Re-humanizing Medicine officially published as of November 28, 2014!
Next event is a radio interview on KUOW, to be recorded this coming week for The Record.
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THURSDAY • January 8, 2015 • 7:00PM
Throughout the field of medicine, science and data reign supreme. In his new book, David R. Kopacz, MD, argues that this has resulted in a predominantly dehumanized profession. If medicine is to be effective, claims Kopacz, doctors must integrate a more holistic and human framework into their training, their practice, and their own personal understanding and self-care. To learn more about Kopacz’s impassioned challenge to the field of medicine and his map for individual and systematic transformation that has implications far beyond the medical field, join us at this special reading and signing with the author.
Reverend Dr. Karen Tate’s book Voices of the Sacred Feminine: Conversations to Re-Shape Our World, brings together interviews from her, “Voices of the Sacred Feminine Radio Show.” It includes transcripts from such notables as Jean Shinoda Bolen, Noam Chomsky, Riane Eisler, Matthew Fox, and Starhawk. The book includes 41 interviews, divided into five parts, so there is something for everyone in this book as it includes a broad range of scholars, activists, thinkers, creators and writers.
Part I is “Sacred Feminine. Deity, Archetype and Ideal.” This section examines devotional practices with specific goddesses, such as Persephone, Kali, Mary Magdalene, and the Virgin Mary.
Part II is “Embracing the Sacred Feminine. Ritual and Healing.” This section looks at themes such as altered consciousness, multiculturalism, equality and healing.
Part III is called “Sacred Feminine Values – Alternatives to Patriarchy. Politics and Social Change.” This section is quite interesting with Noam Chomsky’s discussion of “Feminism, Patriarchy and Religion;” Riane Eisler’s “The Essence of Good Business: Companies that Care;” and Jean Shinoda Bolen’s “Antidote to Terrorism.”
Part IV is “Rebirthing the Sacred Feminine. Sacred Activism,” which takes on topics like women in the role of the priesthood, changing the masculine pronoun language of religion’s talk of God, and Matthew Fox’s “Cosmic Christ and the New Humanity.”
Part V is a memorial to the late Layne Redmond.
In the introduction, Reverend Dr. Tate points out the imbalance in the United States that 52% of the population are women, but less than 20% of leadership positions in politics, academia, business and religious institutions are held by women. This creates a gender-biased imbalance, not only in terms of individuals, but also in a lack of representation of the feminine in the creation of cultural values and society. She writes that the dominant patriarchy “stands on four legs of a stool: racism, sexism, environmental and cultural exploitation,” (9) and she sees the Divine Feminine as a “great equalizer” to correct these imbalances.
There are a number of reasons why I chose to review this book. My own work my book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine, draws on a re-valuing of many of the traditional feminine values in medicine, connection, compassion, caring, healing, nurturance, and strengthening relationships. I call for a compassion revolution and a counter-curriculum. The compassion revolution is similar to what Riane Eisler speaks her new book, The Real Wealth of Nations: Creating a Caring Economy in her talk, “The Essence of Good Business: Companies that Care.”
She says that “Ultimately, the real wealth of a nation lies in the quality of its human and natural capital. I should add here that an investment in human capital is an investment in human beings,” (224). A large part of the argument for why contemporary medicine is so dehumanizing is the economic argument, but Eisler argues that caring businesses create healthier, more committed and more productive employees – so the compassion revolution in health care may result not just in better, more human care, but also in more economically viable and sustainable care (sustainably economically, but also emotionally for staff). Paul Spiegelman and Britt Berrett make this argument in their book, Patients Come Second: Leading Change by Changing the Way You Lead.
Rev. Dr. Tate writes that we “start by taking responsibility for our own educations,” (10). This is echoes my call for a counter-curriculum within medicine in health care, that in addition to learning the technical aspects of our trades, we must also take ethical and moral responsibility for maintaining and growing our humanity in the difficult setting in which we practice. While much of health care reform calls for external mandates and incentives, I call for individuals to take responsibility for their Continuing Human Education (CHE) as well as their Continuing Medical Education (CME).
Dr. Jean Shinoda Bolen has written such influential books as, The Tao of Psychology, Goddesses in Everywoman and Gods in Everyman, and her contribution to anthology is called, “Antidote to Terrorism.” I found this quite interesting given my recent work with Veterans that I discuss in a companion blog post to this one. She says that “the feminine principle expressed in circles and the masculine principle of hierarchy must come into balance,” (226). Just as the hero’s or heroine’s journey can be viewed as a circle, the “intention to be in a circle with a spiritual center invites the invisible world of spirit or soul to be in the center of the circle and in the center of the psyche of each person in the circle,” (228). She states that a “soldier is taught to kill, which is also what a terrorist is taught. These are not lessons maternal women want their sons to learn,” (228). Furthermore, she points out that the “Mother’s Day Proclamation, written by Julia Ward Howe in 1870, was a call to mothers to gather together to end wars, so that their sons will not be taught to main or kill the sons of other mothers,” (228). I find these observations particularly relevant in regards to the step of the hero’s journey, the inner and outer union of masculine and feminine, as they show the imbalance of a lack of feminine values and influence within the military, within the individual returning Veteran, as well as, it could be argued, within the society that the Veterans return to.
Let’s now look at Matthew Fox’s “Cosmic Christ and the New Humanity.” He describes the Cosmic Christ (a term that goes back to Teilhard de Chardin) as divine presence and the holiness of all being. The “New Humanity” is the creation of the capacity for mysticism, which he defines as “multiple experiences of unity,” “our unitive experiences – when you feel at one with being, one with others, one with yourself, one with God,” (312). Fox says that a healthy community for New Humanity does two things: “it turns out lovers – it turns out mystics, the mystic in every person,” and “secondly, it turns out prophets – that is to say spiritual warriors. The mystic says yes, the prophet says no. The prophet…interferes with that which is interfering with the glory, the sacredness of life,” (315). This focus on mysticism and the ability to say yes to the human and no to the dehumanizing also has relevance for my book, which seeks to develop the spiritual capability of health care providers in order to care for the whole person of the patient, which includes the spiritual dimension.
In closing, there are a lot of different perspectives in Rev. Dr. Karen Tate’s Voices of the Sacred Feminine and there are many topical discussions not just for women, but for all human beings. The book aims to correct the imbalance in our culture and society of the domination of masculine values and the lack of equal representation of feminine values. What we worship and honor in religion and spirituality is a reflection of our behaviors and actions in our mundane lives. In attending to the Sacred Feminine, Rev. Dr. Tate does present many ideas that make us think about our current societal structures and values and these conversations do have the power to re-shape our world.
You can listen to an interview with Dave Kopacz about his book, Re-humanizing Medicine, by Mary Treacy O’Keefe on her radio show, “Hope, Healing and WellBeing” at WebTalkRadio. It is my first radio appearance for the book. It is about 35 minutes long.
You can listen to the interview by following this link.
Thanks Mary for the interview, I think it turned out great!
Also, the book is now in warehouses and I received notice from Amazon that the pre-orders of the book should start being delivered early next month, even before the official release date!
Twenty-five years ago, 7/12/89 (July 12th incidentally being Henry David Thoreau’s birthday), I set out on a 50 hour Greyhound bus ride from Chicago to Seattle. I had just graduated from college and I had a backpack full of books and other essential items. It was my trip to find myself, my vision quest – that in between time of life, between education and adult pursuits. It was one of the foundational events in my counter-curriculum of humanization and re-humanization (I hope to write more in a future blog about this concept of the counter-curriculum as described in my forth-coming book, but before I can do that, I must honor my past).
I spent two weeks in the woods, solo backpacking. It was, perhaps, where I first became aware of the dramatic swings of emotion and thought that can occur that permeate perception. I had a portable library (another feature of the counter-curriculum – always carry a variety of books), most notably Suzuki’s Zen Mind, Beginner’s Mind, Bach’s Illusions, The Portable Thoreau, as well as books by Alan Watts and some novels. I meditated, went hopping along on the rocks in the stream, I had ecstatic views of nature, but all this was also in the context of what I called “goddamned suffering in the woods” which was interchangeably a physical, emotional, neurotic and spiritual suffering. Physical pain was great in the beginning, with the heavy pack and my muscles getting used to climbing (I thought I was “training” for the journey by going for runs in the flat Midwest). The psychological and neurotic pain was immense in the beginning – all the little decisions became immense – should I camp here, or push on? Should I put the tent here or there? Should I relax now and push on later, or push on now and relax later? Luckily, I had some of the best meditation teachers along in my pack and I was great neurotic material to work on.
I also grappled with death and met the limits of what I could control, as I startled awake at night by a noise and wondered about meeting a psychopathic killer in the woods or being attacked by a wild animal. There is a point in the woods, where you have done all you can and you just have to sleep and not worry too much about all the things that could go wrong. This is what the meditation teachers instruct us to do – live in the present, when something happens – react, don’t worry about something that has not happened.
I have been resisting thinking about or writing about this journey of twenty-five years ago because I could not think of what to do to honor it. I have moved to Seattle now, which was the site of my pilgrimage 25 years ago, now it is home. I thought about going back to the mountains, re-tracing the same route, but that idea has no roots to it. So I have just ignored it, up until now.
On somewhat of a whim, I wrote to Kurt Wilt, about his book, The Visionary, about Joseph Rael (Beautiful Painted Arrow). He put me in touch with Joseph by email. I figured, what the heck, I’ll just write him and just say whatever comes out of my mouth. Joseph invited me down to visit him on the Southern Ute Reservation in Southern Colorado and I am writing this as I am on a flight from Denver back to Seattle. What a trip it was talking with Joseph. On the surface, it was to learn from him how to work with helping Veterans return home physically as well as spiritually from our wars, but it was also a spiritual journey for me, as well. And, when I realized that this trip to meet with Joseph was another “peak experience” on my journey, and that it honored my earlier trip 25 years ago – my heart sang with such joy!
I’ll write more in another blog about what I learned from Joseph, and I have a conceptual idea for another book and another class for Veterans based on our talks (I tape recorded much of our three days together). This blog entry is a more personal reflection – who was I 25 years ago? Who was that 21 year old in 1989 trying to find? Who did he become as he set off for medical school in the “big city” of Chicago? Who am I now? What am I grappling with internally? What template am I setting for the next 25 years of my life? Joseph spoke about cycles in a life, traumas, visions, “peak experiences, and events that recur on a certain cycle. What is this 25 year cycle about for me?
I had some major dreams on this trip, “big” dreams as Jung would call them. I spoke with Joseph about them, as well a “big” dream from my past. Visioning. How to envision what this next 25 years are about? I feel more confident, I have less fear, less neurosis (although that is one of the hobbies of the mind), I don’t fear death, but I am overflowing with ideas and concepts that are clamoring to come into physical form. I am just publishing my first book, I have a very rough draft of a second, an outline of a third, a brand new outline of a fourth after this weekend, as well as lecture notes from two classes that I’d like to edit into two books someday. The first half of my life was spent gathering experiences, trainings, travel, and reading, reading, reading. Now I feel the vessel is full – I have taken in a great deal, I have lived and studied, and now I have this tremendous need to move into action, to write books, to teach, to develop classes in order to metabolize, synthesize, and give back to the world what I have taken in from it. Up to this point, I have been cautious about trying to fit my writing into the mainstream of psychiatry and medicine. I view the publication of my book, Re-humanizing Medicine, as a signal that from here on out, I will seek to transform the mainstream of psychiatry and medicine. What drew me to the field was the work of psychiatrists like Carl G. Jung and M. Scott Peck, who blended the wisdom of the spiritual path with the clinical field of psychiatry. I can see that this is consistent with who I am and I see and sense a guiding pathway for how I can move forward along my path, not the path that others might say is most prudent. Another way of putting this is it has taken me 47 years to figure out who I am and what I need to address in my writing and now I feel an incredible pressure to get this all out into the world.
I feel like I should share something personal from my visit with Joseph. I’ll share this. The first morning in the hotel, I looked out at the Animas River (anima in Latin means soul), but it looked like there was a smudge on the window by my breakfast table. Upon closer inspection it was a frosted glass image of a hummingbird, and I jokingly said to myself, “look, there is my soul, flying around.”
I was thinking about the Native American totem animal, and wondering if that might be something I would speak with Joseph about. I had been reading Kurt Wilt’s section on discovering one’s animal. It turned out it was not something we talked about, which was ok. When the same bird lands on your head for no apparent reason, you don’t really need someone else to tell you that there is something to learn from the Nuthatch. Back to this story, though, the last thing Joseph did before I left was a ceremony with an eagle feather. I left his house after three super-charged days and I had some more daylight left that afternoon. The old neurosis had been raising its head – I wanted to get up into the mountains while I was in Colorado and my mind had been running through a bunch of different possibilities: Mesa Verde National Park, the San Juan National Forest, Animas Mountain, maybe that would be a fitting place to go since the Animas River ran through where the hotel was in Durango, Ignacio near where Joseph first lived, and Aztec New Mexico, where we went on a field trip to see the ancient dwellings there.
I came to accept, on a different level, what I have always viewed as my back and forth neurotic tendency. Joseph explained that with our face and our eyes, we are always entering, moving forward into experience and the world, but we also back up, which is receiving, and that these two movements must both happen and support each other. He made a big point of this movement in many of the dances, the forward and backward movement. So, now I have a different paradigm from which to view my moving back and forth, such as driving to Ignacio for what seemed like a fruitless meeting (although I saw such a beautiful sky, sun and clouds),
then driving past where Joseph lives since I had some time before meeting him, then driving back to meet him, then driving back the way I had gone earlier and turned around. This wasn’t pointless neurosis, it was also tracing out a backwards and forwards movement across the land, entering and receiving, taking in and metabolizing, coming into relationship with myself and the land. And then, even though I had made the choice to go to San Juan, I ended up not seeing the exit I had seen earlier and ended up at Mesa Verde and spent an amazing couple hours driving around the park. It is now fitting that I share some of those photos of Mesa Verde National Park, as I had been in the Olympic National Park 25 years ago.
But I never finished my story, at Mesa Verde, after the ceremony with the eagle feather, I saw, in the sunset clouds, the most beautiful vision of a vast eagle in the sunset (I was driving and couldn’t photograph it). Scientists and psychologists can take comfort in this being a projection of my mind as a meaningless unconscious association, but another explanation is that during my visit my soul had started as a little smudge of a hummingbird and grown to a glowing sky eagle with a wing span of many miles. For this next part of my life, I will choose the second explanation.
I’d like to end with a few quotes from my journal from 25 years ago:
Today I am born. I AM ALIVE. Today alone was worth the price and troubles of the trip. I am seated atop a mountain. The view is breathtaking and it is even more spectacular because I climbed up the whole damn thing! I passed snow in the shady spots coming up. Except for a couple of chirpers and a multitude of bugs…it is silent. What more could there be?
When nothing is lost
nothing is gained
When nothing is gained
things are not as they should be
Right now I am at Kyak.
Yesterday…well, there is that earlier entry. After that I went up still higher and a view opened up that was indescribable. I had been on the north face of the mountain and had been viewing the smaller mountains to the north. After I crossed over to the south side and climbed a bit higher, I could see the entire Olympic Range, along with snow/glacier covered Mount Olympus. Breathtaking is the only way to describe the section of mountain I stood on. There was about a 60 degree slope of about 150′ without trees. The only thing between the mountains and valleys beyond and myself was air. I stood and stared for quite a while. I think it would be hard to say that you had been alive if you have not seen something so spectacular.
By the time I had hiked 9.2 miles and found a decent site, I was in a foul mood once again. If I would have seen the guy who wrote that shit about nothing lost, nothing gained, I would have pushed him off a cliff. In the last dying light of the day I opened Zen Mind, Beginners Mind and the only word I could make out was “constancy.”
Yesterday was anything but constancy, from the highest of highs to the lowest of lows…
When water comes to a tough spot, it yields and flows through, sure it may foam a lot and make a lot of noise, but in no time it continues on its way, calm and smooth.
I am here at Flapjack and this is the nicest campsite yet. It is on a small, sunny plain with a lot of birch trees. The river is broad and shallow here. The hike wasn’t too bad, but still my body aches, but it isn’t that bad. I saw a bald eagle soaring around today. I think I heard it earlier, but I couldn’t catch a glimpse of it. There are a lot of swallows or swifts flying about the river. When I got here it was so hot and sunny that I took off my shirt and put on a pair of shorts and wandered down to the river. I tried to wade in, but nearly fell over because all the rocks on the bottom are slippery as hell.
~ 9:30 AM: This morning is a glorious morning. I woke up a little while ago because I was hot, the 1st time since I left Illinois. The sun is shining on the side of the tent and it feels great in here. Every now and then a cool breeze comes through the flaps. There are a lot of low lying, misty clouds at about the level of the hill tops, hopefully the sun will burn those off. Today I think I will hike up the river and look for a secluded spot to take a dip, which would feel great about now. At least I will wash my hair today with my water bottle.
A battle has been going on all morning between the sun and the clouds. Right now the clouds appear to be winning, so I am just lying around camp now. I did wash my hair this morning it was cold and great!
These swallows seem to want to sing together, but always end up being a little off beat or they produce a different tone or pitch, but the effect is more beautiful than if it was planned.
Even though the clouds have carried the day, it is still beautiful out here. The greens have a more muted tone and there is a clear contrast between the lighter birch trees and the darker firs higher up. It is amazing the number of sounds I sometimes hear in the water. I don’t know if it is aural deprivation that makes me hear things or what. I often hear voices or footsteps or hollow clanking, like boats, and today I heard a Native American holy procession. It is easy to imagine how rivers and woods were thought to have spirits.
“We should come home from far, from adventures, and perils, and discoveries every day, with new experience and character.” (Thoreau)
I was sitting and reading a section of Thoreau, “On Higher Laws,” when the mist started descending down from the hills. I quickly made a fire, started my beans cooking, and put everything inside the tent. I put on my rain suit and alternately watched the fire or the mist for about an hour. It was really something to see. My rain suit got damp, but there were never any visible drops falling. I saw an eagle, flying much lower this time, go off into the mist between the hills. It would have made a great Japanese painting, if only I was a great Japanese painter. I ate my beans, they were great, and I opened up my tortillas and had a few of those. It is hard to believe, but my food is finally down to a small, manageable weight. Now I am lying in my tent, digesting my dinner. It has stopped being wet outside, but it is still cloudy.
“To be passing is to live: to remain and continue is to die.” (Watts)
“If you look at it carefully, you will see that consciousness- the thing you call ‘I’- is really a stream of experiences, of sensations, thoughts and feelings in constant motion. But because these experiences include memories, we have the impression that ‘I’ is something solid and still like a tablet upon which life is writing a record.” (Watts)
Today has been a day entirely devoid of human beings. I didn’t even realize this until just now.
Check out the very nice article that Shelly Francis put together about my book on the Courage & Renewal Blog. She excerpted Chapter 10 on “Holistic Decision-Making.”
Here is the quote from my book that the article starts off with:
“Decision-making is something that you can do with either your limited mind and ego, or by letting the choices percolate through your body, emotions, mind, heart, creative self-expression, intuition, spirituality, as well as through the dimensions of context and time – until a decision becomes clear with input from your total Self. Decisions made this way may ‘freak out’ your ego, but they can be truly transformative.”
I am very happy to see the book appealing to a larger, non-health care audience. Re-humanizing Medicine advocates for a personal growth framework for the physician to become a whole person, but this model applies equally to anyone.
Please visit the above link to see the article, you can also look at their programs, I attended their “Integrity in Health Care: The Courage to Lead in Changing Times,” and I wrote a guest blog called Recovering Hope, Poetry and Connection in Health Care that you can also visit, this was published May 9, 2013.
I read this book quite quickly. It is a gripping, emotionally honest memoir and critique of contemporary medicine. Dr. Sandeep Jauhar is a cardiologist and author. His first book was called, Intern, about the first year of residency training, and he writes for the New York Times. With great emotional honesty, Dr. Jauhar charts his journey from finishing his cardiology fellowship and into the world of medicine on Long Island and into the underworld of private practice.
The book starts with a quote from Jung on the mid-life transition:
“Wholly unprepared…we take the step into the afternoon of life; worse still, we take this step with the false assumption that our truths and ideals will serve as before. But we cannot live the afternoon of life according to the program of life’s morning – for what was great in the morning will be little at evening, and what in the morning was true will at the evening have become a lie.”
As Jauhar, documents his own “mid-life crisis” (struggling financially, trying to balance the expectations of his Indian family and golden boy brother, dealing with problems conceiving children, then with the difficulties of being a single income family with small children) he, interestingly, portrays American medicine as being in a mid-life crisis of its own. I think this is a useful way of looking at our health care system today, particularly in light of Jung’s advice about the afternoon of life, that the truths of the morning no longer serve and that we require new truths to prevent crisis from becoming breakdown. There are thus three stories that Jauhar weaves together: the story of his own life, the local realities of cardiology practice in New York, and the larger story of the culture of medicine in the US and how we have gotten to this place. He tells a compelling tale on all levels.
The first story, of the life of Sandeep Jauhar, traces a first generation Indian immigrant to the US, who struggles to balance the “old world” expectations of his family with the “new world” expectations of someone who has spent his formative years in the US. Jauhar captures these cross-cultural struggles and these are just one of the many ways that he is trapped between different people, systems, cultures and expectations. (More on Indian-American immigration and cross-generational issues can be found in the great book by Indian American author, Jhumpa Lahiri, Interpreter of Maladies). Another place that Jauhar is trapped between is between the American dream of having his kids in good schools, providing for his family and his inner morality of not wanting to engage in unethical billing practices (which ties in with the next level of the story of local practice). This story of Sandeep Jauhar at midlife is told with brutal honesty, and the reader can feel the sense of being trapped between multiple forces with no clear way out. He tries ignoring his conscience and doing what everyone else is doing, but that doesn’t work for him. Jauhar points out that every day, one American physician kills him or herself as he weaves the story from the personal, to the local, to the national culture. He tries going to his wife’s family’s guru, but that doesn’t work for him either. The only helpful advice he gets there is slipped to him by another participant at the audience, “Once you know and accept that you are going to die, the future will not haunt you.”
The second story is utterly depressing and is like a never-ending nightmare. Dr. Jauhar, looking to increase his income to support his family in their one bedroom apartment and to pay off medical school loans for himself and his wife, peddles himself all over town, trying to take on more work. The cardiology private practice culture (and it seems he is mostly exploring a sub-culture of Indian and Pakistani immigrant physicians) is rife with over-billing and almost indentured servitude in which the boss brings in young doctors to do the busy work and takes the lion’s share of the profit. Sandeep Jauhar is just not cut out for this kind of work. He comes across as the kind of man you would want as your doctor, thoughtful, not arrogant, not putting himself forward, not focused on the money, but on “doing the right thing” for the patient. However, he portrays the painful clash of his personality and ethics with the ugly realities of private practice cardiology on Long Island. He explains the local history and the vectors of force acting in medicine today.
The third story traces the larger history of American medicine, to the point that Jauhar identifies as its “mid-life” crisis. Medicine today is in a crisis, for sure, and everyone in it is often unhappy, the doctors, the nurses, the staff, and the patients. Dr. Jauhar explains how we have gotten to this point and provides an intelligent critique. He moves from the personal to the cultural as he summarizes research on physician suicide and burnout. He writes,
“Most of us went into medicine for intellectual stimulation or the desire to develop relationships with patients, not to maximize income. There is a palpable sense of grieving. The job for many has become just that – a job. Something fundamental is lost when physicians start thinking of medicine as a business,” (171).
I cover similar ground to that of Dr. Jauhar in my book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice and the Culture of Medicine. In addition to the critique of the economics of medicine, I also look at the effect of an over-emphasis on science and numbers to the detriment of the human aspects of medicine.
The solutions that Dr. Jauhar suggests are largely systemic, such as shifting the way medicine is reimbursed from fee-for-service to accountable care organizations, bundled payment, or paying doctors as employees rather than based on how much they can bill. He is realistic and sees how difficult it is to reform medicine, but he also points out that one in every six dollars spent in the US goes to health care. However, this still places the responsibility for change with the government, with hospital and clinic administration, with insurance and tort reform. Jauhar does point out that, “Doctors never seem to acknowledge that the widespread burnout in our profession is in part due to the behavior of doctors themselves,” (171). This is an excellent point, we can’t wait for reform and change to come from outside. I quote in my book from physician Peter Salgo’s New York Times piece where he says “we as doctors have felt powerless to change this,” and he puts out a call to patients to demand change. I take this statement to task a bit. We as physicians are the point of contact of medical care within the US. While there are many competing demands, vectors of force, and forces of dehumanization within the institutions of medicine (which both I and Jauhar document), we cannot relinquish our responsibility and the considerable influence we have as the providers of the actual care. However, it does mean that we have to look at our own behavior and challenge ourselves to change, even if it means going upstream and working, at what seems like cross-purpose to the system, by providing humane and compassionate care, in caring for ourselves first of all, and then our clients and colleagues.
Here is where I do take Jauhar to task. He has documented the problems in contemporary medicine. He has shown the painful struggles of physicians within our current system. He has portrayed the moral crisis and the mid-life crisis in medicine today. But, in the narrative of the book, it looks like the way that Dr. Jauhar solves these problems is to move to the suburbs and to reduce his expenses. Is this the best we can hope for in medicine today, a small personal reprieve? I like Sandeep Jauhar, I feel like I know him from how well he writes and how well he captures the existential dilemmas of contemporary medicine. I think in bearing witness and documenting the disillusionment of an American physician, he has done a wonderful service. I think we need to look at what he says, though, that burnout in our profession is in part due to the behavior of doctors themselves. This means that we can address this problem by changing our behavior and this is something that we can do now, we do not need to wait for political or institutional reform. I encourage Dr. Jauhar to read Parker Palmer’s article “A New Professional: The Aims of Education Revisited.” Palmer has written that “institutions are us,” and he outlines the way that professionals can take responsibility for the ethical direction of institutions. We need to move beyond critique and into change and transformation.
I found myself thinking as I read Sandeep Jauhar’s book, would my book work in his situation? Would it help at all? He documents dehumanization in himself and in the profession. I aim to re-humanize medicine through empowering individual professionals and encouraging them to develop themselves as whole people in order to provide whole person care to their clients. I encourage a counter-curriculum, which individuals have personal responsibility to create and maintain in order to preserve their precious humanity that is so needed in medicine today. I call for a compassion revolution in medicine. And I am not alone in this, Parker Palmer, Robin Youngson and Tony Schwartz, just to name a few, are out there trying to change the way that we think of ourselves as human beings in our work places. But as I read Jauhar’s book, I found myself wondering, is this enough? Is my approach practical or even feasible? Maybe it only works in psychiatry? How would if fare in the underworld of private practice cardiology in distant Long Island? I feel that my framework is generalizable, as I have developed while working in many different practice settings in two different countries. There are days when I despair about the systems we work in and all the ways that our institutions seem designed for the opposite of compassionate care of the whole person. But, I think my book can help. We have to do something. We can do something. Dr. Jauhar, if you are out there, I’d like to send you a copy of my book. Thank you for your emotional honesty and your excellent critique of the mid-life crisis of American medicine. I think we can do something more to nourish our humanity as well as that of our clients and colleagues.
A Review of Hector and the Search for Happiness
Hector is a psychiatrist, whose life seems perfect, ordered and predictable. The only problem is that he gradually realizes that although his private practice patients have so much, they are perpetually unhappy. Eventually he comes to realize, too, that he is unhappy. It is a classic midlife crisis, he is successful in the world, but the interior meaning and vitality of life elude him.
Swiss psychiatrist, Carl Jung wrote that for men, the midlife period marks a time of moving from an external, materialistic orientation to a more inner, spiritual orientation. “Midlife is the time to let go of an overdominant ego and to contemplate the deeper significance of human existence.”
This is exactly what Hector sets off to do. His overdominant ego has controlled and limited his experiences in life, he feels compelled to break his routine and to go off on an adventure. The movie starts with a dream sequence, Hector is flying a biplane, his trusty childhood dog in the co-pilot seat. He loses his dog and instead an assassin attacks him from behind, the plane is running on empty and goes into a dive – and he awakes to another day of the same breakfast, the same patients with the same problems and a very pleasant, but measured life. His childhood dreams were of being a pilot, flying, exploring the world (he has Tintin memorabilia in his office), yet he lives his life in complete safety and isolation in his office. One of his most endearing clients is a clairvoyant who has lost her ability to tell the future and feels like she is inauthentic. She also gives Hector prescient advice.
At first Hector thinks he needs to go on a journey to do research so he can better help his clients learn what true happiness is, but he eventually realizes that he himself is too controlled to know true happiness and that his quest is, in reality, for self, to live and experience happiness.
He travels to China, meets a businessman and sees all of what money can buy, but it is not happiness. He goes to Tibet and feels a brief glimmer of happiness, but he loses it. He goes to South Africa where his friend from university practices in a free health clinic. Here he sees his friend living a dream of service to humanity, and of being loved for who he is. But this is also a very dangerous place, as Hector soon finds out. He bumbles along, his kindness to others making him friends and people are changed in subtle ways around him (for instance he sorts out a drug lord’s wife’s psychiatric medication and this has a small humanizing effect on the man). Hector next travels to LA, where he seeks out his childhood sweetheart, who is now married, with two kids and pregnant with a third. She teaches him that happiness does not lie in the past. On the flight to LA, he is called upon as a doctor to take care of a woman with terminal brain cancer traveling to see her sister for one last time. He dismisses his kindness and work with the woman as nothing, but she teaches Hector that, “Listening is loving.”
The last lesson he learns is from a psychologist studying happiness through brain imaging. Hector reviews the wide variety of emotional experiences he has undergone, but is still holding back. At one point, something breaks through, and he learns that happiness is feeling everything all at once, fully and deeply. Happiness is a by-product of being capable of feeling everything. This fits with my experience working with clients and from my own self-observation. It is possible to stop “negative” emotions, but it is at the cost of dampening “positive” emotions as well. The way I think of it, they flow through the same channel, so to speak, and the only choice is to feel it all, or to try to dampen and repress emotions.
All through the movie, Hector has a small journal that he doodles in and writes down his maxims of happiness. While he learns that lists and aphorisms do not make happiness, it is still worth sharing this list. The movie is based on the successful series of books by the French psychiatrist and author, François Lelord.
Here is the list from the book:
This movie is really lovely, funny, heart-warming, profound, and thought-provoking. It portrays a man becoming who he truly is, overcoming his fears and defenses, becoming engaged in the world and being fully human. Simon Pegg is great as Hector. Rosamund Pike does a wonderful job as Hector’s somewhat neurotic girlfriend, who creates medication names for a pharmaceutical company. All the actors are well cast and the movie flows well, despite moving through so many settings and characters. It was directed by Peter Chelsom, who also directed the 2001 film, Serendipity, amongst others.
I just read the recently released book, Doctored: The Disillusionment of an American Physician, by Sandeep Jauhar. I will write a review of this book soon, as the theme of this book, as well as the theme of Hector are relevant to my book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine. The joyless practice of medicine that Dr. Jauhar describes in painfully honest detail aptly captures the dehumanizing elements of medicine. Hector, while a bit of a feel-good romantic comedy, offers a portrayal of one doctor’s attempts at re-humanizing himself, his practice and the larger culture. He creates a counter-curriculum of life experience and he not only writes the book on happiness, he lives it, too. I give it 5 stars for being fully human. (The soundtrack was great, too, but not available yet).
(2010 Kindle e-book)
“Sri Krishna alone is my lover. I have gone mad with grief.”
“I will have no peace of mind unless Sri Krishna comes to me.”
These quotes open Gnanananda’s book on Mira Bai, described as having “dedicated her entire life to God and endured all the difficulties of life. Awake or asleep, all the time she thought only of Sri Krishna.” Princess, widow, mystic, poet, musician and Hindu Saint, Mira Bai (alternatively Mirabai or Meera Bai) lived in the 1500s (1498-1546) in Rajasthan (the Northwest of modern India). She is known as a “the most renowned woman poet-saint of India,” (Daniel Landinsky, Love Poems From God). Gnanananda describes Mira as “the very embodiment of Bhakti (or devotion to God).” Wikipedia describes Bhakti as “closely related to Islamic Sufism, which appeared around the same time: both advocated that a personal expression of devotion to God is the way to become at one with him.” Gnanananda expresses this bhakti devotion with loving care of the subject of Mira Bai.
This Kindle e-book gives a biography of Mira’s life, starting with her birth in a noble family. As a small girl she saw a wedding procession and asked what the bridegroom was and then asked to have one to play with. Her grandfather gave her an idol of Krishna and said “Take good care of him.” Another story tells of her wanting the Krishna idol of a holy hermit. The hermit was visited by Krishna in a dream and was told to give his idol to the young girl. When she was older, Mira Bai was married to a man whose family disapproved of her constant devotion to Lord Krishna. At this point, Gnanananda admits,
“It may seem strange that one should regard God as the husband and behave accordingly. But it is not a new thing in the Bhakti cult. There are several types of Bhakti (devotion). They are classified according to the relation that exists between God and the devotee.”
Vatsalya Bhava: God as Parent
Dasya Bhava: God as Master
Sakhya Bhava: God as Intimate Friend
Madhurya Bhava: God as Husband
Gnanananda states that Madhurya Bhava is the highest form of devotion for it includes all other forms of relationship.
This type of devotional love of God has roots in Christianity, as well, for instance in the writing of St. John of the Cross, author of Dark Night of the Soul (who lived during a similar time, 1542-1591) and John of Ruysbroeck (1293-1381) in his book, The Adornment of the Spiritual Marriage; or even the earlier Old Testament book, The Song of Songs in which bodily love and spiritual love are intertwined. A very nice book of poetry exploring the writing of poets from many religious traditions in regard to different forms of the divine love is Daniel Ladinsky’s Love Poems From God (2002). The Poet Seers website is also a nice place to visit for poems and short biographies of poets.
Mira was thought to be mad by her in-laws, and they attempted to sequester her, poison her, and tarnish her name. However, “she was known among the people as ‘a great saint,’” (Gnanananda). Her fame was such that the Moghul Emperor, Akbar the Great, (who was an integrator of religions) visited Mira in disguise and laid a diamond necklace at her feet. Although she refused the gift, Akbar (in disguise) said “I cannot take back what I have brought for Sri Krishna. Please do not refuse,” (Gnanananda). Thus, she was not able to turn away Akbar’s gift.
However this gift made her in-laws even more angry with her and she survived several attempts to kill her. She sought refuge at a holy place, however the leading man at the site refused her entrance as she was a woman. She rejoined, saying, “I thought the only man in Brindavan is Sri Krishna. Now I see there is a rival.” Thus she outwitted the holy man as, “In the Bhakti cult the love of the wife for her husband is said to be the best form of devotion. According to this all are women in this world. God is the only Man,” (Gnanananda). This short book ends with a discussion of the disappearance of Mira, offering different possible ends of her life, for instance, that she was finally merged bodily with Sri Krishna, such was her devotion. This mirrors the story of the Virgin Mary’s Assumption bodily into heaven.
Mira Bai was a strong woman, poet, singer, mystic and Hindu saint. As a mystic, she argues for a direct communion with God and this was threatening to the male hierarchy, both religious and political. She is a champion for women’s (and all humans) rights to worship God directly and her devotional poems blend a physical sensuality and subversive, revolutionary, single-minded love of God which takes precedence over all other laws and hierarchies.
It is fitting to end with a couple of poems of Mira Bai, translated by Daniel Ladinsky.
A Hundred Objects Close By
I know a cure for sadness:
Let your hands touch something that
makes your eyes smile.
I bet there are a hundred objects close by
that can do that.
beauty’s gift to us–
her power is so great she enlivens
the earth, the sky, our
A Great Yogi
In my travels I spent time with a great yogi.
Once he said to me,
“Become so still you hear the blood flowing
through your veins.”
One night as I sat in quiet,
I seemed on the verge of entering a world inside so vast
I know it is the source of
Mira Knows Why
The earth looked at Him and began to dance.
Mira knows why, for her soul too
is in love.
If you cannot picture God
in a way that always
You need to read
more of my