Melanie Dreher (PhD ’77) on the intersection of Nursing, Anthropology and Cannabis Research

Melanie Dreher is a nurse and anthropologist who has spent five decades bringing the fields together in her research on cannabis use in Jamaica. She has served as the dean of several nursing schools, while also teaching on faculty of programs ranging from public health to anthropology. Her research has been funded by March of Dimes, NIH, and the State Department. She is currently consulting for different health groups, using ethnographic methods to helping bring leadership in line with the needs of staff and patients.

Thank you for making time to talk, Dr. Dreher. Your work is incredible and you’ve found such a unique balance of care provider and anthropologist.

Actually, I was thinking about that recently;  not so much about my research per se, but about the intersection of anthropology with so many industries and disciplines. I just completed a consultation for a medical center in Syracuse NY,  where they had just begun the process of recruiting a new dean for their College of Nursing. My consultation was not unlike an ethnography – taking the cultural pulse of the College by interviewing the “natives” (faculty, staff and students), participant observation; observing their use of time and space, and reading documents and observing artifacts that reveal the social institutions of the College culture over time and place.  I think this speaks to the application of anthropology to just about any human endeavor or situation . . .  understanding the culture – whether it’s a community, a school, a city or a nation – will facilitate leadership and guide change.  

That’s interesting – and great – that they’re at least working on getting some system for finding better fits for positions of power in important institutions.

Many large corporations are now hiring anthropologists for their C- suites: professionals who can detect and  interpret organizational culture, often necessary for critical decisions.. Most CEOs understand finance and leadership but often don’t understand how  cultural rules impact both..  Boeing, for example: missed the many warnings that their new airplane had a lot of problems. Paying attention to the people on the ground, how they do their jobs, and the way they relate to each other and to  management is critical both for generating profits and – in this case – saving lives. 

So can you tell me more about your relationship to Anthropology at Teachers College?

I think I was in the first class of the Applied Anthropology program in1968.  And of course it was during Vietnam so we were almost all women (one man). Under the guidance of Professor Comitas, Teachers College assumed a national leadership position in expanding the application of anthropological method and theory from the study of “exotic” cultures to contemporary institutions and phenomena – education, health care, the environment, racism, feminism, immigration and drug use. The “revolutions” were taking place in New York  — the women’s movement, the civil rights movement, and the peace movement, all of which were grist for the anthropological mill.  It was an exciting time to become an anthropologist – not unlike what is happening today with all the culture wars. This is a rich moment in our history for young anthropologists  to study  the impact of culture while living through it. 

Absolutely – that relates strongly to the work I’m looking to do in Brazil on the elections and democracy there. There are so many parallels.

Well, I need to introduce you to our Brazilian scholar, Renzo Taddei, a student of Professor Comitas, who directs the Ethnographic Field School of the Comitas Institute for Anthropological Study (CIFAS). Professor Comitas was convinced  that our understanding of all areas of human endeavor would benefit from the application of anthropological theory and method.  Currently, the CIFAS Field School primarily attracts anthropology students but the ultimate goal of the School is to be a resource to scholars and leaders from all disciplines and professions seeking to understand and resolve the problems of their fields through an ethnographic approach.. 

So, just to put it up front, my mom and sister are both labor and delivery nurses and so when I saw your research and background, I was particularly intrigued. So can you give us a little bit of background on how you got to TC and anthropology alongside nursing?

I came to New York City from Rochester, New York to become a nurse. At the time, nursing was less a career goal and more of a vehicle to get New York State to pay my college tuition in a city where I desperately wanted to live.  There was a nursing shortage at the time and the State, in its great wisdom, provided scholarships and stipends to anyone willing to enroll in nursing school.  But when I got into nursing, I really loved it.. It wasn’t just a matter of checking the IV and taking a pulse: you had to learn to develop a therapeutic relationship – unique to each patient. This was my first exposure to the impact of culture on health and illness. 

After  my nurse’s training, I completed my bachelor’s degree at LIU in Brooklyn but the impetus to study anthropology at Teachers College, Columbia University was again an externally-driven opportunity. An enlightened federal government thought it would be a great idea for nurses to have a theoretical foundation for their practice, rather than just following doctor’s orders. Nursing research was almost non-existent, as were doctoral programs in nursing so the Department of Health and Human Resources made the investment to send promising nurses off to get doctoral degrees in other disciplines. Dr. Elizabeth Hagen from the psychology department at Teachers College wrote the grant proposal and in 1968, the first nurses entered the Joint TC/Columbia Applied Anthropology program.  Since I had never taken an anthropology course as an undergraduate, I spent the first year filling each semester with nothing but  anthropology courses  . . .  it was wonderful!

We actually had the choice of pursuing doctoral degrees in psychology, sociology or anthropology. Although I had never taken a course in Anthropology, I had read books by Margaret Mead and thought it would be amazing to  meet and study with her.  I was interviewed by Professor Comitas , who asked me “so, why do you want to be an anthropologist?”  I think I said I didn’t know but I wasn’t fond of sociology and had already had enough psychology but mostly,  I just wanted to take courses with Margaret Mead. Amazingly, he accepted  me into the program anyway. 

That’s such an unconventional way of getting into a PhD program in anthropology – how did that lead you into cannabis research?

Oh, again, purely by chance and opportunity.  I had no interest in marijuana research. I had never smoked it but I did have a boyfriend who was a jazz musician, so I kind of knew what it was about.  I also had never been to Jamaica, and I had never done field work. So, after my first year,  when Professor Comitas told me how I would be spending the summer of 1969, I protested that I really was not qualified for this assignment. His inimitable response was::  “You’re a smart girlie, you’ll catch on.” I think  he knew something about me that I really didn’t know about myself:  Because I was a nurse, I had no problem asking personal questions, I was a good observer and I was a good recorder. It’s a nursing thing: I can sit in an airport and pick out the other nurses   . . . we are consummate observers which is a great asset for doing anthropology.  He also knew I would take really good field notes:  nurses understand the importance of charting everything.

So, he sent me off to Jamaica where I spent my first summer of fieldwork on a mountain top with Jamaican farmers and their families. Dr. Comitas  and his  colleague, Dr. Vera D. Rubin, had been funded to do a cross cultural comparison of marijuana which was gaining considerable attention in the United States. Nobody really cared about marijuana when it was effectively contained within African American and Mexican communities. But its presence on college campuses made important people very nervous and the amotivational syndrome speculation in which students using marijuana were likely to neglect their studies, drop out of school and join a peace movement made it ripe for an NIMH research initiative. 

Dreher on a farm in Jamaica

There were five of us in Jamaica that summer. After Professor Comitas died last year, I pulled up boxes of those early field notes and found the letters we exchanged during that first field trip, with all of us learning to be anthropologists in our different settings.  Professor Comitas (by this time we had advanced in our status and were calling him Lambros),  would arrive every month or so to “check” on us. In my case, he accomplished this by stopping along the road to ask a complete stranger if he knew a white lady living in the village,  “Oh, yeah, man. She nice.”  “And what does she do?”  “She type letters for people.” “She help women have baby too.” So he knew what I was doing in my spare time before he even arrived – always a surprise – at my door.  Being  a nurse helped me a lot. I could make myself useful in a village that had no on-site healthcare provider. This included delivering babies and getting people to the hospital when necessary. Being a nurse helped me become a better field worker and became my way of thanking informants for allowing me to enter their culture. I also leveraged my fieldwork equipment by typing letters for villagers they could send to relatives abroad.

Dreher with two Jamaican children

Did you end up doing your dissertation over that field work that was a part of that larger project?

I was the first fieldworker to be part of the marijuana study. I never set out to do a dissertation on cannabis in Jamaica. As you probably can tell by now I never set out to do much of anything that I actually accomplished.  Opportunity presented itself and I think I just kept myself in  a state of readiness. Not only did I learn about how rural Jamaicans grew, sold and used cannabis – or “ganja,” as it is called in Jamaica, I learned about Jamaican culture, and how that culture shaped the cannabis narrative in such a different way than the U.S.  I never thought of it as particularly controversial research but soon discovered an enormous editorial bias making it  difficult to get published if you had something positive to say about cannabis. Nursing pretty much rejected my research. Of course now I’ve become  a rock star with cannabis proponents and “exonerated” by the nursing community.

Although it wasn’t necessarily my favorite cannabis project, our research on prenatal cannabis exposure and its impact on neonatal development has received the most public attention – enthusiasm and criticism. With the help of the Harvard Brazelton group who consulted on the research, the study was published in Pediatrics 1994. It is still contested, but no one has yet conducted a study that refutes our findings. A great strength of the project was having graduate students- both in nursing and anthropology – actually living in the same communities as our informants and observing, first hand, their consumption of ganja on almost a daily basis. Frankly, even our research team was astonished when the results showed that, at one month of age, the exposed babies performed significantly higher on every item of the Brazelton Neonatal Assessment. We wondered how we were ever going to get the results published. But if readers look carefully, it was our cultural data that explained the results. We made no claim that cannabis use during pregnancy necessarily results in neurologically healthier babies. We simply said  that it appeared to do no harm. And I will  not tip my hat to any of the doubters until they provide a comparable study.  So, yeah, they can argue about it, but those are the results of a well-conceived and well-conducted study.

So this study was done after you had finished your PhD?

Yeah, much later . . . I defended my dissertation in 77, about four years after I got back from the field. I was busy teaching at UMass Amherst and having babies. In fact, I was pregnant when I defended my dissertation and then went back to Columbia as an Assistant Professor in  the School of Public Health. I already had a kind of reputation at that point, and got a Post Doc from NIMH to continue my work in Jamaica. I was doing all the “right things” for a beginning academic career, including publishing my dissertation.  I was funded by the March of Dimes for the prenatal study and in the middle of that, took an endowed chair at the University of Miami. While at Miami, I got an NIH award  for a  pre-school follow-up of the same kids who were in the prenatal study.  But when I sought funding for the next study (testing the same cohort at age  8-10),  the federal government got crazy. After the submission of a revised proposal, I got a phone call saying “Melanie, we’re not going to fund this study.” Essentially Congress didn’t like my results and NIH is funded by Congress. I have since wondered how I could have been so naive. 

By that time I was in my second deanship – back at UMass Amherst, so it wasn’t as if I had nothing to do. But coming to terms with the politicization of research shifted my thinking from scientist to activist. I knew I had a few more projects in me so I got some funding from the State Department to examine claims of increasing multidrug use – ganja and crack/cocaine – among women in Kingston. There was clearly a culture for ganja  in Jamaica, complete with social rules regarding who, how, where and when it could be consumed. There was no culture, however, for crack/cocaine. Most of the young women who quickly became addicted to this substance lived on the streets as sex workers. And yes, many were smoking ganja as well, but often for the first time in their lives and for the purpose of relinquishing their crack addiction – and it was working! Far from being multi-drug users, they were self-treating and deploying the cheapest, most available and comprehensive therapy to become sober again, care for their children and reunite with their families and communities. In addition, social services had assumed that ganja was the “gateway” to Cocaine, when it was, in fact, just the opposite.  In some ways, this is one of my favorite research projects, because it challenged the dominant viewpoint of medical and social service professionals. By understanding the culture in which these women lived out their addiction, we could  understand their behavior and look for effective treatment modalities.  It also suggests that we need to examine the implicit biases that social workers and health providers bring to their encounters with patients.  

This exemplifies how these categories, like “multi-drug user,” are so contextually defined and loaded with value judgments. Especially when cross-cultural research is funded using a particular language and a particular kind of medical knowledge that is informed by that language, there are a lot of conflicts that arise.

 Exactly. I also remember thinking at the time,  Who needs NIH when we’ve got the State Department?  We  did some important work there which has been reinforced by similar studies in other countries. It’s been fun to challenge the traditional narratives with cross-cultural findings. In this case, it’s taken several decades and has been, fortunately, supported by cannabis activists  to whom I am deeply appreciative for keeping this research in front of the public for so many years. In my last deanship at Rush University, I remember one morning walking to work when one of my students rode by on his bicycle, yelling “Dean Dreher, your research went viral!”  – and it only took 30 years!

Did you ever have any problems in terms of getting jobs or getting research positions because of your work on this kind of contested subject? 

Both and neither. I don’t think it helped or hurt but it definitely made it more interesting.. When I was Dean at the University of Iowa, which is a fairly conservative state, I hosted the first clinical conference on cannabis in the United States, at the request of a cannabis-activist organization called Patients Out of Time. POT was started by a nurse in Virginia and her husband, both of whom had been officers in the  US. Navy. We met at a conference in 1980 and they were quick to embrace the medicinal and health promoting potential of cannabis. It has been the most promising narrative for persuading the American public. Frankly, I did NOT want to host this conference at the major public university in a very conservative state and was thankful to have tenure which I had always under-appreciated.  But in the end, the University administration raised no objection. The Chronicle for Higher Education showed up and even the Health Editor of the New York Times was there. So “the U” got a lot of good publicity and only a few irate letters from alumni. 

I have been employed by five universities and served as Dean in four of them and have encountered little discrimination – even when I had to request access to the University safe to store my samples (a DEA requirement).  On the other hand, I’ve been searched, detained, arrested, and had my samples seized at airports – even with advance notice to customs – despite being stodgily dressed.  Fortunately these events never made the front page. 

The other thing that happened during that period between my first visit to Jamaica and “now” is that scientists at Hebrew University and St. Louis University were busy discovering the properties of THC, the presence of cannabis receptors in our body and eventually the endocannabinoid system throughout our bodies that promotes homeostasis.  I had always wondered how ganja could be effective treatment for so many conditions, ranging from morning sickness to teething, colic, asthma, glaucoma, arthritis, seizures, anxiety, gastro-intestinal problems, and diabetes and facilitate sex and social discourse.  Jamaicans, who have a rich enthnobotany of cures and preventatives still refer to ganja as the “King of herbs.”  Once this important physiological/botanical was on the way, it made my findings in Jamaica much more credible.  

It’s interesting when you said earlier that your bedside nursing experience is actually what made you a good anthropologist, I just naturally thought it would be the reverse, that becoming an anthropologist would make you a better nurse.  It’s interesting to think about.

Well, I think my nursing experience gave me a head start on being a good fieldworker in the sense that I already had developed good observational and communication skills. But what anthropology has done for my understanding of nursing, has been to step back from my first profession and look at it from the view of an outsider and to see its enormous potential as well as its shortcomings. This is not unlike the “re-entry” period fieldworkers describe when they return  to their home countries and begin to challenge everything they previously took for granted.  I’m still a nurse but I have been incontrovertibly changed by the experience of another living in another culture. I still have a license to practice and I’m still the first person my relatives and friends call when they have a health problem. And no one says, “gosh I’ve had this headache for four days, I think I’ll call Melanie the anthropologist.”  They call “Melanie, the nurse.” But exposure to another culture has required that I challenge the current narrative. Florence Nightingale was a genius (she founded epidemiology) and her exposure to the Crimea and other European countries, clearly shaped her vision of nursing which she ultimately defined as simply “helping people live well.” Anthropology is ultimately about understanding “how people live.”  They are related. 

Do you think that in nursing programs, there is enough of an overlap that brings cultural competency into the medical field?

Perhaps not so much when the emphasis is on managing disease, even though Nightingale never mentions a specific disease in her famous “Notes on Nursing.” She was, however,  quite specific about “being sick” as a human experience and provided guidance for nurses on caring for “the sick.” But she never said that nursing was limited to the care of sick people.  Even sick people, even dying people can be helped “to live well.”

Getting back to your mom and sister, for example, I have tried to convince maternal-child health faculty members to expand their students’ practice learning from labor and delivery to  include case management of  pregnant families, assessing the the family’s readiness for a new citizen, identifying community resources; then being “there” for the birth event; and then continuing case management for the postnatal period when all the “bad stuff” is most likely to happen. Moms get overwhelmed, siblings feel neglected, dads feel exploited, everything gets very complicated and there is not a nurse to be found.. This is not true in other cultures. Our nursing community could fix this, starting with educators and students. All this to say, we all can be better nurses if we think cross-culturally. Anthropology has made me a better nurse, a better leader, and a better grandmother.. 

For people who are graduating with their masters, and who are thinking about getting a PhD or people who are about to graduate with their PhD, and they’re thinking about how to leverage these skill sets – do you have any advice for them?

I would advise them to have confidence that the anthropology skill set has enormous and diverse application in almost every human enterprise. So then, it’s a matter of the kind of role that peaks your imagination – educator, researcher, consultant, social commentator, politician, etc, and then, the human activity you want to study – religion, healthcare, education, art and music, social justice, recreation, transportation the military, environmental sustainability, international relations, etc. The possibilities with a degree in anthropology are endless and it may take more than a few tries to find the right career destination . . . and that’s OK.  And if your first position isn’t where you want to stay, just put on your ethnographer’s hat, make a two-year commitment to learn as much as you can about that kind of work and take those learnings to your next “assignment.”  Anthropology is  not just a career . . . it’s an adventure.  

Interview conducted by: Lizz Melville