires a basis for both
learning and action. The concepts and skills developed through these
activities are brought together in “design groups.”
In these groups we challenge the assumptions of contemporary society in
order to explore how a better society might be designed. One of the ways
we do this is to make “false” statements based on our desires. These
statements are untrue in the present system, but would become true in
another, differently designed, system.
Patch and I have given a lot of attention to the matter of care and how
society’s beliefs about it impact the choices we make and the
institutions we create. Care is a human need. Permaculture takes Care of
People as one of its ethical foundations.
But what do I mean by care? Care occurs when one person temporarily
becomes part of another’s (social/emotional/personality) structure. And
what do I mean by need? I use the word “need” whenever I wish to speak
of conditions that must be met continuously and unconditionally if
living organisms are to be motivated to maintain themselves, their
identities, their existence.
Some “false” statements on care, based on what I desire, are: 1. That
care is not linked with burden—to care for someone is not a burden. 2.
That there are two—TWO—needs in relation to care: people need to get
care, AND people need to give it. 3. Thus, care is a relationship built
on a configuration of needs and offers. Care does not move in one
direction only—from generous giver to unfortunate needy receiver, but in
both directions at once; the giver becomes a receiver, and the receiver
a giver. When I use the word care, I understand it as going in both
directions at the same time.

“In Permaculture, everything works both ways.”

PA: A good deal of my passion for care comes from my mother and my
friends, and from the circumstances surrounding my growing up. I spent
my childhood and youth on army bases overseas while my father was away
at war. Nothing about the military made me interested in it, ever. But
my mother gave me tender loving care; she fully cared for me.
A propensity toward science led me to think about medicine, a
profession to care, and in my early teens I read the books of Tom
Dooley, M.D. about his work helping in places where there was no
medicine. These books were a hymn to caring. I liked his language, how
caring is “thinking to do,” and not with the implication that the
cared-for were a burden. I believed (a mis-understanding, I later
learned) that his being a doctor made him a caring person. After I
became involved in medicine, I learned that a doctor’s practice defines
the healing interaction more than his profession.
My father was a soldier. Fighting two wars broke first his soul and
then his body: I became a war orphan at age 16. I had already learned
that violence is never intelligent, when, moving from Germany back to
the U.S. and to the South in 1961, I became immediately aware of the
racism in Virginia. I naturally took part in the Civil Rights Movement
and still find it incomprehensible that every citizen didn’t rise up and
say: “We are all in this together. Stop this hatred!” During that time I
realized our society was in a crisis of lost caring. This shout rose
from every novel I read of the 20th century. Tom Dooley had shown me
that it was possible to express care through one’s actions, and from his
example and from my own interests I was drawn toward a career in
medicine.
When I finished medical school I began to see the strict, hierarchical,
white-male-dominated institution—only recently integrated, that lay
ahead of me: I knew I could not work in it. Fun and love were excluded,
as well as any discussion of compassion or care. So far away from care
was the medical system that care grew to mean the best machines and
drugs, and not an experience and action of compassion, generosity,
intelligence, art, and foolishness.

SP: It doesn’t take much to go a stretch and notice how in our society
receivers of care are perceived as burdens. For, after all, what are
they doing but taking? Burden permeates all language around care. It’s
assumed. Well-meaning book after well-meaning book asks how can we deal
with the burden of care, who shall have the responsibility for care, how
can we pay people enough to take on the burden of care.
Some “false” statements on care, based on what I desire, are: 1. That
care is not linked with burden—to care for someone is not a burden. 2.
That there are two—TWO—needs in relation to care: people need to get
care, AND people need to give it. 3. Thus, care is a relationship built
on a configuration of needs and offers. Care does not move in one
direction only—from generous giver to unfortunate needy receiver, but in
both directions at once; the giver becomes a receiver, and the receiver
a giver. When I use the word care, I understand it as going in both
directions at the same time.
“In Permaculture, everything works both ways.”

PA: A good deal of my passion for care comes from my mother and my
friends, and from the circumstances surrounding my growing up. I spent
my childhood and youth on army bases overseas while my father was away
at war. Nothing about the military made me interested in it, ever. But
my mother gave me tender loving care; she fully cared for me.
A propensity toward science led me to think about medicine, a
profession to care, and in my early teens I read the books of Tom
Dooley, M.D. about his work helping in places where there was no
medicine. These books were a hymn to caring. I liked his language, how
caring is “thinking to do,” and not with the implication that the
cared-for were a burden. I believed (a mis-understanding, I later
learned) that his being a doctor made him a caring person. After I
became involved in medicine, I learned that a doctor’s practice defines
the healing interaction more than his profession.
My father was a soldier. Fighting two wars broke first his soul and
then his body: I became a war orphan at age 16. I had already learned
that violence is never intelligent, when, moving from Germany back to
the U.S. and to the South in 1961, I became immediately aware of the
racism in Virginia. I naturally took part in the Civil Rights Movement
and still find it incomprehensible that every citizen didn’t rise up and
say: “We are all in this together. Stop this hatred!” During that time I
realized our society was in a crisis of lost caring. This shout rose
from every novel I read of the 20th century. Tom Dooley had shown me
that it was possible to express care through one’s actions, and from his
example and from my own interests I was drawn toward a career in
medicine.
When I finished medical school I began to see the strict, hierarchical,
white-male-dominated institution—only recently integrated, that lay
ahead of me: I knew I could not work in it. Fun and love were excluded,
as well as any discussion of compassion or care. So far away from care
was the medical system that care grew to mean the best machines and
drugs, and not an experience and action of compassion, generosity,
intelligence, art, and foolishness.

SP: It doesn’t take much to go a stretch and notice how in our society
receivers of care are perceived as burdens. For, after all, what are
they doing but taking? Burden permeates all language around care. It’s
assumed. Well-meaning book after well-meaning book asks how can we deal
with the burden of care, who shall have the responsibility for care, how
can we pay people enough to take on the burden of care.

PA: Looking closely, I saw many glaring examples where loss of
care—turning care into a burden as Susan would say—did horrible things
to the practice of medicine: it became greedy; it became a business,
with insurance companies and pharmaceutical and hospital suppliers
swarming in for their share of the profits.
Care is never where greed is.

SP: I believe care has two facets: 1. the (well-known) need to receive
care, and 2. the (unacknowledged) need to give care. Even by
articulating that care meets two needs, I step outside the boundaries of
present-day society, language, behavior. (Hooray!) Giving care is
usually perceived as a virtue, something good people do, a noble
calling. Rarely is it seen as a need. Mother Teresa, we say, helped the
poor. Good Mother Teresa. We don’t say—though perhaps we should, “And
the poor helped Mother Teresa!”

PA: The only saving grace within the greedy medical system, was the
health professionals who still cared. Yet whatever real care I found
came from the nurses, orderlies, cleaning people, or volunteers—mainly
people in lower paying jobs, most of them women. The rude, top-of-the
hierarchy doctors got the most money (anyway before corporate medicine
)
but gave the least amount of care. Care was clearly devalued. There was
no insurance reimbursement for it. I believe care even got in the way.
Yet, women are so reluctant to stop caring that many heroic women
continue trying to bring care even to corporate medicine.

SP: The story of care being the satisfaction of the receiver’s needs is
the story of present-day society. I don’t want that story, that
language, that society. I stipulate that care is not a one-way movement,
where the giver gives a goody (care) to the poor unfortunate receiver.
Rather, care is bi-directional, for I am aware that something is being
created and transacted in care that both parties enjoy.
I say that care is a situation of two overlapping stories: the story of
the need to get care, and the story of the need to give it. Care happens
when these two stories are designed to meet.
Thus, I use the word care when—and only when—I’ve designed a situation
where the human needs to receive and to give care are linked. When only
the need to receive care is acknowledged, then I am speaking of charity,
not care.
I’m willing to swallow charity. But I will not forget that what I want
to taste (because in my life I once had it)—is care.

PA: I knew that if I was going to play doctor, I would have to create a
context, a hospital, where care wouldn’t be penalized, a place where—as
Susan would say—my need to care wouldn’t be suppressed, indeed, would be
an essential expression of the healing situation. With the Gesundheit!
Institute I wanted to address every problem in health care delivery and
suggest alternatives based in care.
I knew that individual health was inseparable from family, community,
and social health. Therefore community problems, societal problems, and
environmental problems all fell within the domain of health care
delivery. And so from the perspective of giving care, poverty and
justice became concerns of the Gesundheit! project as surely as illness,
for the one could not be addressed without regarding the others.

SP: Care happens by design: when the needs to receive and to give care
are linked.
 From our students at the school, who study and apply permaculture ideas
jubilantly, I’ve learned about that relationship called companion
planting—plants help each other thrive when rooted down next to one
another. So, for example, a plant that needs to grow in the shade and
offers protection from beetles is placed next to another that offers to
grow tall and can’t abide beetles. Or, in the animal world: a garden
offers a chicken room to scratch, seeds and bugs as food, shade, home
range; while the chicken offers the garden aerated soil, fewer weeds
and bugs, manure.
This linking of needs and offers in the plant and animal world points
to a method of design for the social world as well. Permaculture invites
us to look at every element in all its functions. This leads naturally
to understanding the way things work both ways. Design that links
needs and offers ensures stability and sustainability, as the components
of the system provide for each other.
In the social world no one wants to be a burden—no one. Older people
willingly incarcerate themselves in nursing homes, in order to avoid
seeing themselves as burdens to their children. Bi-directionality or
mutuality eliminates the possibility of burden, because in a mutual
system, each component plays the dual roles of benefactor and recipient.
This idea of companion plants and animals has influenced my thinking
about care. Are there other ideas from permaculture that show care for
people as well as for the biosphere?

Susan Parenti may be contacted at sparenti at ux1.cso.uiuc.edu. Patch Adams
at the Gesundheit Institute, 6855 Washington Blvd., Arlington, VA 22213.


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