Un-Weathering Community Health: Voice As Expression
ITA 2024 Conference (Guest Lecturer)
Understanding the Concept of Weathering: A Framework for Health Inequities
I was first introduced to the term "weathering" through a program called the Behavioral Health Pipeline. During one of the lectures, Michael Curry, CEO of the Massachusetts League of Community Health Centers, led a discussion that left a lasting impression on me. He recommended the book Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society by Dr. Arline Geronimus, a work that I now believe everyone should read. This book highlights the profound connection between behavioral health and the social and structural barriers various communities face in healthcare.
The Weathering Hypothesis
Dr. Geronimus’ research culminates in what is known as the “weathering hypothesis,” which proposes that chronic exposure to discrimination has adverse impacts on health outcomes, contributing to racial health disparities. Initially, her work focused on Black and Brown mothers, examining how experiences of racism affected their life expectancy and overall health. Younger mothers who had encountered fewer instances of racism tended to experience fewer chronic health problems, and this trend extended to the health of their infants. The idea that one’s exposure to systemic oppression could directly affect physical health sparked widespread discussion and, at times, controversy.
Some critics questioned whether Geronimus was advocating for younger pregnancies as a solution, especially in marginalized communities. However, her work goes far beyond this narrow interpretation. The core of her research emphasizes the cumulative impact of social and economic disadvantage, and how this exposure, over time, erodes health outcomes for individuals across various racial and ethnic groups.
Beyond Racial Disparities: Widening the Scope
What sets Geronimus’ research apart is how it evolved to include more than just Black women’s experiences. She expanded her studies to include Latinx mothers, Mexican immigrants, and impoverished white individuals. What ties these groups together is not their racial background, but their shared experience of adversity and the social barriers that diminish their health across all aspects of life.
Her findings have shifted the dialogue surrounding health inequities. The focus is no longer solely on individual health behaviors or choices but on the external social and environmental factors that shape these choices. Health inequities cannot simply be reduced to personal responsibility—there are structural forces at play, such as access to healthcare, education, employment opportunities, and social support networks, that shape outcomes in profound ways.
The Erosion of Health: A Metaphor for Weathering
Geronimus’ metaphor of "weathering" brings this phenomenon into sharp focus. Imagine a rock being exposed to the elements—wind, rain, and snow. Over time, the rock erodes, eventually breaking down. Similarly, individuals exposed to chronic stress, systemic racism, and social inequality face constant erosion of their physical and mental health. Just as the rock has no control over the weather, individuals often cannot control the oppressive societal forces that impact their health.
This understanding has sparked deeper conversations among healthcare providers, therapists, and interns about what more can be done to combat health inequities. It's clear that diagnosing and treating health conditions cannot solely rely on standard medical approaches. We must consider the broader context—how social conditions, not just genetic predispositions, shape health outcomes.
Epigenetics: Linking the Environment to Health
A crucial concept linked to weathering is epigenetics, a term that was new to me when I first encountered it. Epigenetics refers to how external factors such as the environment, behavior, and social experiences influence gene expression, without altering the underlying DNA. This concept helps explain how prolonged exposure to adversity can lead to significant health challenges, transcending generations and altering long-term health outcomes.
As healthcare providers and mental health practitioners, we have a responsibility to consider these external factors in our work. Understanding weathering and its impact on health disparities offers a new framework for approaching treatment, one that goes beyond traditional healthcare models. We must acknowledge the profound role that systemic inequalities play in shaping health outcomes and take action to address these social determinants in our work.
Voice as a Pathway to Overcome Weathering: The Role of Expressive Therapies
The use of voice to overcome weathering is not a new concept, but within the field of expressive therapies, I was excited to discover how the expressive arts can play a pivotal role in providing a solution. Voice, in its broadest sense, is a powerful tool for healing, especially in the face of the social and psychological erosion caused by chronic stress and adversity.
In my own practice, I use a diagram that outlines the various aspects of voice as puzzle pieces, which I introduce in both group and individual sessions. This visual tool helps clients connect with their own voice, giving them a way to express feelings of loss, confusion, or marginalization. And yes, voice is itself a modality that exists across all forms of expressive arts. It can be heard in the tone of music, seen in the narratives of dance, felt through art, expressed in the dialogue of drama, and authored in the words of poetry.
Voice connects with an audience in a way that allows for an exchange—an interaction between the speaker and listener that can be deeply therapeutic. In expressive therapies, this dynamic back-and-forth occurs when we establish an environment of safety, community, and shared values. Voice, in this context, becomes a vehicle for creating connections that transcend individual experience and speak to something more collective.
Voice as a Pathway to Overcome Weathering: The Role of Expressive Therapies
The use of voice to overcome weathering is not a new concept, but within the field of expressive therapies, I was excited to discover how the expressive arts can play a pivotal role in providing a solution. Voice, in its broadest sense, is a powerful tool for healing, especially in the face of the social and psychological erosion caused by chronic stress and adversity.
In my own practice, I use a diagram that outlines the various aspects of voice as puzzle pieces, which I introduce in both group and individual sessions. This visual tool helps clients connect with their own voice, giving them a way to express feelings of loss, confusion, or marginalization. And yes, voice is itself a modality that exists across all forms of expressive arts. It can be heard in the tone of music, seen in the narratives of dance, felt through art, expressed in the dialogue of drama, and authored in the words of poetry.
Voice connects with an audience in a way that allows for an exchange—an interaction between the speaker and listener that can be deeply therapeutic. In expressive therapies, this dynamic back-and-forth occurs when we establish an environment of safety, community, and shared values. Voice, in this context, becomes a vehicle for creating connections that transcend individual experience and speak to something more collective.
Integrated Storytelling: Layers of Voice in Therapy
One way I incorporate voice in therapy is through integrated storytelling, a blend of voice and narrative therapy that encourages clients to share their stories, layered with meaning, perspective, and emotion. Within this framework, there is always a sense of curiosity—a space for "What if?" and "But why?" This is the beauty of voice: it comes from a place of deep personal experience but is meant to be shared, weaving connections between individuals and creating a shared narrative.
We all carry different stories, but within those stories, there are often shared themes and experiences. When we build our voice and share it, we realize that although our books may be different, we often have similar chapters. This realization fosters a sense of belonging and validation, which is crucial in helping clients overcome the wear and tear of weathering.
By integrating voice into expressive therapy, we provide clients with a means of reclaiming their narratives, empowering them to resist the forces of erosion that weathering brings. Through music, dance, art, drama, and poetry, individuals can rediscover their voice, allowing them to express their unique stories while connecting to the universal human experience of facing adversity. This not only heals the individual but also builds a community where stories are shared, voices are heard, and resilience is cultivated.
“Someone who used whatever talent they had to do for their work, to help repair tears in their society, to make things a little better through the use of whatever ability they had. Doing something outside of themselves.”
~ Ruth Bader Ginsburg
REFERENCES:
Geronimus, A. T. (2023). Weathering: The extraordinary stress of ordinary life in an unjust society. Little, Brown Spark.
