Nature, Medical Humanities & Medical Activism

Jonathan McFarland, President of Doctor as Humanist, and I recently had the honor of presenting at the University of Washington Nature & Health conference on Thursday, October 14th, 2021. Our overall talk was Nature, Medical Humanities, and Medical Activism. Jonathan presented on Nature & Medical Humanities and I presented on Nature & Medical Activism. Here is the powerpoint from my talk.

Thanks so much to Josh Lawler, Star Berry, and the whole conference team from the University of Washington Nature & Health program. It all ran very smoothly and professionally and brought together great speakers from around the globe. There is a groundswell of interest in looking at the bi-directional effects of Nature & Health – we, at Doctor as Humanist, are planning a free, virtual symposium next month. Register for free for our Nature & Medicine: Restoring the Balance Between Earth & Health – we hope to see you next month!

Nature & Medicine: Restoring the Balance Between Earth & Health – Nov 12 & 13

I am on the Doctor as Humanist’s conference planning committee for our free, virtual, international symposium – Nature & Medicine: Restoring the Balance Between Earth & Health on November 12 & 13, 2021. Register here.

We’ve got a great line up of speakers and round table panelists, including Bob Lawrence, one of the founders of Physicians for Human Rights and Center for a Livable Future Professor Emeritus in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health and the founding director of the Center for a Livable Future; Rachel Corby, author of ReWild Yourself: Becoming Nature; Julia Corbett, author of Out of the Woods: Seeing the Nature in the Everyday; Lewis Mehl-Madrona, author of Coyote Medicine and Narrative Medicine; Qing Li, author of Forest Bathing: How Trees can Help You Find Health & Happiness, amongst many others. Link to the program.

One of the projects we are doing as part of the symposium is the Tree of Medicine – a photomosaic on the Mosaically site. You can post on Instagram or Twitter with the hash tags: #NatureMed2021 and #DoctorHumanist and we’ll upload your photos into the Tree of Medicine. You can write a few words of why this photo is important to you and how it relates to Nature & Medicine. Here are a few of the photos I’ve posted.

An unexpected beautiful scene on a walk through Seattle – reminding me that Nature is here, now.
The face on this tree on San Juan Island’s Lime Kiln State Park reminds me of the sentience of nature.
Cannon Beach, Oregon, a breath-taking & invigorating view.

The idea behind this conference is to highlight the many benefits of nature & health while also expanding our idea of being a medical professional to including the health of the Earth. We are in a symbiotic relationship with Nature and cannot exist apart from Nature. In fact, we ourselves are nature, we are made up of nature, our backyards are nature. I’ll be giving a workshop on Saturday 11/13/21 with a focus on Nature is Here, Now. The care of Nature begins with the care of ourselves, the nature of our homes, the nature of our backyard, and breaks down the artificial separations of humans/nature and city/nature. I’ll be joined by a couple of great psychiatry residents I’ve been working with, Eunice Stallman, MD (who has been doing an elective on Narrative Medicine) and Lewis Kerwin, MD (who has been doing an elective on Nature, Health, and Design). We’ll be joined by my friend, photographer and author, John Riggs, author of Clear Cut – The Wages of Dominion. I wrote a review of his book on 5/8/20.

Each of us on the planning committee recorded a short video on the Tree of Medicine project and the Nature & Medicine: Restoring the Balance Between Earth & Health, here’s the link to my video.

We hope you join us!

Nature & Medicine: Restoring the Balance Between Earth & Health on November 12 & 13, 2021. Register here.

How are you doing…really?

How are you doing…really? New post on CLOSLER: Bringing Us Closer to Osler

This is a reflection piece on the challenge of answering this simple question, asked so many times a day, “How are you doing?” While this is usually asked in passing, the true answer to this question is increasingly complex for health care workers as the pandemic wears on.

You can read the essay, here, and some past essays published on CLOSLER, here. The piece features a detail of my painting, “Planting the Seed of the Heart,” which was published in Walking the Medicine Wheel: Healing Trauma & PTSD.

Thanks again, CLOSLER, for all that you do for person-centered care & provider well-being!

Planting the Seed of the Heart, D. Kopacz (2016)

Haystack Rock & Cannon Beach, Oregon

Cannon Beach, looking South at Haystack Rock

We recently took a drive down the Oregon coast and I took a lot of photos of birds, sea, sky, and sand at Cannon Beach and Haystack Rock. A number of birds nest at Haystack Rock, including Tufted Puffins, Murres, Gulls, and Cormorants. I didn’t realize that we had puffins on the Pacific. I had tried to see them in Nova Scotia, without success. I had seen many at a relatively close distance in Iceland, but all the photos turned out slightly blurry, unfortunately. Here we got to where we could see the Tufted Puffins with our naked eye and then I zoomed in and took photos where they landed, somewhat blind. While you can definitely tell they are puffins, they are a bit blurry – so the challenge of getting a clear puffin photo continues! The more serious photographers had tripods and that would likely help. Here is a collage of a few blurry Tufted Puffin photos.

We also saw flocks of pelicans and I was able to get some better photos of these interesting birds. We also saw them diving and catching fish at times.

The beach was wide, the sand soft and good for walking barefoot. I can see why this beach is so popular and I didn’t expect the abundance of seabirds and other shore life. The light was amazing at times, one morning a continuous interplay of cloud and sunshine. I even saw a sun halo one day.

There was, of course, a lot of sealife in the tide pools, starfish and sea anemones.

All in all, a relaxing and invigorating trip! There is nothing like walking barefoot on the sand for hours each day!

Interview with Robert Jay Lifton

This interview was conducted by telephone on 5/28/21, recorded, transcribed, and reviewed by Dr. Lifton.

Robert Jay Lifton, MD – photo from his website

David R. Kopacz: I’d like to start by thanking you today for your time and tremendous body of work over the years. There are many ways that your work has influenced my work that I’d love to talk about, but I’m going to focus in, today, on the concept of the witnessing professional. I wonder if you could start by talking about this concept of the scholar-activist, the witnessing professional.

Robert Jay Lifton: I came to the idea of the witnessing professional in connection with a companion term of malignant normality. Malignant normality being the imposition on a society of a set of expectations that are highly destructive but are rendered ordinary and legal. Of course, the most grievous and extreme example of malignant normality is in connection with my work on Nazi doctors. In that sense, the German physician at the ramp in Auschwitz and other camps, sending Jews and others to their deaths was functioning in a kind of malignant normality. That is what he was supposed to do. That was his job, so to speak.

RJL: Within malignant normality we professionals have the capacity for exposing it, identifying it, and combating it, and that is the development or evolution of the witnessing professional. He or she is witness to the malignance of the claimed normality and not diminishing one’s professional knowledge but actually calling it forth as a means of creating one’s particular witness.

DRK: I wonder, how does this relate to our normal or historical concepts of professionalism, and how professionalism is taught today, in the health professions, with this tight focus on evidence-based medicine and protocols?

RJL: I became interested in the history of what we now call professionalism and the professions and, as you may know, it begins with profession as a profession of faith, of religious faith or commitment to a religious order. Over time, especially as we developed and moved into more of modern society, the idea of a profession became more associated with skills and increasingly technical skills. So, the idea of the professional or the profession became, what I would call technized, and the moral element of it was, in a sense, neglected or denied. In its most extreme form, the technized professional is a kind of hired gun for anybody who will pay him or her for professional knowledge. So, the witnessing professional, then, is a return to the inclusion of an ethical dimension in professional work. If you or I carry out some form of psychiatric or medical healing―that can be seen quite easily as a moral or ethical act. We shouldn’t lose the ethical dimension of being a professional. It is true that sometimes, as a professional, we have to  step back and not experience fully another’s pain, or even the pain that we cause others, such as with a surgeon making a delicate operation or even a psychiatrist taking care of a very disturbed patient. But, at the same time we need to maintain, within the concept of the professional, that ethical or moral dimension and our own openness to some of that pain.

DRK: I am very interested in this idea of professionalism―in my writing I have contrasted the disconnection of the technician and the connection of the healer. I think this goes back, in a way, to the art and science of medicine. My first book was called Re-humanizing Medicine because I was concerned that people could develop that capacity―the psychic numbing or the splitting or selective professional numbing, which you write about―and that they would idealize that, and come to think that is what being a professional is: to be disconnected.

RJL: I think what you are referring to is the danger of what I call the technization of professions and considerable psychic numbing on the part of professionals, with diminished capacity or inclination for feeling―and that is dangerous. We see it is dangerous in different ways in every possible profession, I would say. So, in a way, the idea of the witnessing professional is an effort to recall a dimension of ethical involvement and limit psychic numbing on the part of professionals.

DRK: I suppose the difference is in being able to use psychic numbing as a conscious tool or technique rather than unconsciously assuming that identity of disconnection.

In thinking about the witnessing professional, there is often a narrative―and I just finished your autobiography, Witness to an Extreme Century―I’ve been really interested in reading the narratives of medical activists, people who take on this identity as a witnessing professional. The narrative goes, “I was minding my own business and just trying to be a good doctor when [X] happened, and I felt my training wasn’t adequate for [X], this experience in the world.” Is a witnessing professional―is it something that only happens in exceptional situations or is it something we can impart or teach to residents and students?

RJL: Yes, there are two questions there. One about exceptional situations and the other the capacity to teach residents or other young medical or psychological professionals the idea of the witnessing professional. A good example for me is the doctor’s antinuclear movement, which led to the formation of the International Physicians for the Prevention of Nuclear War, and perhaps you are referring to that. I have been quite active in it over the years and especially early on. What happened was, there was the capacity of first physicists, and then doctors in general, to recognize that they have something to say about nuclear danger. It began with the idea that doctors would be unable to carry out their traditional tasks in disaster, that is to help the living and provide some kind of healing. I used to talk and say the reason why this doesn’t work is because you’ll probably be dead, and we’ll probably be dead and there will be no medical facilities available for this. It is a recognition that one’s usual training can’t cover the extraordinary revolution in destructive weaponry that we’ve undergone and even the ethics of a particular profession are very inadequate because they would talk about being a kind therapist or bringing the latest knowledge to one’s work as a psychiatrist or physician but that’s not adequate for the problems that confront us. So, there can be these large threats, like nuclear threat, that awaken people to a realization that there needs to be a new, broader ethic that has to do with humanity in general.

RJL: All this can be taught, to a degree. One reason why the term ethical professional is useful is that it gives one a concept with which to connect one’s work and one can see oneself clearly as remaining a professional, not leaving the professional orbit, but using professional knowledge in a broader context.

So, there can be lots of discussion and teaching and dialogue in relation to exactly this. It is already beginning to take place. You may know of a recent issue of Dædalus, which ordinarily is a highly professionalized journal, but they were able, they decided to devote one issue, which was edited by Nancy Rosenblum (who happens to be my partner), about witnessing professionals in relation to climate. I have an essay [“On Becoming Witnessing Professionals”] in it describing the witnessing professional which is the basis for the ideas of the issue. There always has to be a kind of development and commitment by individual people, and that development and commitment is enhanced by a collective expression of this kind of witnessing professional.

DRK: Thank you, I wasn’t aware of that issue. I will look that up. One thing I was wondering, in trying to teach this, how, how would you go about it? Is it a skill set that people can learn, that we can impart and measure? So much of medical education now is focused on objective learning goals. Or is it like a different dimension, like cultivating the heart and compassion and human connection. In other words, does one go into the work having been trained as a witnessing professional, or does one become a witnessing professional because one is open to human suffering and to look at that human suffering in a broader context than just being held within an individual in front of you in the clinic?

RJL: Well, it can be taught, what you are describing after all, with physicians in particular, is ostensibly a healing profession.

RJL: A healing profession, or a professional who attempts to heal, has to take in pain and share the pain with patients, with others. Once one considers, early on, one’s work to be an ethical enterprise, it’s not too difficult for the witnessing professional to take root. I’ve mentioned in my work, observing very young physicians who were not clear about these matters, had some issues about them, but once they committed themselves to joining the physicians’ anti-nuclear movement, they themselves could evolve, become more articulate, and become more clear about who they were. In a strange way, I, in my own experience, as I think others did too, in the physicians’ anti-nuclear movement, felt myself more a healer than ever before in connection with this commitment. It is bound up with healing, for physicians.

Of course, in my case, I had direct knowledge of the Hiroshima experience of people exposed to the first use an atomic weapon on a human population and what that caused and what that resulted in. I could talk about that, as together with Nagasaki, the only record we have of the human impact of, what is by present standards, a very small bomb. But even outside of what we consider directly healing professions, even professions that have to do with other forms of knowledge, including the humanities, can evoke their knowledge to confront the malignant normality that is put before us.

Of course, I’ve made use of the idea of malignant normality repeatedly and strongly in relation to Trump and Trumpism―it is not a single individual matter, but it is a collective form of behavior which pursues and seeks to render lying and deception and attacks, personal attacks on anyone who questions the “Big Lie,” render this the norm, the malignant normality of our own society and we are at the present time very much in the process of seeking to confront that malignant normality as witnessing professionals in our own society.

DRK: I’m glad you brought this up. You wrote the foreword [“Our Witness to Malignant Normality”] to The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess the President. Like many people I was very concerned with, it seemed like many of the things that were happening were the things that happen in fascist or pre-fascist political movements. Dr. Bandy Lee brought that edited volume together, and brought you in for the foreword, and now she has been fired from Yale, ostensibly for violating the American Psychiatric Association’s Goldwater Rule. What are some of your thoughts on Bandy Lee’s work, her dismissal and also the warning this sends to professionals to “stay in your lane?”

RJL: Bandy Lee has been an extraordinary leader in speaking out about what I am calling malignant normality and encouraging psychological professionals to do the same. Nobody should be fired in relation to the Goldwater Rule, which is quite confused, and complicated with the resistance on the part of the American Psychiatric Association to a more thoughtful approach to psychiatrists speaking out, which could contain freedom to speak out while not making hands on diagnoses. I haven’t been working with Bandy Lee for several years and although the Goldwater Rule was mentioned by the Yale department, I am in no way clear about the whole Yale situation.

DRK: For myself, I went through this phase of feeling―“this is wrong, somebody should say something, somebody should do something.” I felt that collective psychology overlaps with my professional domain, and, additionally, I’ve also studied the literature outside of psychiatry, on fascism and history and the genocides of the last century. I felt a need to do something, on the one hand, but I wasn’t quite sure what to do. On the other hand, I had a fear of going beyond my profession if I were to speak out and point out similarities in current psychology to past fascist movements―and yet I was also aware of the “by-stander effect,” where people do not act when something is obviously wrong. I worry with Bandy Lee that this is a cautionary tale of―can you go too far as a witnessing professional, or is the ethical and moral right with the individual, even if they end up getting punished by the institutions?

RJL: What you are describing is a very human concern that witnessing professionals experience which has to do with how much one can say from the standpoint of one’s profession and how far one should go in saying it. There is, as you know, an interaction of psychology and politics that is inevitable. I think, in my own work, and there are others who do it a different way, I invoke what I know from professional experience, or what I think I know from professional experience, and bring it forward in relation to what I say publicly. In my case, of course, I’ve studied Hiroshima survivors and Nazi doctors and I’ve seen in the latter, in Nazi doctors, the very opposite of the witnessing professional. What I’ve called the “killing professional.” I think we have to speak out from what we have seen and recognized and then look at what we believe we know, or have learned, as a professional. Of course, in addition to that, we are also citizens who have ethical concerns about political issues. People have to give their own perspectives on this and there is no, how shall I say, there is no perfect model of how to go about it.

RJL: But I think there is an increasing recognition on the part of many professionals that what they are doing and thinking is not enough and there is a hunger among professionals that I have encountered for entertaining or including an ethical or moral perspective in their professional work and I think that is increasingly available to people.

So, yes, I believe that a witnessing professional should have discipline, one should say what one thinks one has learned as a professional, and not just speak randomly, and that’s really what defines the idea of the witnessing professional.

DRK: It feels like there is a sense in many witnessing professionals’ narratives of this being out on a limb by yourself, of not having been prepared by your education or profession, unless you have gone out of the way and read about different people who have taken on roles as witnessing professionals. So, I guess I go back again to this idea of―what would be the ideal way to teach this to medical students and residents and other health professionals?

RJL: I agree, it can and should be taught and should be discussed. You don’t have to have experienced an extreme situation in order to gravitate toward becoming a witnessing professional, after all, as you say, we undergo residency or training procedures of some kind and we experience all kinds of pain and have access to a lot of confusion on the part of both patient and healer. If we can look at a concept such as the witnessing professional that doesn’t automatically solve everything, but at least can provide a beginning in one’s sense of one’s self, one’s own identity as both a professional who is committed to learning, yes even the techniques of the profession, on the one hand, but is also committed to applying one’s professional knowledge in a broader way that enhances human behavior on a larger scale―that’s what the doctors anti-nuclear movement was about, there is also Physicians for Human Rights. These organizations then constitute a banding together of witnessing professionals who are always, or can always be, at the edge of activism.

The teaching that you emphasize, and discussion during residency, and even in medical school before that, I think could be very important. What happens, as you know, is that there is so much to learn in the training procedure that one is overwhelmed with memorization and details and the broader ethical dimension can readily be lost, but if it is considered early, it may never disappear entirely, and becomes part of, at least a possible, direction that starts early in psychological and medical professionals.

DRK: There are the studies that show that idealism goes down during medical student years and residency training and burnout starts to increase. I always wonder if somehow that idealism―maybe we should look at idealism as a precious resource rather than kind of a naïve, friendly fire incident with medical training where it is lost, where we could right from the very beginning come up with ways to help students preserve their idealism as they are learning that tight, technical focus to also be able to broaden out to the bigger picture.

RJL: Yes, what you say about idealism is important because, on the one hand, medical practice can be a business―it is in a way, but there is a certain element of idealism even a small one, that is likely to go into anyone’s decision to become a physician or a healer. As you say, it is readily lost in the training procedure which is demanding and dominates everything. If one can reconnect with the idealism, the earlier idealism, even a small element of it, that was a factor in that choice of profession, that could inform the witnessing professional.

RJL: Or, to put it another way, if one has the concept of the witnessing professional that one has discussed early on in training, there is a place to recover and extend one’s idealism that is available in one’s mind because it has been placed there, as at least a possibility, early in one’s medical or psychological life.

So, yes, in that way, the teaching of it, the discussion of it early would be very beneficial and students are very sensitive, as you know, and they are very responsive to what they perceive as authenticity and equally critical of what they perceive as less than authentic, the inauthentic. So, if the discussion is initiated with some sense of authenticity, coming from the experience of the initiator of the discussion, if he or she can tell about experiences that cry out for an element of idealism or of moral or ethical behavior in the professional, that will be responded to by students given their sensitivity and capacity to differentiate between what seems authentic to them or not.

DRK: I wonder whether we should institute practices, like some type of idealism practice and some type of suffering practice? A practice of being able to hold on to these ideals and recapture or regenerate them if they are lost. And a practice of being able to accept and embrace the suffering inherent in our professions and our work with people who are suffering and to be able to have a framework to metabolize and grow from that suffering―to turn the suffering into commitment to action in the world or re-dedication.

RJL: Yes, in recent work I have been talking about issues of death anxiety and death guilt and what I call an animating relationship to guilt or an animating relationship to death anxiety. These are forms of suffering which people we treat, or try to help, undergo and which we, ourselves, are hardly immune to and the animating relationship is the capacity to transform death anxiety or mea culpa guilt into what I call the anxiety of responsibility. The responsibility toward something in the way of healing or life-affirming behavior or contribution to the human future. So, these are very real matters. I think they are immediate and practical, but they are also very much aspects of what we call idealism.

DRK: I developed this idea of a counter-curriculum of re-humanization in medical school. I developed it in myself, by being connected to arts and poetry and literature and meditation, from a feeling that I needed to somehow push back against the ever-present scientific curriculum, to save some part of myself that was more than just memorizing biochemistry. I know you have written about the comparison between totalitarian thought reform and psychoanalytic training and I wonder if what is needed in medical education is some emphasis on this ability to be able to resist the brainwashing of technicism or thought reform of becoming an uncaring or unfeeling physician.

RJL: Well, there is a lot of pressure in medical training in the direction of psychic numbing, starting with the introduction to the cadaver. And I think that another way of saying what I think you are suggesting is that medical training involves diminution of feeling in the service of learning techniques.

Now, there is a reaction, getting to psychoanalysis―I’ve been in touch with some psychoanalytic groups in the last few years and there is a considerable movement away from the direction of totalism that I described which can inhabit psychoanalytic training, (which I myself partly underwent and then left). The American Psychoanalytic Association invited me to give their plenary address in 2020 and published it―a paper that specifically confronted thought reform and totalism. I talked about, in that plenary address, the imposition of ideas in a systematic way: criticism, self-criticism, and confession―which characterized Chinese thought reform and I talked about ways of avoiding this kind of totalism and combating it. The fact that I was invited to do so by the leading American Psychoanalytic Association suggests that they too are hungry for ethical directions. That doesn’t mean that much of medical or psychoanalytic training can still be questioned, but it does mean that there is a hunger for this broadening direction that I summarize in the form of witnessing professionals. I also talk about what I call the Protean style or capacity for individual change and transformation and that being associated with our tendency toward symbolism, not just one thing equals another, pen equal penis, or something like that, but rather a whole symbolizing tradition in philosophy and psychology, within which we must recreate everything we encounter, in order to take in anything at all. We are symbolizers, in that sense, and that opens us toward what I call a Protean Self or multiple Self. We have that capacity for combatting controls of the mind and we are also vulnerable to such a kind of process to a degree, but we also have inclinations within us toward rejecting it and opposing it―we can go either way.

Robert Jay Lifton, MD – photo from his website

You can learn more about Robert Jay Lifton & his work at his website and his latest book, Losing Reality: On Cults, Cultism, and the Mindset of Political and Religious Zealotry is a summary of some of his most important books. This interview is also published at The-POV and is reprinted with permission.

Focus on What You CAN Do: Meaningful Engagement in Activities while Managing Chronic Pain

Very grateful to my good friend, Dr. Carol Bowman for this interview with me and lively discussion on “Focus on What You CAN Do: Meaningful Engagement in Activities while Managing Chronic Pain,” focusing on the Personal Development circle of the Circle of Health as part of the VA Whole Health initiative from the VA Office of Patient Centered Care & Cultural Transformation. (Views are our own, although you can find it on the VA website).

My adaptation of the VA Circle of Health (I added the “We” to the center)

Carol and I have taught courses together as National Education Champions for the Office of Patient Centered Care & Cultural Transformation. You can learn more about Whole Health through the VA Whole Health Home page. This interview & discussion is part of Carol’s Whole health for Chronic Pain podcast series and is available on the VA website, or at wherever you find podcasts.

We talk about finding a place for pain in your life when you are working with chronic pain and different ways of transforming pain into compassion and personal growth.

What Does it Mean to Be Human? The Role of Psychiatrists in Philip K. Dick’s Life & Writing

This is the title of my presentation from May, 2012, at the Royal Australian New Zealand College of Psychiatrists annual meeting, held in Hobart, Tasmania, Australia. This is a timeless topic and applies as much as ever to us as we work to come out of this pandemic which has changed how we relate to others and how we relate to ourselves. The struggle to “stay human” in medicine is an ongoing practice and we can learn from the life & works of PKD.

Every Thought Leads to Infinity:

Perspectives on Personal Growth, Psychosis & Spirituality:

Carl G. Jung’s Red Book & Philip K. Dick’s Exegesis

I presented this paper at the International Society for Psychological and Social Approaches to Psychosis, New Zealand/Australia annual conference, August 2012 in Auckland, New Zealand. I thought I would share the slides from the talk.

Caring for Self & Others – before, during (and after) a Pandemic

As we enter into a new phase of the pandemic, I worry about myself and my colleagues in health care – how will we come out of this? How will health care change? When will we feel like we have recovered from the constant changes and worries about our personal and collective health?

I’ve been working for a while on a workbook adaptation of Re-humanizing Medicine. I’ve been seeing if I can get this published or figure out a way to get it out to the larger world as a resource for caring for ourselves & others. I’m not sure exactly what form this will take, but in the meantime, I thought it might be worth revisiting some of the concepts and topics of Re-humanizing Medicine: A Holistic Framework for Transforming Yourself, Your Practice, and the Culture of Medicine that I published in 2014.

I’d like to give a few quotes from the book and put them out into the world as a small offering to address the suffering, burnout, compassion fatigue, soul loss, and moral injury of health care colleagues. The experience of dehumanization is all to prevalent in contemporary medicine and the need for re-humanization is just as needed as ever! Here is the introduction to the book:

Introduction

Only connect! … Live in fragments no longer.

E.M. Forster1

The great error of our day in the treatment of the human body is that physicians first separate the soul from the body.

Plato2

Dehumanization in Contemporary Medicine

This book takes on the task of re-humanizing medicine. We start by recognizing that there is a problem with how medicine is currently practiced: it dehumanizes staff and clients, creating dissatisfaction, suffering, poor performance and medical errors. Dehumanization is an iatrogenic effect of the dominant paradigms in contemporary medicine – the economic/business model and the reductionist and materialistic approach of biomedicine. In the day-to-day practice of medicine, doctors are expected to see more patients in less time and to efficiently reduce people to symptoms, diagnostic codes, prescriptions, procedures and billing codes. This leaves little time or space for people – physician or patient.

Future doctors are attracted to medicine for idealistic and humanitarian reasons, but through training they often lose this idealism.3,4 How can we preserve idealism and humanitarianism in medicine? Practicing physicians have high rates of burnout and job dissatisfaction. How can we reinvigorate the practice of medicine and make it sustainable?

A Counter-Curriculum of Re-Humanization

In medical school, I realized that I had to engage in a parallel education process in addition to the standard scientific curriculum. We could even call this a ‘counter-curriculum’, focusing on re-humanization. At times I found teachers, mentors, and fellow students who practiced this counter-curriculum, but often I had to seek it out on my own in order to balance my education. This book is about that counter-curriculum of re-humanization. Science and evidence-based interventions are one paradigm of medicine, but as human beings working with human beings, we must have a human framework as well as a scientific one.

As a medical student, the first research project I worked on was with Deb Klamen and Linda Grossman at the University of Illinois at Chicago. Our study examined symptoms of Posttraumatic Stress Disorder (PTSD) in relation to medical training and found that 13% of trainees in the study reported sufficient symptoms (relating to their internship year) to potentially qualify for a PTSD diagnosis.5 The findings provide evidence supporting the need to change postgraduate medical education to reduce stress and to enhance the well-being of trainees. I went on to work with Linda and Deb on three other papers that examined medical students’ beliefs and their attitudes toward the controversial issues of homosexuality, abortion, and AIDS.6,7,8 These papers examined how medical student beliefs can shape attitudes that adversely impact medical care. The studies also allude to the fact that people are not purely rational beings, and beliefs, fears and stigma can undermine scientific reasoning or professional ethics. Even my student research experience was concerned with the counter-curriculum of exposing dehumanization and seeking re-humanization.

To re-humanize medicine, the people who work in medicine must be well-rounded, well-developed human beings, as well as safe and effective technicians. A great deal of time, energy, and money is spent in making sure that physicians are good technicians, but are they good human beings? Being a good technician (objective, detached, unaffected by emotion, protocol-driven) can actually interfere with being a good human being. Clinicians should not stop being technicians or scientists, but they have a responsibility to attend to their own humanity, as well as that of the client. The counter-curriculum provides a holistic framework for being a human being, for working with human beings, and for creating systems that deliver care by human beings to human beings.

A Holistic Framework for Medicine

A holistic framework is founded on multiple interacting and mutually influencing sub-systems. Scientific medicine and the objective, observable body make up just one dimension of human health. Sometimes the physical dimension is primary, for instance in physical trauma and surgery. Sometimes other human dimensions are more important. Emotion, mind, love, self-expression, intuition, spirituality, context and time all play a role in health and illness.

A holistic framework is a paradigm for understanding and interacting with human beings. It is a human systems approach and a way of being in the world. Holistic medicine is a philosophy, or a paradigm for understanding what it is to be human, to suffer, to be ill, to be healthy; what it is to change, grow and live. It helps us understand how disconnection can lead to suffering and how connection can lead to healing. Holistic medicine is not defined by using an herb instead of a medication, or by any specific technique or intervention. Being a good technician (whether biomedical or ‘natural’) is part of being a good physician, but being a good physician is more than just being a good technician.

It is hard work to maintain a complex identity that includes being a technician and a human being, but that is what being a medical professional involves: balancing different roles for the purpose of alleviating suffering and treating disease. Re-humanization reconnects the art and science of medicine, the heart and the mind. A holistic framework encourages integration.

When you start to connect in a different way, you change the health care delivery system in which you work. What starts as personal dissatisfaction can become personal transformation, which changes systems. Institutions will always drift toward promoting their own interests over human interests. It is the responsibility of health professionals to ensure that they stay human, help their clients stay human, and ensure that health care delivery systems promote humanization rather than dehumanization.

Intended Audience and Purpose of the Book

I wrote this book for people who are looking for different ways of thinking about and practicing medicine. Dehumanization in medicine occurs throughout the world, particularly as business models replace humanitarian models of care. Many of the examples in the book are specific to the United States or New Zealand, drawing on my experience of practicing medicine in various settings in both countries; but whether dehumanization results from the profit motive of an insurance company (as in the US) or the bureaucratic processes of a national health system (as in New Zealand), the effect is the same. Re-humanizing medicine is a universal need.

This book is written specifically for clinicians, doctors, and physicians,9 who face daily humanitarian10 challenges in their roles, but is of interest to any health care professional or administrator. There are many fields where the application of a trained technique interferes with human connection, so teachers, trainers, educators and business people will find it relevant too. Of course, so will anyone interested in being a whole human being!

Since holistic medicine is a philosophy and a mode of being, I do not list diagnoses and alternative treatments. There are already a number of excellent books that review various complementary, alternative, and integrative medical techniques. The foundation of a holistic medical practice is you, not the services and techniques that you offer. Therefore, this is a book for people who are willing to change at a personal level in order to be better doctors and clinicians.

Contemporary medicine and holistic medicine are not inherently in conflict. My hope is that by defining holistic medicine as a paradigm, rather than as a specific technique, its benefits can be integrated with those of contemporary medicine. My primary argument is that the human elements of medicine need to be valued so that technical interventions occur within a human context.

Holistic Medicine, Re-humanization and the Quality Revolution in Health Care – A Convergence?

There is a worldwide trend in health care that, interestingly, overlaps with the philosophy of holistic medicine. This trend is a focus on quality, efficacy and safety, stimulated by the continual increase in the cost of health care. Experts are calling for a ‘revolution in health care delivery,’11 and ‘system-wide change.’12

Many of the suggestions involve cost-cutting and standardization of treatment. The ‘Quality Revolution’ also raises issues related to re-humanization, such as putting the patient at the center of treatment, making decisions collaboratively, and establishing a ‘continuous healing relationship.’13 These are the strengths of a holistic framework – not only is it patient-centered, but it includes the concept of healing in addition to treatment, and it often encourages low-cost, low-risk lifestyle changes and preventative medicine. It may be that it is time for a Compassion Revolution and a Quality Revolution to join forces in order to make medicine more affordable, safe and effective, as well as more compassionate, caring and human.

Structure of the Book

The book is divided into five major parts. The first discusses the underlying paradigms of the biomedical and economic models of contemporary medicine and how these models have side effects of dehumanization. This critique does not mean that there is no benefit in the contemporary paradigm; rather it is an examination of the strengths and weaknesses of the underlying paradigms of the current system. The second part describes the paradigm of holistic medicine as a way of understanding the whole person. The third part is a ‘self-help’ section that outlines how you, as a clinician, can develop a more holistic and deeper sense of your own humanity. The fourth part is a ‘how-to’ component that describes how to create a holistic practice in any setting and how to re-humanize your practice. The last part describes the benefits of a holistic paradigm for re-humanizing the culture of medicine.

Video available from Toward a New Way of Being with Plants conference!

My sister, Karen, and I presented at last month’s Toward a New Way of Being with Plants conference.

The video of our presentation is available here.

Our overall presentation was called, “Remembering Our Living Relationship with Plants,” my talk was entitled “Toward an Ancient Way of Being with Plants,” and we also featured video that Karen created with Joseph Rael, “Becoming Medicine Initiation Ceremony,” and Karen’s talk was “Shifting Into a Relational Mindset With Nature.”

The conference was great! Very interesting, bringing together scientists, artists, poets, writers, and naturalists from around the world. There is a YouTube channel for the conference where you can watch the presentations.

Thanks to all the organizers and people who brought this great event together! It was very enjoyable, inspirational, and educational.