Words Create Worlds.1

This is a series I have been publishing over the past couple years in the online journal The Badger. The Badger is not a political journal, but in my work with Joseph Rael (Beautiful Painted Arrow) I have been seeing the intersection between spirituality and politics – particularly when politics is against peace and is against human rights. The spiritual path leads to ever greater states of union and love – and yet we are witnessing a resurgence of fascism which is based on separation, division and hate.

Thank you to The Badger for giving permission to post these essays in my blog. You can find the hub for all the issues here, and I will provide a link to the specific issue for each of these essays.

Words Create Worlds.1

A Memoriam for those Killed in the Christchurch Mosque Shootings

Originally published in The Badger, 2019, Year 5, Volume 1

“Words create worlds.” These are the words of Rabbi Abraham Joshua Heschel, here is the full quote, remembered by his daughter, Susannah Heschel:

“Words, he often wrote, are themselves sacred, God’s tool for creating the universe, and our tools for bringing holiness — or evil — into the world.  He used to remind us that the Holocaust did not begin with the building of crematoria, and Hitler did not come to power with tanks and guns; it all began with uttering evil words, with defamation, with language and propaganda.  Words create worlds he used to tell me when I was a child.  They must be used very carefully.  Some words, once having been uttered, gain eternity and can never be withdrawn.  The Book of Proverbs reminds us, he wrote, that death and life are in the power of the tongue.”[1]

I am writing this the day after 49 people were killed in two mosques in Christchurch, New Zealand (March 16, 2019). I have a personal connection to New Zealand, having lived there from 2010 – 2013. I visited Christchurch days before the second earthquake in 2011. I have a series of selfies my wife and I took walking across the courtyard in front of the Christchurch Cathedral, which was destroyed in the quake.

Since leaving New Zealand, I have been working with military veterans. The way I conceptualize my work is that I am helping to guide veterans from a war culture of the military world to the peace culture of the civilian world. It can be a tough journey after speaking words of war to speaking words of peace.

Red Begonias, Christchurch Botanical Garden, (D. Kopacz, 2011)

During this work, I was befriended by Joseph Rael (Beautiful Painted Arrow), who has been working for world peace since the 1980s when he had visions of Sound Chambers, Peace Chambers: circular structures, half above ground, half below ground, with men and women chanting for peace. He has created over 50 chambers for peace across four continents.

Working with Joseph has reinforced and shaped my identity as a psychiatrist who is not just treating mental illness, but is supporting cultural transitions and transformations, and is creating peace. Joseph would agree that “words create worlds.” He often talks about the power of sound and speech. When we were working on our book, Walking the Medicine Wheel: Healing Trauma & PTSD, Joseph would tell me, I am my brother’s keeper.” As I contemplated this saying, I realized he was not just stating a world-view of many indigenous people—that we are all interrelated and connected—but that he was also speaking an antidote to the first murder documented in the Bible. After Cain killed his brother, Abel, God asks Cain where Abel is and Cain says, “I do not know; am I my brother’s keeper?”[2] With these words an identity of separation is created in the Biblical tradition. Joseph, in saying “I am my brother’s keeper,” is using words as an antidote for an illness of separation which is once again becoming an epidemic in our world.

“Words create worlds.” J.M. Berger, author of Extremism, would likely agree with this statement. Writing for the Atlantic, he writes of the dangerous impact of publishing and thus publicizing the words of mass murderers.

“It is far past time to reconsider the standard for publishing such manifestos. That does not mean we should abandon the search for meaning. But manifestos are rarely simple confessional documents. They are works of propaganda, just like ISIS beheading videos and al-Qaeda’s Inspire magazine. Like those publications, journalists should report on manifestos, but they should mediate their propagandistic intent instead of blindly amplifying it. . .We have only begun to suffer the cost of these writings, crafted with an intent no less lethal than their authors’ violent crimes.”[3]

We find ourselves in a war of words. I try not to use the word “enemy.” To think of someone as an enemy is to make them “other” and this is the very root cause of violence, hatred, racism, and bigotry. To meet violence with violence or hate with hate does not create peace. Rather than enemy, I think opponent is a better term. The United States fought wars against England, Japan, and Germany. They were our opponents during the wars, but they are not our enemies. Consider the relationship between Gandhi and Jan Smuts. Smuts was the only person to sign the peace treaties ending both World War I & II. He advocated for the League of Nations following World War I. Yet, earlier in his life, he was a proponent of apartheid and he had a worthy opponent in South Africa on this, Gandhi. While Gandhi was imprisoned he made Smuts a pair of sandals. He returned the sandals for Gandhi’s 70th birthday, writing, “I have worn these sandals for many a summer, even though I may feel that I am not worthy to stand in the shoes of so great a man.”[4]

These two men struggled against each other for their beliefs, and yet they were not life-long enemies. Smuts literally walked in Gandhi’s shoes. We can wonder if this influenced Smuts’ later 1926 book, Holism and Evolution, in which he coined the word, “holism,” the concept of not seeing things through separation and isolation, but as component parts of a larger whole.

Christchurch, New Zealand (D. Kopacz, Feb 2011)

In this war of words we are struggling with our own darker natures, as well as the darker nature of all humanity. It is human nature to view ourselves as separate tribes and clans and peoples based on the superficial colour of our skin or which football team we support, or which religion we belong to. Yet there is also a deeper truth that we are all one, we are all interconnected, sharing the same Earth. The findings of scientists about Mitochondrial Eve and Y-Chromosome Adam tell us that we all are, literally—not just figuratively—brothers and sisters.[5]

This war of words is a struggle about what kind of world we are going to create: a world in which everyone is equal and everyone has a place and a voice, or a world which is only for some people, a world where some people have more rights than others. This is a struggle of words and world-views which is being waged in the hearts and minds of all human beings on planet Earth as we try to come to terms with our interrelatedness and oneness.

Gerald Arbuckle, a Catholic priest and cultural anthropologist (who is from New Zealand and lives in Australia) has been studying the effects of loneliness and isolation and the resurgent rise of fundamentalism in our world.

He calls this a “global epidemic of fundamentalism both religious and political,” and he defines fundamentalists as “boundary-setters . . . marking themselves off from others.” Arbuckle sees, “A typical fundamentalist leader is a populist, homophobic, charismatic, authoritarian man who likes to bully,” a personality type that is only all too common in positions of power across the world.[6]

To see ourselves as separate from others opens the doors to discrimination, racism, and violence. Separation leads to loneliness and authoritarian and fascist movements promise a way out of loneliness through belonging to a tight-knit in-group based on an exclusionary identity opposed to another group or culture. Fascisms power comes from having an “other” who is an enemy. We should be very suspicious of the use of this word “enemy,” for instance in hearing the press called the “enemy of the people,” which is an age-old fascist trope.

Christchurch Cathedral – February 2011, prior to being destroyed in earthquake (D. Kopacz)

New Zealand Prime Minister, Jacinda Ardern’s response to these recent killings was this: “Because we represent diversity, kindness, compassion. A home for those who share our values. Refuge for those who needs it. And those values will not and cannot be shaken by this attack.”[7]

New Zealand is geographically isolated, tucked away in the South Pacific, it has a strong anti-nuclear policy, refusing to allow nuclear U.S. warships into port. In New Zealand, the police do not openly carry guns. One former patient of mine, a teenage refugee from the Balkans, told me, “As soon as I saw the police here in New Zealand do not carry guns, I finally felt safe after years of war.” Now we have a major act of terrorism in New Zealand. In the United States we have debates over gun violence. Second Amendment Rights advocates always argue for more guns after gun violence, but research on gun ownership and gun violence shows that guns are more likely to be used in suicide or against someone in the home than they are against a violent “other.” In the United States, powerful lobbies and ideologies actually banned scientific research on gun violence for fear that it will lead to restrictions in gun ownership.[8] How do we respond to gun violence, terrorism and acts of hatred? Research for individual gun ownership does not support that we should all arm ourselves. The suspected killer in Christchurch, a 28 year-old, Australian born man targeted this gun debate and wanted to fuel the flames. Reporting in the New York Times states:

“Writing that he had purposely used guns to stir discord in the United States over the Second Amendment’s provision on the right to bear arms, he also declared himself a fascist. ‘For once, the person that will be called a fascist, is an actual fascist,’ he wrote.”[9]

We should take a closer look at this word, “fascist,” including its current manifestations and history, because it is like a disease that our global civilization has had a recurrence of in recent years.

Duke professor of Asian and Middle Eastern Studies, Omid Safi writes of these killings,

“This terrorist attack is not an aberration. This is not about mental illness, it is not about one person. This is where all the anti-Muslim, anti-immigrant discourse over the last few years leads to.”[10]

Safi sees the roots of these killing in the ideas and words of white supremacy and he anticipates the gun rights arguments that “guns don’t kill people, people with mental illness kill people.” Yet when we have the confluence of easily accessible lethal means and a growing epidemic of violent words, there is an increase in violent actions. “Words create worlds.”

Nietzsche warned us that those who fight something risk becoming the very thing they fight, “Whoever fights monsters should see to it that in the process he does not become a monster. And when you look too long into an abyss, the abyss also looks into you.”[11]

Pink Begonias, Christchurch Botanical Gardens (D. Kopacz, 2011)

Clarrissa Ward, from CNN, sees a similarity in the ideas and words of the far-right and terrorist organizations.

“To me, there’s almost a symbiotic relationship happening right now between extreme terrorists on the far-right and between some of these other terrorist organizations that we’re more familiar with.

The other thing that’s interesting, and disconcerting, frankly, is how much of the language and ideas he [the Christchurch killer] talks about have also seeped into mainstream political rhetoric.

He talks a lot about the idea of invasion, that Muslim migrants are invading white Western countries. He talks about the birth rate, the idea of replacement, that white culture is being replaced. We’ve heard such words coming from the President of the United States. We’ve heard them coming from far-right governments in Europe, whether it be Italy, whether it be Hungary. . . .

When you look at the zeitgeist and the rise of the far right in Europe and the US, ideas that were once considered as taboo to talk about are now being flaunted and public discourse invariably sets a tone.”[12]

Ward raises this disturbing spectre that Western Democracies are at risk of becoming our enemies—state-sponsored terrorism and extremism. The disturbing rise of far-right ideologies and words is being supported at the highest levels of governments across the globe.

Over the next year, I would like to write about some of these topics of how our “words create worlds.” In working with Joseph Rael, writing our next book, Becoming Medicine: Pathways of Initiation into a Living Spirituality, I felt compelled to write about the responsibility of mystical, visionary, and shamanic experience—that we must work toward “Spiritual Democracy.” At its deepest point, mystical experience leads to an awareness that we are all one and this comes with a responsibility to challenge words of separation which ultimately lead to fascism. Mystical experience is a pathway that leads us to question who we are and gives us a responsibility to use our words wisely to create worlds where we are becoming the medicine that our world needs. As Rumi says, “We are pain and what cures the pain.”[13]

Cape Reinga, North Island, New Zealand – meeting of the Pacific Ocean and the Tasman Sea (D. Kopacz, 2013)

[1] Life Between the Trees blog, https://lifebetweenthetrees.wordpress.com/2012/08/06/words-create-worlds-monday-morning-parable/ I first came across a shorter instance of this quote in the Omid Safi reference below.

[2] The Holy Bible: Revised Standard Version, Second Catholic Edition, Genesis 4.9.

[3] J.M. Berger, “The Dangerous Spread of Extremist Manifestos: By sharing the writings of terrorists, media outlets can amplify their impact,” The Atlantic online, 2/26/19, https://www.theatlantic.com/ideas/archive/2019/02/christopher-hasson-was-inspired-breivik-manifesto/583567/.

[4] Mahatma Gandhi, The Essential Gandhi: An Anthology of His Writings on His Life, Work, and Ideas, ed. Louis Fischer, 98.

[5] This is discussed in National Genographic DNA results. Also see Siddhartha Mukherjee’s The Gene: An Intimate History and “Y-Chromosomal Adam,” Wikipedia.

[6] Gerald Arbuckle, Fundamentalism At Home and Abroad, 28, 9, 15. Also see his recent book, Loneliness: Insights for Healing in a Fragmentary World.

[7] Lucy Bennett “Christchurch mosque massacre: Prime Minister Jacinda Ardern speaks to nation following shootings,” New Zealand World Herald, 3/15/19, https://www.nzherald.co.nz/crime/news/article.cfm?c_id=30&objectid=12213187.

[8] Arthur L. Kellermann, et al, “Gun Ownership as a Risk Factor for Homicide in the Home,” New England Journal of Medicine, 10/7/93, https://www.nejm.org/doi/full/10.1056/NEJM199310073291506. February 13, 2013

Arthur L. Kellermann and Frederick P. Rivara, “Silencing the Science on Gun Research,” Journal of the American Medical Association, https://jamanetwork.com/journals/jama/fullarticle/1487470. J. John Mann, M.D., Christina A. Michel, “Prevention of Firearm Suicide in the United States: What Works and What Is Possible,” American Journal of Psychiatry, Published Online: 22 Jul 2016, https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.16010069 .

[9] “New Zealand Shooting Live Updates: 49 Are Dead After 2 Mosques Are Hit,” New York Times, 3/15/19, https://www.nytimes.com/2019/03/15/world/asia/new-zealand-shooting-updates-christchurch.html.

[10] Omid Safi, Facebook, 3/15/19, https://www.facebook.com/omidsafi/posts/10157227737858793.

[11] Friedrich Nietzsche, Beyond Good and Evil, Aphorism 146, trans. Walter Kauffman (1989).

[12] Clarissa Ward, “How language in the attacker’s purported manifesto mimics the words of ISIS and al Qaeda,” CNN, 3/15/19, https://www.cnn.com/asia/live-news/new-zealand-christchurch-shooting-intl/index.html.

[13] Rumi, “We are the mirror as well as the face in it,” The Essential Rumi, trans. Coleman Barks, 106.

The Art of Becoming Medicine.17

The next two paintings in Becoming Medicine: Pathways of Initiation into a Living Spirituality include one from me and one from Joseph Rael.

With these paintings we are entering into Chapter 10: Enlightenment & Endarkenment. My contribution is “Blue Feather,” inspired by Richard Bach’s book, Illusions. In the book, the teacher Donald Shimoda is encouraging his student, Richard, to practice visualizing from imagination into reality.

Blue Feather, David Kopacz

The painting from Joseph is “Candle of the World #1 – Ordinary and Non-ordinary Realities,” showing 2 candles facing each other with a circular counter-clockwise movement between Ordinary and Non-ordinary Realities. We’ll have Candle of the World #2 in a later series.

Candle of the World #1 – Ordinary and Non-ordinary Reality, J. Rael (2017)

“Listen!” he called across the gulf between us. “This world? And everything in it? Illusions, Richard! Every bit of it illusions! Do you understand that?” (Richard Bach, Illusions, p. 69).

The Art of Becoming Medicine.16

The next two art works from Becoming Medicine: Pathways of Initiation into a Living Spirituality are both done by Joseph Rael (Beautiful Painted Arrow).

The first painting is “When the People Went into the Cave of Existence and Returned as Made People Ceremony.” Joseph often speaks of the True Human and how it is an ongoing process and effort to become a True Human. This painting links the cave as a place of self-connection and transformation, we are still in Chapter 9: Guha: Cave of the Heart.

When the People Went into the Cave of Existence and Returned as Made People Ceremony, J. Rael (2006)

The next painting is “The Vase of Love and Light,” which features a vase with the medicine wheel of the four seasons.

The Vase of Love and Light, J. Rael (2014)

“The ‘c’ in ‘cave’ is pronounced ‘Kay.’ There is a blanket that has been placed over that moment when the people go into a cave, that is why caves were created in the beginning by the original architect, even before goodness. We don’t know who the original architect is. God is a phenomenon that we have created. Kay means to cover oneself up with the blanket of something, getting blindsided. But you have to do that, you have to go in blindsided, covering your vision, you can’t be a visionary unless you go into this darkness. Kay also means the beginning. Something has ended. Kay means something has ended because something has just been born, so the caves in ancient time, the caves over here in Colorado, the metaphor of the caves means a beginning. You are blindsided, you have to be blindsided to go into the caves.” (Becoming Medicine, p. 227, Joseph Rael)

The Art of Becoming Medicine.15

The next two paintings from Becoming Medicine: Pathways of Initiation into a Living Spirituality are both by me. They are both from Chapter 9: Guhā: Cave of the Heart. I came across this Sanskrit word, guhā, meaning “cave of the heart,” and I thought it fit quite well with Joseph’s description of the human being as a medicine bag and the center of the heart being represented by the essence of carrying. Our hearts need to be empty at some point in order that we can find their fullness at a later point.

The first painting for this chapter is “Heart Meditation” which I painted around the start of working on Walking the Medicine Wheel: Healing Trauma & PTSD. I realized, at some point, that our heart, although we often think of it as light, labours away in the darkness of our chest. Our heart never sees the light of day. It is up to us to enter into the darkness of ourselves, the darkness of our chests, to bring forth this light hidden in the darkness.

Heart Meditation, D. Kopacz (2014)

The next painting is “Heart at the Center of Dark Matter.” Joseph is always sending me clippings from science news sources about dark matter and dark energy. The Tiwa mysticism is based on going into the kiva and sitting in the darkness to await the emergence of visions and revelations. In this painting I tried to capture the central medicine wheel within the darkness of the heart sending out energy into the cosmos. This painting was from near the end of Walking the Medicine Wheel.

Heart at the Center of Dark Matter, D. Kopacz (2016)

I asked Joseph about the meaning of caves and this is what he said:


Nah au kwee leh neh is the Tiwa word for cave. Nah means ‘self.’ Au kwee – means ‘curved.’ Leh neh means ‘straight like a fence.’ “Nah means that when we enter a cave, we are entering into ourselves and we should think of the cave as our self. We should expect that when we first enter the cave it will turn every which way and it can get confusing, but eventually it will straighten out and you will then find what you are seeking.

“When I was a kid, I would ride my bike and swerve back and forth. I would pretend that I was riding in a cave and swerving down the passageways.. . . I would pretend I was in a golden, diamond-studded cave with jewels as big as coffee cups. Each jewel would have a special sound—I would listen for it in my imagination. My grandfather said that I should listen to things as I moved through them, like passing by rows of trees on either side as I rode my bike and I would listen to them singing. I always was really fond of trees and I spent as much time with them as I could.”

Joseph Rael (Beautiful Painted Arrow)

The End of E pluribus Unum? The De-evolution of “Out of Many, One,” to ME First

Medical Activism Series.2

Doctors Against Fascism Series.2

Article originally published in the online magazine The Badger, 2017, Year 3, Volume 2.

My concerns of the risk to our Union are even greater now than they were in 2017. This article was inspired by the removal of the motto of the United States from the presidential coin as described in the Washington Post article by David Nakamura & Lisa Reinin in the Dec 22, 2017 article, “It’s ‘very gold’: The presidential coin undergoes a Trumpian makeover.”

“The presidential seal has been replaced by an eagle bearing President Trump’s signature. The eagle’s head faces right, not left, as on the seal. The 13 arrows representing the original states have disappeared. And the national motto, “E pluribus unum” — a Latin phrase that means “Out of many, one” — is gone.”

Instead, both sides of the coin feature Trump’s campaign slogan, “Make America Great Again.”

The Great Seal of the United States, Public Domain, Wikipedia

The motto of the United States is E pluribus unum, which is Latin for “Out of many, one.” Joseph Rael (Beautiful Painted Arrow) and I have written about the importance of this motto in our book, Walking the Medicine Wheel: Healing Trauma & PTSD. This motto is of crucial importance for helping veterans return home after war and reconnect to their own hearts and to society, which is why Joseph and I wrote about it, but it is also crucial for all of us and the very fabric of democracy―in the United States as well as in the rest of the world. The ability to see our similarities rather than our differences allows us to see that the suffering of others suffering is our suffering and that others joy is our joy. When we view other human beings as “other,” this sense of separation makes violence possible. Peace comes from a sense of unity, not a sense of “otherness.” “The heart of violence is the divided and separated heart,” we write, the heart of violence is “the heart that cannot see other hearts as interrelated and interconnected.”

“Violence has its roots in the false idea of separation. Physically we appear separate, but even physically we are in a complex web of life with animals, plants, and the earth. When we begin to speak about human realities beyond the physical: emotion, heart, intuition, and spirit, the idea of ourselves as separate beings no longer makes sense. One can only be violent against someone or something seen as ‘other,'” (Kopacz & Rael, Walking the Medicine Wheel: Healing Trauma & PTSD, 214).

Currently in the world, we are seeing more division and separation than coming together in unity. The recent order by the president of the United States banning all international refugees and also citizens of Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen from entering our Nation of Immigrants is the latest and most extreme example of this. This breaks my heart and it breaks the heart of democracy. I worry for the future because, through my work with Joseph, I know that peace depends upon unity and similarity and that the current mania for separation and division is very dangerous. The rise of nationalism has historically been associated with violence and the rise of totalitarian regimes for the very fact that an over-emphasis on “me first” leads to seeing “others” as getting in my way. We teach our little children, “Don’t rush to the front of the line, don’t push others aside.” We teach our children to respect others, and yet respect has been one of the first casualties in the current national and world-wide Me First Movement. In a very, very short time, the public dialogue has shifted so far toward disrespect and hatefulness that people feel justified in hate speech and separation speech.

We are seeing the rise of nationalism world-wide: Brexit, throughout Europe, the Philippines, the United States, Russia, and Turkey. Nationalism very easily leads to violence against “others” and once the mad dog of nationalism is let off leash, even a country’s own people can all too easily be labeled as “others.” The media, which often serves as a watch dog to power, is often the first to be vilified and silenced.

Our institutions of unity and collectivism are being seen as obsolete, holding us back, ineffective. The institution of democracy, the United Nations, NATO, the European Union―these are the organizations that we have created to moderate human selfishness in order to promote peace and equality. Parker Palmer, in his book Healing the Heart of Democracy, writes that democracy is one of the ways that we, as human beings, seek to civilize ourselves. Palmer sees democracy as one of our best tools of civilization and that these tools “constitute the core self-hood called the human heart” (Palmer, 81).

“For those of us who want to see democracy survive and thrive―and we are legion―the heart is where everything begins: that grounded place in each of us where we can overcome fear, rediscover that we are members of one another, and embrace the conflicts that threaten democracy as openings to new life and for our nation,” (Palmer, 10).

How much are we the people of the United States of America making decisions from the heart? To what extent are our current elected officials leading from the heart? What will happen to us if we give up on unity, if we glorify everything falling apart? Louis Ferdinand Céline, writing about World War I, wrote that people had become “madder than mad dogs” because dogs don’t worship their madness.       

“Could I, I thought, be the last coward on earth? How terrifying! … All alone with two million stark raving heroic madmen, armed to the eyeballs? With and without helmets, without horses, on motorcycles, bellowing, in cars, screeching, shooting, plotting, flying, kneeling, digging, taking cover, bounding over trails, root-toot-tooting, shut up on earth as if it were a loony bin ready to demolish everything on it, Germany, France, whole continents, everything that breathes, destroy, destroy,  madder than mad dogs, worshipping their madness (which dogs don’t) a hundred, a thousand times madder than a thousand dogs, and a lot more vicious! A pretty mess we’re in!” (Céline, Journey to the End of the Night).

Céline bore witness to the brutality of World War I and he calls himself a “coward” because he doesn’t want to join in the blood bath of killing “others.” However, non-violence has been raised to a spiritual virtue and political power by people like Martin Luther King Jr. and Gandhi. (Céline did succumb to his own madness and cowardice in turning against the Jewish people in the lead-up to World War II, and citing him here in regard to World War I in no way condones his later anti-Semitism). I choose to quote Céline because his phrase “madder than mad dogs, worshipping their madness (which dogs don’t)” keeps echoing in my mind recently. There is something very scary about the Me First Movement in U.S. politics that is worshipping madness, division, and hatred. This is happening in the United States of America―right now, yet it has roots going back over the past decades, and honestly back to the history of the European colonization of this land.

Going back to the early days of the U.S. “war on terror,” journalist, Andrew Cohen, wrote “Our journey toward Abu Ghraib began in earnest with a single document — written and signed without the knowledge of the American people” (The Atlantic, “The Torture Memos, 10 Years Later,” February 6, 2012). Cohen continues:

“On February 7, 2002…President George W. Bush signed a brief memorandum titled ‘Humane Treatment of Taliban and al Qaeda Detainees.’ The caption was a cruel irony, an Orwellian bit of business, because what the memo authorized and directed was the formal abandonment of America’s commitment to key provisions of the Geneva Convention. This was the day, a milestone on the road to Abu Ghraib: that marked our descent into torture — the day, many would still say, that we lost part of our soul.”

White House Counsel, Alberto Gonzales wrote that the Geneva Conventions should not restrain the United States any longer in how we treat prisoners. “In my judgment, this new paradigm renders obsolete Geneva’s strict limitations on questioning of enemy prisoners and renders quaint some of its provisions,” he wrote. I remember this as a very disturbing philosophical position our government took as it eroded the work of many countries and peoples work to prevent war crimes. When we stop appealing to our higher humanity and to our collective sense of ourselves as brothers and sisters―even while temporarily enemies―we not only take away what makes others human, but we lose our humanity as well. This is because humanity is a two-way street of interaction and of unity. Humanity is a state of interactive being and when we take away this human state of being from others (whether they be Muslims, women, African-Americans, American Indians, people with different sexual orientations or identities, or anyone who disagrees with us), we lose our own humanity as well and we risk becoming mad dogs worshipping our madness as we have let ourselves of the leash of humanity. It is difficult to understand the current anti-immigrant sentiment in the U.S. because anyone who is not a full-blooded American Indian is an immigrant to the United States. The current president of the United States is an immigrant, as are most of us who have come together as one people in the United States.

It breaks my heart to see the people of the world turn our backs on the institutions we have worked so hard to create that call forth our higher humanity and work to promote peace. What we are witnessing is a kind of war of the many against the One. William Butler Yeats, writing in the aftermath of WWI, in 1919 captured this spirit in his poem, “The Second Coming,” which includes the lines:

             “Things fall apart; the centre cannot hold;

             Mere anarchy is loosed upon the world,

             The blood-dimmed tide is loosed, and everywhere

             The ceremony of innocence is drowned;

             The best lack all conviction, while the worst

             Are full of passionate intensity.”

The loss of central cohesion, the centripetal force of humanity, leads to the break-down of our sense of shared humanity paves the way for dangerous economic and social policies and paves the way for violence against “others” whose humanity we have taken away, thereby losing our own humanity.

By Edward Moran – Museum of the City of New York, Public Domain, https://commons.wikimedia.org/w/index.php?curid=229787

Under the new administration, many career diplomats at the US State Department have been asked to leave. One such career diplomat is Tom Countryman who, in his retirement speech said:

“And we want Americans to know that the torch borne by the Statue of Liberty is not just a magnet for immigrants, it is a projector, shining the promise of democracy around the world.  The United States is the world’s greatest economic power, the world’s greatest military power, and with your vigilance, it always will be.  But the greatest power we project is hope, the promise that people can establish liberty in their own country without leaving it.”

In an interview with Steve Inskeep on NPR on February 1st 2017, he further expanded on this idea of the Statue of Liberty as a projector.

“I mean that the promise of America is not just that people can come here and build a better life, a free life. But I’ve been overseas in countries where the American model of democracy has been a powerful inspiration for people to build democracy at home without the need to immigrate to the United States. And if we build walls between ourselves and other countries, we will dim that light forever.”

By Source (WP:NFCC#4), Fair use, https://en.wikipedia.org/w/index.php?curid=39992533

One of our primary global institutions of peace is the United Nations. The United Nations, formed in 1945 in the aftermath of World War II, includes 193 states and serves as the earth’s only inclusive organization that promotes peace between countries and condemns violence. The newly appointed U.S. Ambassador to the U.N., Nikki Haley threatened the organization in her first speech, saying that “we are taking names” and repeating that “this is a time of strength” (Somini Senguptajan, “Nikki Haley Puts U.N. on Notice: U.S. Is ‘Taking Names,’” The New York Times online, January 27, 2017). The speeches and positions coming out of the current administration sound more like those of school-yard bullies than of elected democratic officials. “War is peace, freedom is slavery, ignorance is strength,” this motto of George Orwell’s dystopian society in his book, 1984, warns us about the kind of rhetoric we are now hearing from the Nation of Immigrants. The ME First Movement does not play well with others and it distorts facts and reality to suit its needs. The only thing more dangerous than a bully is a group of people blindly following a bully.

Joseph Rael (Beautiful Painted Arrow) was recognized by the United Nations in a 2/20/89 letter for his work promoting peace through building Peace Chambers on four different continents. What Joseph has taught me is that the work of peace is spiritual work, and spiritual work is what makes us true human beings. Peace requires us to be seekers of our common goodness, our common shared humanity. The place that we find this common goodness and unity is in our hearts.

“If we remember E pluribus unum on the Great Seal of the United States, we will remember that we are called to work toward an ideal that moves us from our many individual identities into a larger Union. E pluribus unum is Latin for ‘Out of many, one.’ This identity is not just the social body of peacemakers, it is also the mystical and spiritual identity of visionaries and mystics. This is the realm of unity that Joseph is familiar with as a visionary and healer,” (Kopacz & Rael, 215).

If we focus on separation and division, we not only destroy peace, we promote violence. This is why Joseph and I say that we all must move from seeing each other as “other” and move toward seeing each other as brother and sister. This is why we cannot give up on E pluribus unum―within the myriad of forms, we must always be seeking the spiritual unity of humanity and the cosmos.

You can access The Badger, 2017, Year 3, Volume 2 for the articles by other authors.

Medical Activism: A Draft of a Working Paper

Activism: A Foundational Element of Professional Identity

Over the past year I have been thinking about the idea of medical activism. I started drafting a paper and have wanted to pursue some of the sub-topics in greater depth and breadth, but I have lacked the time to put this together due to numerous other projects. Still, I believe that these ideas should be circulating at this particular time in history. I do not mean this as a definitive statement on medical activism, but rather I mean it to open a conversation.

Abstract:

The idea of medical activism has been criticized lately, from both inside[1] and outside[2] of the medical field. This paper takes the position that medical activism is a foundational element of professional identity – it defines who we are as professionals as opposed to being technicians or employees of institutions. Medical activism prioritizes caring and advocacy in the face of competing priorities of productivity and profit. Activism can take many forms, but its essence is when caring and healing extend  beyond the internal biochemistry and inner thoughts of the client to include all the factors that we know influence individual and public health: childhood history, trauma, relationships, human rights, toxin exposures, environmental influences, and access to education and self-care. Two broad categories of medical activism are: 1) the reform of health care delivery systems, and 2) action in the political, cultural, legal, relational, and natural environments. These can also be conceptualized as internal (medicine in the clinic & hospital: having to do with the practice and delivery of health care) and external (medicine in the world: addressing public health issues outside the clinic or hospital). Examples of health care reform that will be considered are the movements of holistic and integrative medicine, Whole Health at the VA, the recovery movement in mental health, trauma-informed care, and addressing physician and health care worker burnout and suicide. Medical activism is born, again and again, when circumstances demand, from the identity of the physician/clinician as a professional and a moral agent in society whose “lane” is to treat disease, alleviate suffering, and to promote population health and well-being at local, national, and global levels. We need to make sure that the practice of medicine remains focused on healing and not just on making healthy profits or meeting institutional needs. Since the original conceptualization of this paper, new threats have arisen to the professionalism of medicine: fascism and political attacks on science. These political events, more than ever, remind us that if we do not use our voices we may lose them. Nourishing medical activism keeps the focus on care and compassion in health care and society. We must all adopt identities of what Parker Palmer calls “the new professional” and Robert Jay Lifton calls the “witnessing professional” in which we become moral agents within our world, tearing ourselves away from the never-ending demands of the Electronic Medical Records system, raising our gaze from the computer screen to the world we all live in.

Introduction:

The practice of medicine has changed greatly over the last 75 years, shifting from a practice of largely general practitioners who knew their patients over their whole lives to a fragmentation into sub-specialties, and the proliferation of multiple profit-deriving entities: the pharmaceutical industry, the insurance industry, and for-profit hospital and medical industry. During this time, doctors’ roles have shifted from independent healers engaged and embedded in communities to interchangeable and expendable bit-workers on ever more “efficient” medical assembly lines. Medicine has shifted from a focus on long-term healing relationships to a transactional, technician-based delivery system in which doctors are protocol-managers and data entry clerks.

The idea of medical activism encompasses the role of the physician as a moral agent, a member of a profession who answers to a higher calling. A professional has a moral calling that goes beyond the marketplace of the exchange of money or the influence of power. In speaking of medical activism, we wish to ground our discussion in the ancient profession of medicine, however we do also want to be inclusive and also use “medicine” in a larger context of health care professionals. The term, “healthcare activism,”[3] is a much larger term encompassing grass roots and activist/organizer movements. We do not mean to neglect this critical cultural force of health and healing, however for the purposes of this paper we are concerned with the identity of health care professionals as activists and medical activists.

In this paper we will develop the idea of medical activism as a form of moral agency which is a foundational element of professional identity. While there are many different forms of medical activism, we will focus on a few forms, such as, speaking out, bearing witness, critiquing systems and practices that contribute to disease and suffering, developing innovative delivery systems, reformulating philosophies of care and treatment, and advocacy to promote the health and well-being of individuals, local, national communities, and in this ever-more connected world, the global community. More recent public health issues have arisen with the Covid-19 coronavirus pandemic, the politicizing of sound public health measures (such as wearing masks and social distancing). Another growing public health concern is the growing fascist tendencies in the United States and abroad. We have a number of diagnostic manuals on fascism and we know that fascism is a public health issue: first it affects marginalized groups (Muslims, immigrants, Native Americans, African Americans, the LGBTQ community), then it affects those deemed dangerous to the regime (the “liberal” press, intellectuals, teachers, scientists, “liberal” politicians), and then it starts infecting more and more people with side effects of racism, xenophobia, hate speech toward the above groups, and eventually violence toward the above groups. To the end of cautioning the public about the public health risks of fascism, the formation of the professional organization, Doctors Against Fascism is proposed.

What it Means to be a Professional

To be a professional means that one is constantly professing – similarly if one is a profess-or. The roots of the word “profession” have to do with taking vows and declaring openly and to make public statement. The etymology of the word is related to “profess” and “prophet” going back to the ancient Proto-Indo-European root, *bha-, meaning “to speak, tell, say.”[4] What we are doing as professionals is continual professing – to declare openly and to speak, tell, say.

            Our job as professionals it to profess, to declare openly, to speak, tell, say, to be prophets of health (which is different than focusing on the profits of the health care industry). The industry, the organization, the institution is not an inherently moral creation, it is more like a machine than a holder of morality, and it is the jobs of those professionals within the system to be the moral authority, the moral leadership of the institution.

De-professionalism

            With the rise of economic and productivity medicine we have seen a deprofessionalization[5] and dehumanization[6] of physicians and health care professionals. Corporate medicine is not interested in moral agents or medical activists, but rather what Foucault called “docile bodies,” to play limited roles within the institution. Moral agents and medical activists function independently or semi-autonomously, rather than as interchangeable technicians who dispense the same, generic, non-individualized treatment interventions. While corporate medicine pushes propaganda of customer service, true caring, compassion, and patient-centered care can only be given by individuals to individuals in the context of human relationships. Individuality and humanity are extraneous and problematic variables to corporate, machine medicine. 

Witnessing Professional

            Throughout his career, Robert Jay Lifton has written about the idea of the witnessing professional. He describes the shift toward “malignant normality,” “the imposition of a norm of destructive or violent behavior, so that such behavior is expected or required of people”.[7]

As citizens, and especially as professionals, we need to bear witness to malignant normality and expose it. We then become what I call “witnessing professionals,” who draw upon their knowledge and experience to reveal the danger of that malignant normality and actively oppose it. That inevitably includes entering into social and political struggles against expressions of malignant normality.[8]

The New Professional

In order to teach the next generation of doctors, healers, and clinicians, we need to provide good role models for students to emulate. This is the transmission of knowledge and wisdom that happens from one generation to the next. Without medical professionalism, medical ethics, medical morals, students are left morally adrift. Author and educator, Parker Palmer speaks of the new professional, “a person who not only is competent in his or her discipline but also has the skill and the will to resist and help transform the institutional pathologies that threaten the profession’s highest standards.”[9]

Palmer states that “the very institutions in which we practice our crafts pose some of the gravest threats to professional standards and personal integrity. Yet higher education does little if anything, to prepare students to confront, challenge, and help change the institutional conditions under which they will soon be working.”[10]      

“The notion of a ‘new professional’ revives the root meaning of the word. This person can say, ‘In the midst of the powerful force- field of institutional life, where so much conspires to compromise the core values of my work, I have found firm ground on which to stand―the ground of personal and professional identity and integrity―and from which I can call myself, my colleagues, and my profession back to our true mission.’”[11]

Science presents itself as “value-free” but the practice of medicine is one of moral agency.

Medical students enter the profession of medicine with idealism (which we know our medical education system diminishes) and yet they also enter having cultural biases. Research has been done on medical student attitudes toward homosexuality,[12] AIDS,[13] abortion,[14] the homeless,[15] immigrants,[16] and torture[17],[18] and how those attitudes might shape clinical care decision.

The Practice of Medicine as Continual Revolution & Reform

The beginning of Western Medicine is often said to have begun with Hippocrates who, rejected supernatural causes of illness, establishing the beginning of the scientific method and initiating a revolution of the truth which vanquished the other, competing, schools of medicine. The choice of Hippocrates as the “Father of Medicine” is somewhat arbitrary, as the study of nature, health, illness, and healing is ancient and has been practiced by all cultures. Hippocrates stands out as a medical activist in the musings of writers of history, as a medical activist championing science, rationalism, empiricism, and materialism.

The Structure of Scientific Revolutions

Thomas Kuhn, in The Structure of Scientific Revolutions, describes the stages of progress in science, starting with “normal science,” which mainly consists of technical puzzle solving. There comes a time when enough anomalies accumulate which do not fit the current scientific paradigm, which eventually leads to a crisis point. At the crisis point, the majority of scientists continue to adhere to a paradigm which is no longer as helpful as it once was, while a smaller group of scientists begin exploring new paradigms. Scientific revolution occurs when a new viable paradigm arises and there is conflict between the old and the new.

Semmelweis

Before the acceptance of germ theory, in the mid-1800s, Semmelweis tried to convince doctors that they should wash their hands after leaving off doing autopsies and before examining mothers who had just given birth. Although this seems common sense to us from our vantage point, Semmelweis was ridiculed, lost his appointment, and died in a mental institution. The concept of invisible pathogens was not part of the existing paradigm of understanding disease. We can consider Semmelweis as a medical activist who tried to protect the well-being of his patients and challenged the medical establishment.

Virchow

In the late 1800s, Virchow was tasked by the Prussian government to research an outbreak of typhus, in Upper Silesia, which had a large minority of Polish people living in poverty. His prescription was social and political: elimination of social inequality.[19] He came back with recommendations regarding poverty, services, and even political recommendations. This resulted in him losing his job. He wrote, “Medicine is a social science and politics is nothing more than medicine on a large scale,”[20] and that doctors “are the natural attorneys of the poor.”[21]

Social Determinants of Health

In addressing social determinants of health, Vicente Navarro writes that “we need to broaden health strategies to include political, social and cultural interventions that touch on the social (as distinct from the individual) determinants of health,” (15).[22]

Moral Determinants of Health

Berwick’s recent article, “The Moral Determinants of Health,” argues for an expansion of the role of professionals to include societal reform. “Healers are called to heal. When the fabric of communities upon which health depends is torn, then healers are called to mend it. The moral law within insists so.”[23]

Refounding: Reinvigorating the Founding Principles of Health Care

Another line of support for viewing medical activism as a core element of medical professionalism comes from anthropologist Gerald Arbuckle’s work on the concept of “refounding” in organizations. Arbuckle has observed that, over time, organizations and institutions lose touch with their original founding vision. A crisis-time comes and a “refounding individual” arises who challenges the status quo and seeks to revitalize the institution by bringing it back in line with the original, founding vision. The new state is a hybrid integration, though, of the new state of the surrounding culture and the original vision. This is to say it is not simply a return to the historic founding rules of the institution, but is a creative adaptation of the founding vision with a modern re-interpretation. An opposite way of trying to resolve the institutional crisis is a literal and rigid return to the past, which Arbuckle describes as the root of fundamentalism. Fundamentalism is reactionary and resists any change, growth, or adaptation. Refounding is a hybrid, bringing the spirit of the old into a new formulation within a new time and place. Arbuckle’s descriptions of the “refounding person” are consistent with the idea of the medical activist that we are discussing.

The ongoing health of institutions requires “refounding persons,” who remember the “original instructions” of the institution, the principles and ideals upon which the organization was founded but periodically loses its way. The refounding person is like the hero or heroine in Joseph Campbell’s hero’s journey – an individual who takes on what seems like an individual challenge that turns out to be healing for the entire community and places the people back in harmony with sacred and with the world. The refounding person is a person whose job it is to declare openly, to speak, say, tell, that we have lost our way, we have gone out of balance, and that we have to work to get ourselves back in balance, internally as individuals, in our relationships, in our community, and within our larger culture and our interrelationships with the world.

Cultural Models of Medicine within Contemporary Health Care

Interestingly, Arbuckle has worked in medical institutions as a consultant and this led to his book, Humanizing Healthcare Reforms. One of the challenges in healthcare reform, he finds, is that there are multiple cultures at play within modern medical settings and that in discussions between various clinical staff, accountants, and leadership, people bring different cultural world views, however these views are not clearly articulated and defined, so they are like invisible walls that impair discussion. He describes different cultural models of healthcare: traditional (indigenous medicine), foundational (Western values of care for the poor, sick, and suffering), biomedical (scientific, evidence-based medicine), social (living environment and inequalities), and economic rationalist (the business model of medicine with a focus on efficiency and productivity). These different cultural models of healthcare inevitably lead to cultural clash and crisis. Medical activism, or refounding,  in healthcare would be a revitalization of some of the models of medicine (e.g. the traditional, foundational, and social) that have been neglected and suffered under the dominance of the economic rationalist and biomedical models. “In healthcare,” Arbuckle writes, “the need to refocus on moral and spiritual ideals means returning to a mission based on founding values such as solidarity, equity, respect and compassion,” (16).

Examples of Health Care Critique & Reform

An ongoing critique of the contemporary practice of medicine is a moral duty of physicians. It is up to us, as professionals, to hold true to the mission and purpose of health care: caring for people who are suffering and ill. Institutions may have vision and mission statements but they are incapable of moral agency and compassion because those are human traits, not bureaucratic functions. Within this critique of contemporary medicine, we will look at several issues: burnout, physician suicide, the pressure on physicians and health care workers to become narrowly defined technicians rather than healers, and the general loss of caring within the practice of health care.

Holistic and Integrative medicine are examples of reform and refounding. Many advocates of holistic and integrative medicine have felt corporate and biological reductionistic medicine have lost touch with the heart and soul of what it means to be a healer. The science of medicine has nearly eclipsed the art of medicine.

The following are some bullet points to be more fully developed:

  • Limits of evidence-based medicine
    • Groopman, How Doctors Think
    • Beahr, The Limits of Scientific Psychiatry
    • Pathological Objectivity
      • Scientism – scientific fundamentalism
      • Defensive mechanism
      • As part of burnout triad – extreme form of emotional distancing
  • Re-humanizing Medicine
    • Healer vs. Technician
    • Counter-curriculum of re-humanization
    • Compassion Revolution
  • Holistic & Integrative Medicine
  • Recovery Model in mental health
  • Physicians for a National Health Program
  • Micropractice, Ideal Medical Practice
    • Work of L. Gordon Moore[24]
  • Burnout
    • Institutional factors
    • Danielle Ofri: “The Business of Healthcare Depends on Exploiting Doctors and Nurses” [25]
  • Physician suicide
    • 300-400 suicides/year, size of three average medical school classes

Medicine in the World – Possible sections

The “first task of the doctor is therefore political: the struggle against disease must begin with a war against bad government,” (Foucault).[30]

Samuel Shem, in his essay, “Fiction as Resistance,” writes:

“We believed that if we saw an injustice, we could organize, take action, and change things for the better…When we entered our internship, we were told to treat our patients in ways that we didn’t think were humane. We ran smack into the conflict between the received wisdom of the medical system and the call of the human heart.”[31] Shem describes turning to fiction writing as a resistance to “brutality and inhumanity, to isolation and disconnection.” His recommendations on how to resist “the inhumanities in medicine” are four suggestions: 1) “Learn our trade, in the world” to be aware that “Medicine is part of life, not vice versa;” 2) “Beware of isolation. Isolation is deadly; connection heals;” 3) “Speak up…speaking up is essential for our survival as human beings;” 4) “Resist self-centeredness…learn empathy.”[32]

Bullet points to more fully develop examples:

  • Human Rights
    • Human Rights Medicine & Psychiatry, e.g. international trauma work
    • LGBT Rights
    • Women’s Rights
    • Culture, Diversity, Religious Tolerance – addressing racism and intolerance
    • Immigration policy and public health
  • Racism
    • Black Lives Matter
  • Trauma-Informed Care
  • Judith Herman’s view of the tendency to forget trauma and the need to for those who work with traumatized populations to bear witness and be moral agents.
  • Peace/Recovery from War & Violence
    • The influence of Buddhism and Mindfulness in Health Care
    • Gun Violence
  • Preserving/Continuing Healing Traditions
    • e.g. Shamanic work, physicians working with indigenous cultures who have written on benefits of incorporating elements into contemporary medicine
    • Lewis Mehl-Madrona, in a study of Indigenous elders, learned that “Healers have to maintain some independence from political structures.”[33]
    • Medical Pluralism[34]
  • Social, Climate, Environment
    • Flint, Michigan – lead in drinking water
    • Poverty
    • Homelessness
    • Promoting the health of the Earth
  • Public Safety

A recent example of professional activism is found in the book, The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts assess the President. Many well-respected researchers and clinicians came together to raise awareness of public health and safety concerns stemming from their view of the dangerousness of the 45th president of the United States. Stephen Soldz and Brandy Lee write that

“Professionals are an important component…helping to provide checks on powerful institutions and alerting the public to wrongs. Professions operate with an implicit social contract with the broader society to contribute their special knowledge and training for the greater good.”[35]

They caution that what “is often missing from [ethics] training is any deep engagement with fundamental ethics principles and ethical thinking.” They see the comments and actions of the 45th President as a risk to public health and safety and feel that the safety risk comprises a duty to warn which overrides the past Goldwater rule which prohibits psychiatrists from diagnosing public figures.

They argue that the ethical principles of justice and universality “direct health professionals to pay attention to the wider world beyond the clinic as they call upon us to serve the broader public, not just those who become our patients. And they direct us toward the world of public policy and of ‘politics,’ broadly defined, as a way of collectively improving public health.”[36]

            Soldz and Lee mention a number of recent examples of health professional activism, including opposing the involvement of psychologists and health professionals in torture under the Bush administration; opposing the use of psychiatrists in the Soviet Union to punish dissidents; physicians against nuclear war; physicians against land mines; and physicians supporting civil rights and health equity; and physicians for a national health plan.[37] They write that these examples illustrate that “activism by health providers is compatible with and even integral to professional responsibility toward society.”[38]

            In this same volume, Robert Jay Lifton writes of the ideal of “witnessing professionals” who combine a “sense of outrage with a disciplined use of our professional knowledge and expertise.”[39] Lifton cautions that if we define ourselves too narrowly, as technicians, we lose our sense of identity as witnessing professionals. This is a caution alongside those who argue that many professions are being deprofessionalized.

  • Doctors Against Fascism
    • Proposed founding of this organization based on the systemic fascism in politics affecting public health
  • Doctors as Public Health Advocates
  • The Institute of Peace Medicine

I have long thought of writing a book called, Re-spiritualizing Medicine. This does not mean going backwards into religious fundamentalism, but rather recognizing that human beings are inherently spiritual creatures. By spirituality I do not mean religion, but rather a sense of aliveness, vitality, connection to other people, connection to the natural world, connection to something larger than our own egos. The spiritual underlies our sense of interconnectivity with humanity and all life.

Since 2016 I have been working with Southern Ute visionary artist and healer, Joseph Rael (Beautiful Painted Arrow). His work since the 1980’s building Sound Peace Chambers around the world led to him being recognized by the United Nations for his work for world peace. Ultimately, peace is a public health issue, although we do not often think of it that way. War, violence, hatred, oppression, racism – all these are the opposite of peace. Perhaps we should found an Institute of Peace Medicine to address the social and moral determinants of health, but also to promote peace, unity, and non-duality as core human principles to protect and nurture human life and the life of the planet.

Spiritual Democracy

Joseph and I borrowed the term, spiritual democracy from Steven Herrmann. This idea of spiritual democracy also addresses many of the social and moral determinants of health. It also is an antidote to fascism. Fascism is founded on division and separation of us and them and on the priority of the will of the leader, and a small group of people defined to be like the leader, over the social good of the global community. Here is what Herrmann writes about spiritual democracy:

“Adopting the big idea of Spiritual Democracy, the realization of oneness of humanity with the universe and all its forces, can help people feel joy, peace, and interconnectedness on an individual basis. It can also inspire us to undertake sacred activism, the channeling of such forces into callings that are compassionate, just, and of equitable heart and conscience, and give us some tools to start solving some of these grave global problems, while uniting people on the planet.”[40]

Sacred Activism

            The idea of spiritual democracy is related to the idea of sacred activism. This goes a step beyond professional or medical activism, but grows out of a common love and care for humanity and our environment. Herrmann credits Andrew Harvey for originating this term:

“Each of us, it seems, is guided by such a star and it varies in its fixed orbits, in different fields of sacred action, in every person’s life. A central existential task is to discover what that star is and to make its light, the inner fire of human love, burn brightly against the darkness, as a calling to live by. . . . Sacred activism is a spiritual practice for bringing about planetary changes through a receptivity to, and response to, experiences of a mysterious energy, force, or power, which move through the human body, psyche, and entire cosmos in an effort to bring about alterations of consciousness, cultural transformation, and ultimately: world peace.”[41]

World peace may seem like a big goal, but would that not bring about the greatest improvement in public, global health? The current US administration pulling out of the World Health Organization and the UN Human Rights Council is the opposite of what will heal us – as individuals, as communities, and as a stewards of the global ecosystem. Spiritual democracy, sacred activism, re-spiritualizing medicine and an Institute of Peace Medicine are logical extensions of the doctor and clinician as moral agents and profess-ors of public health.

Conclusion

We stand at a unique time in history – a global pandemic, smear campaigns against public health experts, attempts to silence or manipulate science for political ends, the politicization of basic, scientific principles of public health. We also stand at a time when fascist words are turning into fascist behaviors.[42] We have seen these early symptoms in the 20th Century and they can become fulminant and more deadly than a viral pandemic. Now, more than ever, we as physicians, we as clinicians, need to re-claim activism as a core identity. We need to speak, tell, say, to speak openly, to speak publicly about the public health threats of this time in history. We have guidance of those physicians and clinicians who have gone before us and how they have spoken up for the health of the people and the public.

            We can draw on Robert Jay Lifton’s development of the witnessing professional. We can draw on Parker J. Palmer’s development of the new professional. We can draw on the moral foundations of our professions, to become moral agents for social change as we diagnosis and treat the moral determinants of health and the public health threats of the day.


[1] “Take Two Aspirin and Call Me by My Pronouns: At ‘woke’ medical schools, curricula are increasingly focused on social justice rather than treating illness,” Stanley Goldfarb, Wall Street Journal, 9/12/19

[2] “Doctors Revolt After N.R.A. Tells Them to ‘Stay in Their Lane’ on Gun Policy,” Matthew Haag, The New York Times, Nov. 13, 2018. The original criticism was in a Tweet from the NRA, “Someone should tell self-important  anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.” https://twitter.com/NRA/status/1060256567914909702

[3] Laverack, Glenn. Health Activism: Foundations and Strategies. Sage: Thousand Oaks, 2013.

[4] Online Etymology Dictionary for “profession,” “profess,” “prophet.” https://www.etymonline.com/search?q=profession

[5] http://www.professionalsaustralia.org.au/blog/deprofessionalisation-matter/

[6] Kopacz, David. Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine. Washington DC: Ayni Books, 2014.

[7] Lifton, Robert Jay. Losing Reality: On Cults, Cultism, and the Mindset of Political and Religious Zealotry. New York: The New Press, 2019, p. 189.

[8] Lifton, Robert Jay. Losing Reality: On Cults, Cultism, and the Mindset of Political and Religious Zealotry. New York: The New Press, 2019, p. 190.

[9] Palmer, Parker. The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life. San Francisco: Jossey-Bass, 2007, p. 202.

[10] Palmer, Parker. The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life. San Francisco: Jossey-Bass, 2007, p. 199.

[11] Palmer, Parker. “A New Professional: The Aims of Education Revisited.” Change, Vol. 39, No. 6 (Nov-Dec, 2007), pp. 6-12.

[12] Klamen, D, Grossman, L, and Kopacz, D. (1999). Medical student homophobia. Journal of Homosexuality, 37 (1): 53-63.

[13] Kopacz, D., Klamen, D., & Grossman, L. (1999). Medical students and AIDS: Knowledge, attitudes and implications for education. Health, Education & Research, 14 (1): 1-6.

[14] Klamen, D, Grossman, L, & Kopacz, D. (1996). Attitudes about abortion among second-year medical students. Medical Teacher, 18 (4): 345-346.

[15] Morrison, A., Roman, B. & Borges, N. Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes Toward Homeless Persons. Acad Psychiatry 36,211–215 (2012) doi:10.1176/appi.ap.10080112

[16] Hudelson, P, Perron, NJ, & Perneger, TV. (2010). Measuring Physicians’ and Medical Students’ Attitudes Toward Caring for Immigrant Patients. Evaluation & the Health Professions, 33(4), 452–472. https://doi.org/10.1177/0163278710370157

[17] Dubin K, Milewski AR, Shin J, Kalman TP. Medical Students’ Attitudes toward Torture, Revisited. Health Hum Rights. 2017;19(2):265–277.

[18] Bean J, Ng D, Demirtas H, Guinan P. “Medical students’ attitudes toward torture,” Torture 18/2 (2008) pp. 99–103.

[19] Mackenbach, J. (2009). Politics is nothing but medicine at a larger scale: Reflections on public health’s biggest idea. Journal of Epidemiology and Community Health (1979-), 63(3), 181-184. Retrieved August 8, 2020, from http://www.jstor.org/stable/20720916

[20] Quoted in Vicente Navarro. What we mean by social determinants of health. Global Health Promotion Vol. 16 (1):5-16; 2009. Original reference: Virchow R. Die medizinische Reform, 2 in Henry Ernest Sigerist, Medicine and Human Welfare 1941:93.

[21] Mackenbach, J. (2009). Politics is nothing but medicine at a larger scale: Reflections on public health’s biggest idea. Journal of Epidemiology and Community Health (1979-), 63(3), 181-184. Retrieved August 8, 2020, from http://www.jstor.org/stable/20720916

[22] Vicente Navarro. What we mean by social determinants of health. Global Health Promotion Vol. 16 (1):5-16; 2009

[23] Berwick DM. The Moral Determinants of Health. JAMA. 2020;324(3):225–226. doi:10.1001/jama.2020.11129.

[24] L. Gordon Moore, ‘Going Solo: Making the Leap,’ Family Practice Management. February 2002, American Academy ofFamily Physicians website, accessed April 7, 2012.http://www.aafp.org/fpm/2002/0200/p29.html .

[25] Ofri D. The Business of Healthcare Depends on Exploiting Doctors and Nurses: One resource seems infinite and free: the professionalism of caregivers. The New York Times, June 8, 2019.

[26] Dean W, Talbot S, Dean A. Reframing clinician distress: Moral injury not burnout. [published correction appears in Fed Pract. 2019 Oct;36(10):447]. Fed Pract. 2019;36(9):400-402.

[27] Norman SB. Moral Injury. National Center for PTSD website. https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp. Accessed April 27, 2020.

[28] ZDoggMD. It’s Not Burnout, It’s Moral Injury. March 18, 2019. https://zdoggmd.com/moral-injury/47 . Accessed July 30, 2020.

[29] Talbot SG, Dean W. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. STAT. July 26, 2018. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/. Accessed July 30, 2020.

[30] Michel Foucault, The Birth of the Clinic (New York: Vintage Books, 1994), 38.

[31] Shem, Samuel. Fiction as Resistance. Annals of Internal Medicine. Vol 37(11):934-937; 2002.

[32] Shem, Samuel. Fiction as Resistance. Annals of Internal Medicine. Vol 37(11):934-937; 2002.

[33] Mehl-Madrona, L. “What Traditional Indigenous Elders Say About Cross-Cultural Mental Health Training,” Explore, 2009, 5:20-29.

[34] Michael H. Cohen, Healing at the Borderland of Medicine and Religion (Chapel Hill: University of North Carolina Press,2006), 3.

[35] Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xxviii.

[36]  Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xxxi.

[37] Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xxxiv – xxxv.

[38] Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xxxv.

[39] Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xlix.

[40] Steven Herrmann, Spiritual Democracy: The Wisdom of Early American Visionaries for the Journey Forward, xiii.

[41] Herrmann, Spiritual Democracy, xvii–xviii.

[42] I have been writing a series of essay under the heading, “Words Create Worlds,” in the online magazine The Badger, https://beingfullyhuman.com/?s=words+create+worlds&submit=Search.

The Art of Becoming Medicine.14

The next two art works from Becoming Medicine: Pathways of Initiation into a Living Spirituality are both by Joseph Rael (Beautiful Painted Arrow). The first painting is “The Blowing Breath of Dark Energy.” I have a small photo of this piece in my office, near where I work. Joseph is fascinated by scientific discoveries around dark matter and dark energy. Joseph says that “darkness is where all the good ideas are.” I’m not sure how old this painting is – it is from a number of 35 mm slides of Joseph’s artwork that we had transferred to digital.

The Blowing Breath of Dark Energy, J. Rael (2020)

The next art work is “The Underside of a Far Larger Ship.” Joseph often speaks about space, ETs, and the stars as our relatives and home. He says that according to traditional teachings, we came from the stars and one day we will return there. This is an image of a vision of ship he saw flying above the Earth.

The Underside of a Far Larger Ship, J. Rael (2015)

These art works are from Chapter 7: Story Medicine and it opens with a vision Joseph had of a new creation story:

Joseph Rael’s New Creation Story


Joseph called me with a dream/vision he had one morning:


“Grandmother was making strong black coffee one morning and brought a cup to Grandfather. She also brought the coffee upstairs to the children and gave it to them so that they would get out of bed. She wasn’t supposed to do this, so she didn’t tell Grandfather this. [Joseph relates that this happened to him when he was a young boy, that he was given coffee secretly in the morning to wake him up so he would get dressed for school].

“When Grandfather drank the coffee he had an epiphany, an inspiration. He had a white sheet of paper in front of him and he hit it and it made the sound, one—weh-mu! He hit it again and it made the sound, two—wehseh! Then again, three—paah-chu! He continued to hit the paper ten times, counting out the numbers of inspiration one through ten: four—wii, five—paah-nu, six—maa-tschlay, seven—cho-oh, eight—wheh-leh, nine—whiii, ten—tehn-ku-teh. He hit the paper with a multi-colored colored pencil that he had and with each hit he created a circle of colored light that emanated out
from the Big Bang of the central point.


We talked about this vision for a while and I wondered why God needed the cup of coffee for inspiration (I do live in Seattle). I wondered if the black liquid coffee could represent the blackness of the Void that existed before creation. I like this idea that God drank in liquid blackness and out of this inspiration came a vision, which Joseph describes as the soul drinking light—and out of inspiration comes rainbow circles of light creating Creation out of sound, light, color, breath, and vibration.

In Joseph’s vision, we also have the interaction of the feminine and the masculine in creation, the feminine providing the inspiration through the liquid black of coffee, but also showing the introduction of duality and
the use of coffee for both the inspiration to create the Universe, but also abusing the coffee to force the children awake. In the exegesis of the vision, Joseph mentioned that the Grandmother was an older generation than the Grandfather, not necessarily the partner of the Grandfather, but maybe the Grandmother of the Grandfather—thus we have the interesting idea that perhaps the Grandfather was one of the children that the Grandmother was trying to get up, dressed and off to school, and what slipped out was that the child/Grandfather smacked the paper 10 times and created the Universe before running off to school.

Joseph explained that prior to the Grandfather having the epiphany, he was living in darkness, in the Vast Self. He was an artist who had learned to see in the dark, making his sketches. He hadn’t yet moved into the Circle
of Light. “Darkness is where all the good ideas are,” says Joseph, this is where the source of inspiration is. With the first hit of the paper, simultaneously a sound and light are created. This is the point of light at the center of the medicine wheel. It is the light of epiphany, the light of movement, there is now a central organizing point. With each hit of the paper, a new colored circle of light of the medicine wheel is created.


In talking about this dream/vision, Joseph says, “Of course we are God, we are the artist.” Each of us is creation, but we also keep creation going through our lives and as we cycle through the medicine wheel we create energy—the friction in our lives creates sparks and gives off light. The medicine wheel gives a structure, organization and context to all life events. It shows how life moves in circles: each year we move from winter to spring to summer to fall and back to winter again; each life comes from the earth and returns to the earth; each inspiration and epiphany begins in the North (winter/spiritual) and then moves to the East (spring/mental), then to the South (summer/emotional), and then to the West (fall/physical). The medicine wheel explains how spiritual inspiration becomes mental idea, becomes emotional feeling, and then becomes a physical thing in material reality. The medicine wheel shows that there is no artificial boundary between the spiritual and physical, rather there is a bridge, or a rolling wheel that moves the energy along, manifesting in different dimensions at different times.

(Joseph Rael, Becoming Medicine, 167-169).

The Art of Becoming Medicine.13

The next two art works from Becoming Medicine: Pathways of Initiation into a Living Spirituality are both by me.

“Dove of the Holy Spirit,” is a bright and vibrant painting – colors exploding out of the blackness of the void. I keep it by me, on my desk, where I work.

Dove of the Holy Spirit, D. Kopacz (2017-2018)

The next painting is, interestingly, a bird flying in the opposite direction to the first painting. I did a series of two paintings of crows flying through the darkness of the void. Joseph often speaks of dark energy and dark matter and is fascinated by these energies and spaces that we can infer but that we cannot see with our usual senses.

Crow Flying through Cosmos, D. Kopacz (2018)

“Carrying is the same as initiation. At sunrise, the sun’s light initiates the day. At sundown, the sunlight initiates the night by ending the light of the day and beginning the dark of night. Similarly, life is carrying all that is; all plants, animals, and things. Life initiates us into linear time. We live from one moment to the next one. We live inside each moment, then it passes on so that we can become something new. A past moment that just died carries and becomes the foundation for the new knowing that was just born.” (Joseph Rael, p. 165, originally from Sound, p. 111).