Lost in the Wilderness of the Body

I haven’t written anything for Being Fully Human for some time. I have been on an odyssey, a continuing journey, through the inner reaches of the body and the outer halls of academic medicine. You see, I have been lost in the wilderness of the body.

I was diagnosed with nevoid melanoma last year. Nevoid means mole-like, similar to the common nevus (mole). It did not look like a typical melanoma with irregular borders, asymmetry, or coloration. It looked like a regular mole. However, this was not a common mole, but a malignant cancer that had spread to two of the lymph nodes in my axilla (armpit), making it a Stage IIIa cancer.

My oncologist recommended adjuvant immunotherapy to prevent any recurrence. Immunotherapy is a relatively new treatment for cancer over the past decade or so. Nivolumab is a monoclonal antibody (-mab) that “switches on” the body’s own immune system in a way that over-rides the immune-blocking properties of cancer. The risk, however, is that one’s activated immune system can turn against the self, causing various autoimmune conditions anywhere in the body.

Numbers mean Everything & Numbers mean Nothing

The decision to start this medication was difficult for me. With roughly a 10% chance of potentially permanent side effects, this is a serious medicine. The decision was even more challenging because I was considered “cancer-free,” nothing was visible on any of the scans or blood tests. However, my oncologist thought there was a 10-20% chance that I could have a recurrence of melanoma without treatment.

The decision involved flailing back and forth between the numbers about recurrence and the numbers about serious side effects. I was intellectually trying to make the “right” decision. In oncology, treatment protocols are all about numbers – numbers are everything. For me, however, an individual, not a population statistic, I realized that numbers could also mean nothing. No matter what the statistics, what happened to me would happen to me. When my oncologist said that he thought my risk of recurrence might be closer to 20% and immunotherapy could cut that risk in half, I decided to go on the year-long course of monthly IV infusions.

Still in Training

When I first was diagnosed with melanoma, my friend, co-author, and teacher, Joseph Rael (Beautiful Painted Arrow) asked me why I thought I had gotten cancer. I sputtered out a couple of things and he interrupted and simply said, “Because you are still in training.”

This attitude could actually apply to all of life. When anything goes the way we don’t want it to, we could say, well, this is a good training exercise – what can I learn from it, how can I grow? To approach life as a student, rather than a victim, is the road less traveled, the pathway of transformation.

The first infusion of Nivolumab was uneventful. I felt a little tired after, but nothing dramatic. However, about two weeks later my right foot hurt every time I took a step. This lasted about three days and then the pain resolved but I had tingling paresthesia of neuropathy. When I told my oncologist, he said somewhat incredulously and dismissively that this medication had a less than one percent chance of causing neuropathy, other medications could cause it more commonly. He seemed suspicious of my symptom and then referred me to another doctor, a neurologist. That appointment was three months out.

Two weeks after the third infusion the neuropathy symptoms intensified and began to move up my legs – tingling, electric jolts, burning sensations, aches, and cramping pains.

Like A Brush Fire

Over two weeks the neuropathy picked up speed, reaching my chest (which led to an emergency room visit to evaluate chest pressure and cramping that later seemed to be related to the spread of the neuropathy). I was alarmed at the rapidity of the upward spread – like a brush fire – and I began reviewing different kinds of rapidly ascending neuropathies.

During my neurology rotation in my medical education I had met an unconscious neurologist who had developed Guillain-Barré that paralyzed his breathing muscles and he was on a ventilator. This was one of my concerns given that rapid spread and for a time it seemed like the neuropathy might also be involving my heart. I underwent another series of tests: brain and spinal MRI, chest CT, EMG, autonomic testing, nerve biopsy and lab test after lab test.

Drowing in Quicksand

I felt like my team was always a couple steps behind the rapidly evolving symptoms and that they lacked imagination to think beyond reductionistic symptoms to encompass the overall pattern of what was happening. The image came to me of sinking in quick sand and the medical team watching me from the solid ground, telling me they wouldn’t toss me the life preserver until they determined what kind of sand I was drowning in. I imagined them requesting a geology consult that would take three months to arrive and then the geologist would send samples of the sand to the lab for analysis while I slowly drowned right in front of them. It was a strange and unsettling feeling of being seen and not being seen, as if they were more interested in the composition of the sand than they were in my own life and well-being.

Eventually they started Prednisone to shut off the immune activation. This was a high dose of steroids, up to 100 mg and then a slow taper down. It pushed the neuropathy symptoms mostly back down below my waist, but I was still having active symptoms in my lower body. During the taper, at about 60 mg the symptoms began spreading into my chest again, but at a slower speed. At around 20 mg the neuropathy symptoms moved into my neck, face, forehead and scalp.

Now, off prednisone, I continue to have head-to-toe neuropathy symptoms. I have continuous aches and cramps in my limbs – from shoulder to hands and hips to feet. We still don’t have a definitive diagnosis for the neuropathy, although the neurologists suspect small fiber neuropathy. The results of the nerve biopsy, which may confirm the diagnosis, are still pending after six weeks.

In addition to the paresthesia, tingling, burning, aching, cramping symptoms, I also developed a heavy feeling in my legs, difficulty standing straight (but walking ok), leg tremor, low back pain, and balance problems. After describing my unsteadiness to two oncologists and three neurologists, a practical ER resident suggested I get a cane so I didn’t fall. That was quite helpful if I had to stand for a while when I was out walking or going to the clinic for an appointment, I could use the cane as a prop or kickstand to steady my legs. This obvious recommendation was overlooked in the mania of medical/technological medicine.

Despite my detailed descriptions, and even the doctors own objective findings on physical exam, I haven’t felt that any of the doctors have adequately explained the balance symptoms and instead have focused on trying to determine what kind of neuropathy I have.

I’ve been off work for two and a half months and just returned to work part-time this week. I still have head-to-toe neuropathy symptoms. I don’t have to use a cane for short walks, or prop myself up with the counter if cooking or doing dishes. I do still feel off-balance and use my hands to steady myself as I walk through the house, as if I was on a ship rolling at sea.

Modern-Day Alchemy

If I seem embittered toward the medical system – I am. I have had some very compassionate nurses, and a couple physicians who were not part of my immediate specialty care team. My primary care doctor is great, but I’ve been lost in the wilderness of medical specialties, medical technology and evaluations, and twice been to the emergency department. On the one hand, medical technology surgically removed the cancer and identified the two metastatic lymph nodes, and as far as we can tell, removed all visible signs of the cancer. On the other hand, I can’t help but think of immunotherapy as contemporary alchemy, with my young oncologist as a kind of modern-day alchemist, playing around with mercury and other arcane substances to try to create the philosopher’s stone that will be the panacea to cure all cancer.

Pharmakon: Poison & Cure

The ancient Greeks had a word for medicine – pharmakon. They also had a word for poison – pharmakon. These modern-day alchemists, in their zeal to cure, may be causing a whole panoply of iatrogenic diseases. The dual nature of pharmakon – a poison and a cure – should engender humility, caution, and a sense of awe at the mysterium tremendum et fascinans of life – the terrible yet fascinating mystery of health, life, illness, and death. The hubris of modern-day alchemy is that we reduce people to numbers and then we can plug those numbers into protocols, and we make the numbers go up or down. Doctors can lose a sense of personal responsibility and accountability because they are just “following orders” of the protocol. Health and illness are the great mysteries of life and we need to have a healthy appreciation of the mystery and uncertainty of life.

Please don’t mistake my personal narrative as medical advice. If I had advanced metastatic cancer, the trade-off of my ongoing symptoms for being cancer-free would be a different calculation. However, for me, I didn’t feel sick until I received the treatment to make me “healthy.” I’m not sure the trade-off, from a cost-benefit analysis was worth it.

Iatrogenic Soul Loss

I also feel like I have been hood-winked by contemporary medical, technological science again! When I was in medical school, I felt like I was losing an important part of my humanity as I grew in skill as a medical technician. I felt I was losing my soul and I developed the idea of a counter-curriculum of re-humanization – a kind of soul retrieval through meditation, reading, poetry, the arts, and creative practices. Now, as a patient, I feel another loss of my soul and humanity as I’ve been processed through the medical system. I’ve been continually frustrated as I’ve laid open my soul to these young doctors who are always attending to the demands of their computers. I’ve wondered if the problem is me – maybe I’m documenting in too much detail, or recounting too many symptoms. I’ve spent hours editing down my updates, trying to capture the complexity and evolution of my symptoms while simplifying it so that the briskly busy, multi-tasking young physicians can take in the information I am providing. Our medical system has no problem spending hundreds of thousands of dollars on pharmaceuticals and technology, but it is almost impossible to have a doctor sit down, person to person, and spend the time needed to understand what the patient is going through, let alone properly understand a complex system pattern.

I got excited about the new science and technology of immunotherapy for cancer treatment. I got caught up in the medical dream of curing cancer. But personally, I’m living out the dark side of pharmakon – feeling like I was a perfectly healthy human being (other than the surgically-removed melanoma) who now has a potentially permanent disability, that is still evolving, from the pharmaceutical tha was supposed to make me more healthy.

iatrogenic (adj.)
“induced by a physician,” 1920, from iatro- + -genic.
word-forming element meaning “a physician; medicine; healing,” from Greek iatros “healer, physician” (see -iatric)
word-forming element meaning “producing, pertaining to generation;” see -gen + -ic

The Greek word for physician or healer is iatros. The Greek word for soul is psyche. As a psychiatrist – or psyche-iatros – I’ve viewed my calling and role as reminding medical professionals that we should be striving for a balance of our roles as technicians and our roles as healers. As we seek to modulate the inner workings of the body with technology, we should balance this with the role of the healer who works with our psyches – our souls – as well as with our bodies.

To treat the body without the psyche or the psyche without the mind is to be at least partially insane. Human reality is psyche-soma, mind-body. To ignore this holism is to ignore and blind ourselves to half of reality, which means we are voluntarily insane – if by insane we mean someone who ignores or is unaware of reality.

Lost in the Wilderness of the Body

I’ve been lost in the wilderness of the body – but to say it this way is really not quite true. This illness experience has shown me that my psyche and soma, my mind and body are one. I have been exploring the inner reaches of the territories of my being. This is not looking at the body from outside, trying to manipulate it into health, but rather exploring a vast wilderness of the unknown within myself. What we do not know at first appears dark until we bring the illumination of consciousness into that dark realm.

Rather than wail and gnash my teeth or rail at the contemporary medical technology system, I try to remember the words of Beautiful Painted Arrow, “You are still in training.” Then I ask myself, “What can I learn here, in this dark wilderness of the body, what treasures might lurk in the abyss, what vistas might be found over that mountain ridge?” Rather than trying to negate or eliminate sickness, or try to run out of this wilderness back into the light of the remembered memory of who I used to be in some sunny meadow outside of this dark wood, I will go deeper into the unknown realms of the body.

We need to explore ourselves, our inner natures as well as our outer natures. We need what Nietzsche called the great health:

…a new health that is stronger, craftier, tougher, bolder, and more cheerful than any previous health. Anyone whose soul thirsts to experience the whole range of previous values and aspirations, to sail around all the coasts of this ‘inland sea’ (Mittelmeer) of ideals, anyone who wants to know from the adventures of his own experience how it feels to be the discoverer or conqueror of an ideal, or to be an artist, a saint, a lawmaker, a sage, a pious man, a soothsayer, an old-style divine loner – any such person needs one thing above all – the great health, a health that one doesn’t only have, but also acquires continually and must acquire because one gives it up again and again, and must give it up!. . .And now, after being on our way in this manner for a long time, we argonauts of the ideal – braver, perhaps, than is prudent and often suffering shipwreck and damage but, to repeat, healthier than one would like to admit, dangerously healthy; ever again healthy – it seems to us as if, in reward, we face an as yet undiscovered land the boundaries of which no one has yet surveyed, beyond all the lands and corners of the ideal heretofore, a world so over-rich in what is beautiful, strange, questionable, terrible, and divine that our curiosity and our thirst to possess it have veered beyond control – alas, so that nothing will sate us anymore![1]

[1] Nietzsche, Friedrich. Nietzsche: The Gay Science: With a Prelude in German Rhymes and an Appendix of Songs (Cambridge Texts in the History of Philosophy) (pp. 246-247). Cambridge University Press. Kindle Edition.

A Bowl Full of Ideas for Inventive Minds – Release Date: 6/2/23!

Our next book will be coming out in a few weeks!

This is a short book for children and the young at heart, filled with 18 ideas from Joseph and accompanied by his artwork.

Every child is born a Holy Being

We are all on a journey—the Journey of the Holy Being. This journey starts when you are born. The secret is that you are already a Holy Being when you are born…Go ahead and read these ideas I am giving you, but beware because you will eventually become a Holy Being if you read this book! Actually, you already are—you just forgot . . .Joseph Rael (Beautiful Painted Arrow)

Available for Pre-order through:

Itasca Books

Barnes & Noble


We hope you enjoy this offering bowl of 18 Ideas to stimulate your inventive mind!

Medical Activism & Professional Identity

It seems that now, more than ever, it is important for physicians and health care workers and professionals to have a sense of professional identity that involves engagement and activism in the world to protect and promote human health. Human health cannot be attained in isolation from other humans and the community. This means that if any suffer, all suffer. Human health can also not be attained in isolation of environmental and ecological health. The word “health” has its roots in “wholeness” which situates the individual within the ecological.

If you are interested in health, the environment, and the medical humanities, consider joining the Doctor as a Humanist for our 2nd Annual Offering on Nature & Medicine a webinar on Saturday, November 5th, 2022 – register for free here.

Here is some background on my evolving work on the concept of medical activism and its relationship with professional identity – from a University of Washington-Idaho Psychiatry Grand Rounds 1/20/22.

Recent Podcasts & Articles

I’ve been doing a few podcasts lately – which is always a fun chance to talk about some of the work I have been doing. I’ll include a few photos from the past year to remind us of the world within which we all live & work.

Yellow Warbler in crab apple tree, Seattle, WA

I spoke with Andrea Nakayama on her 15-Minute Matrix Podcast on “Mapping the Costs of Caring,” looking at burnout, compassion fatigue, moral injury, and soul loss in health care workers. Here is an excerpt speaking about the similarities of burnout and soul loss:

The soul is the thing that makes us alive and vital and engaged and connected around the world. When we lose that, we lose all those kinds of things that connect us to ourselves and to others…How do we bring the soul back? It would be what things make the soul happy, what kinds of things bring you joy? And so how can you build this into your life? I think the distinction is you could start with self-care to support the ego, in the sense of your personality, but I think of the healer, the role of the healers, to be honest with delving into what can be the breakdown of the ego, and then the rebuilding back as a healer.

Yellow-Rumped Warbler in crab apple tree, Seattle, WA

I had a very nice dialogue with Lewis Mehl-Madrona and Glenn Aparicio Parry on his Circle of Original Thinking Podcast, “Integrating Healing Traditions with Lewis Mehl-Madrona and David Kopacz.” Definitely check this out, such an honor to have a generous time to speak with Lewis & Glenn. Check out their great books as well!

The print edition of Parabola Magazine, Fall 2023 featured “This Vibrating Land,” an excerpt from an interview that I did with Glenn Aparicio Parry that we featured on The POV interview website.

I also had a book review “Lessons from A Field Guide to Getting Lost by Rebecca Solnit on CLOSLER as well as an essay “Building Cultures of Caring.” Here’s an excerpt:

Perhaps burnout is a symptom of a larger problem. Perhaps we’ve cut ourselves off from a root of support in our work, we have lost touch with a spiritual and humanistic dimension of who we are and that when one suffers, all suffer. We have lost touch with our interconnection, our non-duality. What did Mother Teresa, Mahatma Gandhi, and Martin Luther King Jr. draw upon when working with the immense suffering in the world? Gandhi spoke of satyagraha as “the Force which is born of Truth and Love,” and Dr. King, spoke of this as “soul force.” Perhaps we should consider developing some kind of non-dual medicine, some kind of practice of non-separation in our healing work.  

Whiskey Creek, Washington

A longer interview and dialogue was an invitation to speak on The Soul Space, entitled “Hero’s Journey & Resilience in the Face of Suffering,” (7/1/22).

Last, but not least – I had a chance to catch up with former Seattle VA Primary Care Mental Health Integration teammate Dr. Nicola De Paul on “Burnout, Moral Injury, and Radical Caring” on her Menders: Love & Leadership in Health Systems Podcast. Check out our dialogue as well Nicola’s discussions with other great thinkers working to bring Love & Leadership into Health Systems!

I also recently had the privilege of interviewing Richard C. Miller, PhD, the developer of iRest, Integrative Restoration, a form of yoga nidra. Here is the link to part I where we talk about his development of iRest and early influences, including J. Krishnamurti. Part II will be published soon on the interview site that Usha Akella and I developed, The POV.

If you have some down time, please check out any of these articles and podcasts that may be of interest to you, as well as look up some of the other great interviews on these podcasts!

Pacific Coast, Washington State

Burnout: Soul Loss & Soul Recovery keynote lecture at Seattle University, Saturday 6/25/22

The 13th Annual Giving Voice to Experience Conference will be available via online Zoom as well as for in-person attendence on Saturday 6/25/22 at Seattle University .

I will be giving the keynote 1:20 – 2:40 PM (Pacific Time), “Burnout: Soul Loss & Soul Recovery in Mental Health.” I’ve been interested in exploring the significant overlap between the ancient condition of soul loss and the modern occupational syndrome of burnout. I will be discussing burnout and soul loss from a variety of perspectives. I will be presenting material from my next book, Caring for Self & Others: Tools for Transforming Burnout, Compassion Fatigue, and Soul Loss. I have signed a contract with Creative Courage Press for publication early 2023.

I was originally going to present 3/7/20, but this was just at the start of the pandemic and as many events at that time it was cancelled. I am so exicted to be able to finally present this talk and the concepts of burnout and soul loss have a much deeper and personal meaning to me, now, after recent years.

The conference is $20 for students and $60 for general public and professionals. 6 CEUs (Continuing Education Units) are available.

Here is a link to the Conference Schedule, the theme is “Maintaining a Soulful Approach to Psychological Research & Practice: Swimming Upstream in a Technological Society.”

Here is the registration link.

Nautilus Book Awards – Gold & Silver Medals!

Our most recent two books were both chosen for Nautilus Book Awards! Due to the pandemic, books published in 2020 and 2021 were eligible for entry.

Becoming Medicine: Pathways of Initiation into a Living Spirituality (2020) by David R. Kopacz, MD & Joseph Rael (Beautiful Painted Arrow) was awarded a Gold Nautilus Award in category 24 C “Religions/Spirituality of Other Traditions.” This book is available in two editions, an Art Medicine Edition that is full color printed on glossy art paper and a reasonably priced black & white edition.

Becoming Who You Are: Beautiful Painted Arrow’s Life & Lessons for Children Ages 10-100 (2021) by Joseph Rael (Beautiful Painted Arrow) & David R. Kopacz MD was awarded a Silver Nautilus Award in category 35 “Young Adult Non-Fiction.” This book also won the Paterson Prize for Books for Young People this year.

Thank you to the Nautilus Book Awards who strive to recognized “Better Books for a Better World!”

Burnout: Soul Loss & Soul Recovery

I will be giving a keynote presentation at the 13th annual Giving Voice to Experience conference, whose theme is “Maintaining a Soulful Approach to Psychological Research and Practice: Swimming Upstream in a Technological Society.”

13th Annual Giving Voice to Experience Conference

“Maintaining a Soulful Approach to Psychological Research and Practice: Swimming Upstream in a Technological Society”

June 25, 2022, 8:30 am – 5:30pm, Seattle University 

Oberto Commons – Sinegal 200

My talk on “Burnout: Soul Loss & Soul Recovery” seems even more relevant now than it did when the conference was originally planned for March of 2020 – at that time the pandemic was just evolving and we didn’t know one day to the next whether we would be gathering or not. I was already, at that time, beginning to look at the similarities between burnout in health care and the ancient concept of soul loss. After all, what is it that stops burning in burnout? What is it that we lose when we feel we are just pushing ourselves through the motions at work? Where have our hearts gone? Where have our souls gone? Now, after two years of pandemic life and social distancing, as well as the larger social injustice issues and division in the USA and war and conflict in the world, it seems even more vital than ever that we re-connect to that which makes us fully human.

For a number of years, Seattle University used to host the Search for Meaning Book Fesitval that I attended regularly. It saddens me that SU is no longer running that program since 2017, but I am honored to speak there and be part of the tradition of inquiry into life’s meaning and greater purpose. Here is the abstract for the talk:

Keynote Information 

“Burnout: Soul Loss & Soul Recovery in Mental Health Care”

presented by David R. Kopacz, MD

Burnout and compassion fatigue are becoming the norm in healthcare after two years of a pandemic. The World Health Organization recognizes burnout as an “occupational phenomenon,” with feelings of energy depletion; increased mental distance from one’s job, negativism, and cynicism; and reduced professional efficacy. While many perspectives on burnout focus on prevention through stress management techniques, we can look at burnout as “soul loss” which can then become the beginning of a transformational healer’s journey. A transformational perspective shifts our focus to the care of the soul and on how to recover soul once it is lost – this is a valuable skill for us as healers to use in our own lives as well as in our therapeutic work with clients.

David Kopacz is a psychiatrist in Primary Care Mental Health at Seattle VA and a National Education Champion with the VA Office of Patient Centered Care & Cultural Transformation. He is an Assistant Professor at University of Washington and is certified through the American Boards of: Psychiatry & Neurology; Integrative & Holistic Medicine; and Integrative Medicine. David is a graduate of University of Illinois, undergraduate in Urbana-Champaign and medical school and psychiatric residency in Chicago. He has practiced in the US and New Zealand. His publications include: Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine; Caring for Self & Others: Transforming Burnout, Compassion Fatigue, and Soul Loss (in press); and with Joseph Rael (Beautiful Painted Arrow) Walking the Medicine Wheel: Healing Trauma & PTSD; Becoming Medicine: Pathways of Initiation into a Living Spirituality; Becoming Who You Are: Beautiful Painted Arrow’s Life & Lessons for Children Ages 10-100.

Here is the link to the conference for registration and a flier for the conference. 6 CEUs are available for the one day conference. For further information about the conference, please contact Professor Steen Halling: shalling@seattleu.edu

“The Gates of Paradise: Shamanic Memories from an Indian Visionary” – in Parabola (Summer 2022)

Thanks to Parabola Magazine for excerpting a passage from our latest book, Becoming Who You Are: Beautiful Painted Arrow’s Life & Lessons for Children Ages 10-100.

The excerpt is entitled “The Gates of Paradise: Shamanic Memories from an Indian Visionary,” and is availabe online in Parabola Summer 2022 Edition with the theme of Ancestors. It is currently available online, but the whole issue is worth reading, with an articles on P. L. Travers, Vaclav Havel, Nelson Mandela, and many different topics on the theme of Ancestors.

The article also features two of Joseph Rael’s paintings, “Sage Woman becomes visible to – bless “the People,” and “Crystal Chamber,” which I’ll include below.

We are very happy that this book is getting some notice as it is an autobiography of Joseph’s life specifically aimed at passing on wisdom to the next generation, how fitting that it is in the Ancestors issue of Parabola: The Search for Meaning. The book was also recognized as a winner of the Paterson Prize for Books for Young People.

Paterson Prize for Books for Young People – 2022

It is a great honor to receive the Paterson Prize for Books for Young People – Grades 7-12 – for our most recent book Becoming Who You Are: Beautiful Painted Arrow’s Life & Lessons for Children Ages 10-100! This is an annual book award put on by the Poetry Center at Passaic County Community College in New Jersey.

Paterson, is of course, home to the poet/doctor William Carlos Williams and the great beat poet Allen Ginsberg.

I visited Paterson in July 2017 when I was in New Jersey for work. I bought a copy of William Carlos Williams’ Paterson, and read it by the Great Falls of the Passaic River. If you can’t make it to Paterson in person, there is always the Jim Jarmusch film, “Paterson,” about a poet bus driver named Paterson.

What do I do? I listen to the water falling. (No sound of it here but with the wind!) This is my entire occupation.” (William Carlos Williams, Paterson, p. 46).

Thank you to The Poetry Center at Passaic County Community College for this award!