In this section EMPOWERED refers to a sense of freedom of the people. This can be pursued or obstructed by healthcare. In the early 21st Century it is more often obstructed. Pursuing HOLISTIC practice offers some hope of unblocking the road toward an EMPOWERED population. It is necessary for we healthcare practitioners to understand and empower ourselves. The section on SELF-CARING has more on this, but if we follow the basic principles set out by Freire, our own learning towards wisdom and health will be a journey with patients and colleagues as companions.
Being disempowered can arise for many reasons, but they all lead to ill-health. In developing countries this is often extreme poverty with lack of access to education, to rewarding work, to safety and justice and to healthcare. In developed countries there is more often a lack of aspiration linked with a culture of dependence and meek acceptance of the status quo as we are kept mesmerized by stuff and stimulation. Other times, we seek power in order to boost a fragile ego, an underlying sense of powerlessness that thrives on perpetuating the disempowerment of the population.
There is more known about the practical approach to empowerment of the oppressed poor than there is about action with the mesmerized middle classes or the demagogic leader. Perhaps the seminal work for the socially submerged poor is Paulo Freire’s ‘Pedagogy of the Oppressed’ – a short book first published in 1970. This was based on his pioneering educational work in Latin America and has been widely adapted for use in areas of deprivation in the relatively affluent West. But Freire makes it very clear in his book that oppression within an affluent society, amongst people who are far from poor, is fundamentally no different, but perhaps harder to understand and act upon because it is less visible.
Freire’s approach is rooted in dialogue. In education he describes the relationship of teacher and student as needing to be an indivisible unit: teacher-student or students-teachers. He goes on: ‘The teacher is no longer merely the-one-who-teaches, but one who is himself taught in dialogue with the students, who in turn while being taught also teach. They become jointly responsible for a process in which all grow. In this process, arguments based on “authority” are no longer valid; in order to function, authority must on the side of freedom, not against it.’ (Penguin 1993 p61; emphasis in original text). It is a short step to seeing exactly this applied in healthcare. It is a description of co-creation. In complexity terms it is an example of a complex responsive process from which emerges new and novel understandings in a continuing state of becoming for all involved (ref*). It is this, as the foundation of relationships, that HOLISTIC healthcare pursues. Obviously, for the technical treatment of disease, there is often an inequality in skills. There is also an inequality imposed by the fear of illness and death on the part of the patient, but this should make no difference to the veracity of the needs of the underlying relationship in the pursuit of health and fulfilment.