The Time is Right to Revisit Health Care for All – A Review of Dr. Quentin Young’s Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause

“The time is always right to do the right thing.”

― Dr. Martin Luther King, Jr

The US response to the public health crisis of the pandemic and extremism has been sorely lacking. While these two infections may seem unrelated at first, there are ways that they are interconnected.

Institutional policies of inequality lead to poorer medical and social outcomes (see Wilkinson & Pickett’s The Spirit Level: Why Greater Equality Makes Societies Stronger). Inequality is also leading to higher death rates from “diseases of despair” from overdoses, suicides, and the consequences of alcoholism (see Deaths of Despair and the Future of Capitalism by Case & Deaton). In areas with higher rates of deaths of despair, there have also been “votes of despair” for nationalist, racist, authoritarian leaders.

Health is health. All health is holistically interconnected – physical, economic, social, political, moral, and spiritual.

Today, on Martin Luther King Day, I would like to give a brief review of the work of Dr. Quentin Young (9/5/1923 – 3/7/2016). I was familiar with Dr. Young’s work when I was a medical student and resident in Chicago (1989-1997) as described in Everybody In, Nobody Out: Memoirs of a Rebel without a Pause (2013). I saw him speak on Physicians for a National Health Plan and I would hear him occasionally on WBEZ Chicago Public Radio. He was a champion of Cook County Hospital and reading his book takes me back to my time in Chicago and my fond memories of clerkships at the old Cook County Hospital, Fantus Clinic, and Jorge Prieto Clinic where I did my family practice, general surgery, surgical oncology, and plastic & reconstructive surgery rotations as a medical student.

Over the past five years, I have felt a growing responsibility as a physician and a professional to speak up on what I have seen as public health risks from the attitudes, statements, policies (and lack thereof) of this presidential administration that is now in its last few hours. I have written on the need for physicians and professionals to have an identity that includes public, social, and moral responsibilities that go beyond the doors of the consulting room. (See Medical Activism: A Foundational Element of Professional Identity).

Dr. Quentin Young embodied the archetype of the physician as medical activist. He was Dr. Martin Luther King’s doctor when King was in Chicago – writing that he “became my hero…and my patient,” (53). He marched alongside Dr. King and tended his scalp laceration after being hit with a rock – after which Dr. King said, “I have to do this―to expose myself―to bring this hate out in the open,” (65). Dr. Young championed Cook County Hospital and sought to strengthen its network of community clinics when he was Chairman of Medicine there 1972-1981. Here is what he said he learned at County, “I am convinced that until we, as a nation, have a system of universal health care, including everyone―everybody in, nobody out―until we provide that, we as a society must provide care through a system like County,” (36).

Dr. Young was an active member of many different civil and human rights movements, including the Medical Committee for Human Rights where he marched and provided medical care in the South, he marched in Chicago with Dr. King, he provided medical care on the street at the 1968 Democratic National Convention, he was the founder of the Health and Medicine Policy Research Group, he served as president of the American Public Health Association, and national coordinator for Physicians for a National Health Program – to name just a few organizations. Throughout his career he worked for racial justice, universal health care, and improving the health care of the poor and marginalized. His work was as a doctor, an activist, an organizer, and a change-maker – in short, a medical activist par excellence. Dr. Young was not afraid of a good fight and his work brought him before the House Un-American Activities Committee before it disbanded in the late ‘60s.

Medical Witness

I had heard of the term, bearing witness, from my background in trauma work. Dr. Young writes that the term, medical witness, was used in the Civil Rights movement. The work of the doctor in the Civil Rights movement was, “we bore not only our doctor’s bags, but witness,” (57).

“‘Medical witness’ was a term used in the movement to refer to bringing focus to an issue of indignity or an issue of inequity: visiting doctors offices that had ‘colored’ and ‘white’ waiting rooms, hospitals that had segregated wings and the very obvious disparities between the African American population and the white populations,” (74).

The Good Fight in the Name of a Good Cause

Dr. Young summarized a few teaching points on the good fight (pages 171-172).

  • Don’t be afraid to say the same thing over and over again to lots of different audiences
  • Always use sarcasm and humor
  • Draw on every literary and artistic device you can from Shakespeare to the Smothers Brothers
  • Always connect lots of different struggles: from struggles against racism to struggles to end the war to struggles to get resources for the community
  • Always remember to draw on and recall past great heroes such as Dr. King
  • Don’t be afraid to take on established offices of power, to struggle against them and make them become enabling resources for the movement
  • Yes, there are great risks of selling out, like becoming the boss at County, but in this there is also opportunity to inspire and catalyze and gain support for the struggle from below
  • Know when to move on
  • Sometimes you need to strike a balance between long-term commitments―which are lifelong―and tactical strategies―which have to be constantly rethought
  • Don’t be afraid to be labeled a radical or a socialist

Health Care in the USA is a Failed Experiment with Market Forces

Mardge Cohen and Gordy Schiff write of working with Dr. Young. For him, they say, “Organizing for political demonstrations, lobbying politicians, disrupting visits for key phone calls and meeting outside of the office, were all part of how he appreciated and served patients,” (177). They describe that Dr. Young saw that doctors and patients have to work together, saying

“the personalization of the individual and the destruction of the community, the emblems of our time, are conspicuously manifested in the role models enacted in the healthcare settings. A revised concept would envision changes in the role of physicians, nurses, and other health providers and in the role of the patient who would come to be regarded as the keeper of his or her own medical health,” (177-178).

Cohen and Schiff quote Dr. Young as saying about health care in the USA, that the “diagnosis is clear, we have a failed experiment with market forces,” (178).

Medicine is Only One of the Determinants of Health

John McKnight writes in the book,

“[At] that time Quentin and I had worked in Cuernavaca, Mexico, with Ivan Illich, the radical critic and social historian. Illich emphasized that health was not the product of medicine. Rather, medicine was one of the numerous determinants of health and that it often misled people to believe that there was something called a ‘health consumer.’ Illich argued that you could ‘consume’ medicine but it was primarily the social, cultural and economic environment that ‘produced’ health,” (199).

Everybody In, Nobody Out (203)

Dr. Young was one of the early supporters of Physicans for a National Health Program (PNHP), founded by Drs. David Himmelstein and Steffie Woolhandler. This is where I first, personally, encountered Dr. Young, seeing him speak at a conference and I quickly became a student member of PNHP. My thoughts about a national health program have fluctuated over the years. When I ran a private micropractice for 5 years, I became aware of how vast and intercalated into the health care system the insurance industry is. I also became aware that the insurance industry describes paying for someone’s health care “a loss.” This is a fundamental philosophical and linguistic problem. If health care is viewed as a loss then the obvious thing to do would be to try prevent loss – in other words, the primary motive health insurance companies is to prevent health care from occurring – that is the bottom line of health insurance companies.

Living and working in New Zealand for 3.5 years I had a chance to work and receive care in a nationalized health care system. I received care in the public and private systems (at the time around 5% of health care in New Zealand was through the private systems and private health insurance was closer to the cost of car insurance in the US). I had national health insurance, even when I had the equivalent to a green card, when I was on the permanent residency track (incidentally, as a functioning participatory democracy New Zealand law requires all citizens, permanent residents, and even those on the permanent residency track to be registered to vote). For primary care, there was a small copay based on how wealthy the community you lived in. The system worked great and people were happy with it. Everybody was in, nobody was out.

The pandemic is teaching us how “great” the US health care system is―it is not! The United States ranks 37th in the world in health care, despite spending far and away the most. Also see the arguments of PNHP for a single-payer plan. The pandemic shows us that the health of all depends upon the health of everyone. If the virus is spreading through the community, it doesn’t matter who you are if you get exposed to it. The health of the individual is the health of the community and the health of the community is the health of the individual – you cannot disconnect these things, we are all in this together. The time is right to work for health care for all. It is time to Make America Healthy Again.

Dr. Young’s Final Words: “The future can be bright, but only if we work to make it so

“The health system isn’t working in this country―fiscally, medically, socially, morally,” (216).

“Health care is a human right. There should not be market solutions in a life-and-death game,” (217).

“We need to redouble our efforts to extirpate racism from every aspect of the U.S. life,” (240).

“We need to pass single-payer national health insurance, an improved Medicare for all. We cannot rest until everyone, without exception, has unimpeded access to high-quality care,” (240).

“We need to radically reduce the huge wealth disparities in our country, where the vast majority of our economic assets are controlled by the ‘1 percent,’” (241).

“We need to get big money out of politics and elections,” (241).

“And we need a more rational, humane foreign policy,” (241).

“Over the years, I’ve been accused by right-wing circles of being ‘un-American’ for having advocated for a more humane society. These charges have left me unfazed. I am merely an American who has exercised my constitutional rights. I remain unbowed,” (241).

“To a certain extent this book chronicles, from a health viewpoint, the evolution of the tension between these two trends―toward justice or injustice. Whichever trend prevails will define the 21st century.”

“I retain a terrible reputation for excessive optimism. The glories of humankind’s ingenuity and inventiveness have not yet been exhausted. The future can be bright, but only if we work to make it so,” (242).

The Art of Becoming Medicine.30

This is the final installment in the Art of Becoming Medicine. Joseph Rael (Beautiful Painted Arrow) and I have been featuring our artwork from our book, Becoming Medicine: Pathways of Initiation into a Living Spirituality. These are the last two paintings in our book, and fittingly one is by me and one is by Joseph.

“Heart Radiation” is from a series in 2014 I did when we were working on our book, Walking the Medicine Wheel: Healing Trauma & PTSD.

Heart Radiation, D. Kopacz (2014)

This painting is accompanying the text of the “Entering the Heart Ceremony” that we close the book with. This exercise, or ceremony, takes you through a series of doorways through your physical heart, the heart of humanity, the heart of life, the heart of creation, and finally into the heart of the Creator and the heart of the medicine wheel. At this point, the journey that we started in walking around the medicine wheel in our first book together is complete as we progress through initiations into being a shaman, a mystic, and a visionary and end in the center of the heart of the medicine wheel. We’ll offer this ceremony to you here:

Entering the Heart Ceremony

Find a quiet place where you will be able to sit for a while, either inside or outside. Find the center of the space where you will be sitting. Orient yourself to the North and take one step in that direction, honoring the place of innocence. Turn around, facing South, and step back into the Center of your medicine wheel, honoring the place of carrying. Take a step to the South, honoring the place of placement. Turn around, facing North and step back into the Center, again honoring the place of carrying. Turn to the East, and take one step forward, honoring the place of purity. Turn around, facing West, and step back into Center, honoring the place of carrying. Take one step to the West, honoring the place of awareness. Turn around and step back into Center, once again honoring the heart of carrying.
Now you will walk the medicine wheel. Face the East and take one step forward, intone the sound of the letter A_aaahhhhhhhhh, drawing out the sound as long as you can as you step around the perimeter of the circle to the South and then intone the sound of the letter E_eeehhhhhhhhh. Follow the wheel around to the West and intone the letter I_eeeeeeeee. Follow the wheel to the North and intone the sound of O_ooooooooo. Now step to the Center and intone the sound of the letter U_uuuuuuuuu.
Now you can sit comfortably in the center of the medicine wheel, this is the place of carrying and it is the heart of the medicine wheel. As Joseph reminds us, the microcosm is the macrocosm, thus this is the heart of the medicine wheel, it is your heart, it is the heart of the Earth, it is the heart of the Universe, and it is even the Heart of God—Wah Mah Chi—if you can walk deep enough into the heart.
We will now be going through a series of doorways. First we will enter your personal heart and trace the flow of blood through the medicine wheel of the heart. Venous blood, after giving its oxygen to the body, returns to the heart from the Northwest, the place of connecting spirit and body, entering into the right atrium. Next follow the flow of blood into your right ventricle in the Southwest, the place of the connecting body and emotion. From here the blood is pumped to the North, the place of Spirit and Innocence. Here the blood enters into the lungs and is transformed as the inner venous blood connects with the outer oxygen- rich environment coming into the lungs. The venous blood now turns from dark to bright red arterial blood as it carries more oxygen as the physical matter of the body creates a container in which the movement of the blood connects with the movement of the breath—thus we have Breath, Matter, Movement, thus we have Wah-Mah-Chi entering at this point. Next, follow the blood as it comes back into the heart from the Northeast, the place of connecting spirit and the mind, as it enters into the doorway of the left atrium. From here the blood travels to the Southeast, the place of connecting mind and emotion in the left ventricle. From here the arterial blood travels North, to the spirit again, and then travels throughout the body, revitalizing it and carrying the breath into matter through the movement of the blood.
The atria and ventricles of the heart are empty chambers that can fill with blood and then empty, a continual process of accepting what life has to give, allowing transformation, and then giving goodness away to the rest of the body. These empty chambers might remind you of the word that Abhishiktananda used—guhā: the cave of the heart. Now that you have circulated through your own personal heart, the time has come to enter into the center of your heart, for it is here that you will find the doorway into the deepest chambers of the cave of the heart, which we can also call the secret garden. Move into the center of the heart, this is the still point at the center of all the circulating movement of the burning fire of the blood. In this still center-point, look around for a doorway. It is dark here in the center of the heart, despite the burning of the blood, you can look with your eyes, but you need to see with your inner, non-ordinary vision. You must feel into it with your non-ordinary senses. Locate the doorway—it might be on the wall, or the ceiling, but it could possibly be on the floor as it leads deeper into the heart. Open the door of your heart and step through the threshold into this next larger space of your heart, feeling the opening of stillness and space within your center. You are now in the heart of humanity. Feel your way into this heart of humanity where your heart and the heart of humanity are one.
Once you have acclimated to the heart of humanity, begin looking for the next doorway that opens into an even deeper stillness of heart. Using your non-ordinary senses, locate the door, open it, and step through, entering into the heart of life. Open up into the heart of life where the heart of every living thing is one. Even things that don’t have an obvious heart like plants have their center here. Open up into this greater spaciousness, feeling more space open up within your heart and feeling a vastness that you are entering. Take some time getting comfortable in the heart of life.
Start to look around for the next doorway, looking all around with your non-ordinary vision. Find the door, open it, and step through into the heart of creation—this is the heart of every physical thing, all biological beings and rocks, water, soil, and even space. Feel this space open up within the center of your heart as you step forward into this vast space. Spend some time enjoying being one with creation.
There is still another doorway as you begin looking around again with your non-ordinary vision. In this realm, you get used to letting go of your identity—moving from the personal, to humanity, to life, to creation. Find the door, open it, and step through, entering into the Heart of God,
the Heart of Wah-Mah-Chi—the Heart of the Creator. Here you are One with everything, resting peacefully in the light of the Heart of the Creator. You have taken four steps through four caves of the heart. You have been practicing heart medicine as you have been circling deeper into the heart medicine wheel.
Now it is time to go into the heart of the heart medicine wheel, taking a step into the center of the heart of the heart medicine wheel. By now you should be used to using your non-ordinary vision to find the door, open it, and walk through, as you do so. You now are entering into what Joseph calls Vast Self. This is the place of non-duality. There is not even oneness, because it is before the counting even began. Feel the peace of Vast Self, the place before Creation, the place that watches Creation being created out of itself and yet remaining the same. Be still, be still . . . still . . .

The last painting by Joseph is “One Sun and Four Moons” from 2018. It also features black holes. Joseph has told me, in the past, that the black eyes of his spiritual figures in paintings are black holes.

One Sun and Four Moons, J. Rael (2018)

Although this is the ending of our The Art of Becoming Medicine series, working with Joseph is like always opening new doors. We are already nearing the end of a draft of our next book, Becoming Who You Are: Beautiful Painted Arrow’s Life & Lessons – a book for children of all ages, but particularly those in the transition from childhood into the teenage years. We have a rougher draft of a book for younger children called A Bowl Full of Ideas for Inventive Minds: Learning How to Count to Ten in Tiwa. We have also started the talking and idea stage of a book on Art Medicine, which will focus on Joseph’s visual art and the healing properties of artwork. There is always more to do with Joseph! The ending is just the beginning

The Art of Becoming Medicine.29

We are nearing the end of this series on the art from our book, Becoming Medicine: Pathways of Initiation into a Living Spirituality. These next two art pieces are by Joseph Rael (Beautiful Painted Arrow).

The first is “Rainbow Bird and Blue Star Woman,” a vibrant painting from 2009. Joseph’s Tiwa name, Tsluu-teh-koh-ay means Beautiful Painted Arrow, it can also mean Double Rainbow. At the lower left of the painting is “entrance to Oceanus’ cave.” Joseph often describes a vision he had of going to the bottom of the sea to meet Oceanus, the Lord of the Waters. This vision and Joseph’s relation to the ocean, even though he lives in the high desert, is important to him and he has advocated a ceremony on the 7th of each month for the purification of the oceans.

Rainbow Bird and Blue Star Woman, J. Rael (2009)

The next painting is another favorite of mine, “Up to 2000 Songs per Day of Bird Song Chiuu-Cho-Cha-Aah-Neh.” This section of the book these paintings are found in includes chapter 17 Returning to the Garden of Paradise and 18 Secret Journey to the Secret Garden.

Up to 2000 Songs per Day of Birdson, Chiuu-Cho-Cha-Aah-Neh, J. Rael (2005)

We are separated from the Garden by a paper thin space. It is a parallel reality. You are there without going there. We don’t have to walk there or even have to travel there. You travel with thought, not with physical energy and it pulls you there rather than you having to put effort on your part to get there. (Joseph Rael)

Words Create Worlds.9 – Death & Life are in the Power of the Tongue

Well – that is what we’ve been warning you about.

Words create worlds.

Violent words create violent acts.

Fascist words create fascist acts.

Seditious, treasonous, insurrectionist words create seditious, treasonous, insurrectionist acts.

Even after the debacle spectacle at the Capitol yesterday, 147 Republican lawmakers voted against democracy, voted to overturn the election.

I have been writing this column called, “Words Create Worlds,” about how what we say begins to create reality. Psychiatrist Robert Jay Lifton warns about malignant normality, when we gradually become desensitized to words and our reality gradually becomes malignant. Our country has become unhealthy in mind and body and spirit. We are suffering from a nearly unchecked spread of Covid-19 coronavirus pandemic – with no coordinated national public health policy and politicians actively promoting unhealth; we have also been suffering from a disease of the mind and social body: fascism. Now we have new words creating our worlds.

treason (n.)

c. 1200, “betraying; betrayal of trust; breach of faith,” from Anglo-French treson, from Old French traison “treason, treachery” (11c.; Modern French trahison), from Latin traditionem (nominative traditio) “delivery, surrender, a handing down, a giving up,” noun of action from past participle stem of tradere “deliver, hand over,” from trans- “over” (see trans-) + dare “to give” (from PIE root *do- “to give”). A doublet of tradition. The Old French form was influenced by the verb trair “betray.”

insurrection (n.)

“an uprising against civil authority,” early 15c., insurreccion, from Old French insurreccion or directly from Late Latin insurrectionem (nominative insurrectio) “a rising up,” noun of action from past participle stem of insurgere “to rise up.”

sedition (n.)

mid-14c., “rebellion, uprising, revolt, concerted attempt to overthrow civil authority; violent strife between factions, civil or religious disorder, riot; rebelliousness against authority,” from Old French sedicion (14c., Modern French sédition) and directly from Latin seditionem (nominative seditio) “civil disorder, dissension, strife; rebellion, mutiny,” literally “a going apart, separation,” from se- “apart” (see secret (n.)) + itio “a going,” from ire “to go” (from PIE root *ei- “to go”).

Meaning “conduct or language inciting to rebellion against a lawful government” is from 1838. An Old English word for it was folcslite. Less serious than treason, as wanting an overt act, “But it is not essential to the offense of sedition that it threaten the very existence of the state or its authority in its entire extent.”

Let’s return back to where this phrase originates with Rabbi Abraham Joshua Heschel.

“Words create worlds,” Rabbi Abraham Joshua Heschel.[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 thatthe 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.”[2]

Death and life are in the power of the tongue. We have a great sickness in this country and are in need of words of healing – not words of violence, not nasty words, not fascist words, not seditious words, not treasonous words, not insurrecionist words. We are in need of words of healing, words of unity, words of spiritual democracy. Let us stop creating destructive worlds through destructive words. Also, please wear your damn mask, we are in a pandemic and that is the most basic public health policy – it is not politics, it is science.

Here are the links to my essays over the past couple years on this subject:

Words Create Worlds.1: A Memoriam for those Killed in the Christchurch Mosque Shootings

Words Create Worlds.2: Rebecca Solnit and Calling Things by their True Names

Words Create Worlds.3: Remembering the Past & Learning from History

Words Create Worlds.4: The Fight for Humanity – or should we say – Working for Humanity

Words Create Worlds.5 To Fight Against This Age: On Fascism & Humanism

Words Create Worlds.6 Doctors Against Fascism

Words Create Worlds.7 – The Cure: Spiritual Humanity

Words Create Worlds.8 – The Public Health Crisis of Fascism

Ripple Effects of 2020

What have we gone through this past year? How can we know what we have gone through when we are still going through it? How can we see the ripple effects, the unforeseen consequences, and the unconscious antecedents of this past year?

When we don’t even know, fully, what we have gone through, what we are going through, and where we are going – how can we even guess how the ripples of our own experiences will interact with the ripple effects of others’ experiences?

Are we lost at sea? Floating in waves of the Cosmic Ocean?

Are we on solid land, or in the waves? Is it calming down, or are amplitude waves and surges building?

Where are we supposed to be? Now that we think we are out of the swells of the Ocean, maybe we were better off there, maybe now we are stranded and stuck.

Can we stop? Can we pause? Can we study the patterns of what we have created in the midst of what has been creating us?

Maybe what we thought we knew is not what we should have known – or maybe now we see that there is a need for a new knowing, a gnosis of the complexity of interactions between individual and society, between humanity and nature, between statehood and global citizenship.

Can we find some meaning and wisdom by slowing down and reading the signs of the destruction before we jump to rebuilding? Was the “old normal” really the society that we want to live in, that we want the coming generations to live in?

We are moving into the future at every moment. At every moment we are leaving the past. We are where we are now, and this is the place that we must live and build our future on the foundations of the past.

Admittedly, the pandemic is a big event, with lots of ripple effects and unforeseen antecedents and consequences. But were we really living the lives we wanted – the best lives for all of us and for the environment? Are our social creations of the economy, the transportation infrastructure and technology, our capitalist economic system, the level of poverty and homelessness – even pre-pandemic, the education systems, the health care systems (which have revealed their vulnerabilities and our lack of a public health system and the limitations of caring within health care and society in general) – are these the systems that we want? These systems and institutions weren’t found in nature. Somebody created them – it must have been us.

How is the way we are living, the society we have created, impacting the environment? What does our footprint in the natural world look like?

Some of us may think we were not very affected by the pandemic – and yet if one is affected, all are affected.

No man is an island entire of itself; every man 
is a piece of the continent, a part of the main; 
if a clod be washed away by the sea, Europe 
is the less, as well as if a promontory were, as 
well as any manner of thy friends or of thine 
own were; any man's death diminishes me, 
because I am involved in mankind. 
And therefore never send to know for whom 
the bell tolls; it tolls for thee. 
(John Dunne)

We each have our own experiences of the pandemic, and yet there are patterns, similarities – we are all in this together!

Can we all find our common humanity? Can we learn to appreciate the ecosystems and milieus in which we live and how everyone is interconnected and that we are responsible for what happens in our slip stream, even if the consequences are unintended?

Can we learn to see the ripple effects of our actions, the patterns that we create, the collateral damage and “unintended consequences” of our institutions and systems?

Can we build a beautiful and harmonious pattern within society – that amplifies others rather than drowning them out, excluding them, or hoarding all the resources people and the planet need to be healthy, publicly healthy, globally healthy?

Must we build our tight little circles of exclusion, our walls of xenophobia?

Can we expand our perspectives?

Can we open up our hearts and minds and lives to the world? Can we embrace our interconnectedness rather than build fortresses in the sand?

What will we choose to do in the new present, once things get back to normal? Will we re-create a malignant normality, or will we create a beautiful and healthy society and world – a beautiful economy, a beautiful transportation system, a beautiful educational system, a beautiful transportation system, and a beautiful health care system, full of caring for all?

All photos from Copalis Beach, Washington state, December 2020

Where will we choose to go? What footpath into the future will we follow?

The Art of Becoming Medicine.28

We continue featuring the artwork from Becoming Medicine: Pathways of Initiation into a Living Spirituality. The next two art works are by Joseph Rael (Beautiful Painted Arrow).

The first piece is “In the Currents of Time,” from 2005. We see a medicine wheel of the seasons moving sun-wise (clockwise) and two fish, one swimming upstream and one swimming downstream. Although time flows forward in ordinary reality, Joseph says that time can flow backward in non-ordinary reality. Everything is circular – if you don’t get something right the first time, you will circle back around to it and some point. Similarly, the past of the country and the past of the land continues to exert an influence.

In The Current of Time, J. Rael (2005)

The next piece is “Breath Matter Movement and Space Time,” from 2014. Breath Matter Movement is how Joseph translates the word for God in the Tiwa language, Wah-Mah-Chi.

Breath Matter Movement and Space Time, J. Rael (2014)

We only have four more art works to feature and we will bring this Art of Becoming Medicine series to a close.

Joseph and I have been working on our next book together. He wants it to be for 10-12 year olds and it will include Joseph’s life & lessons from when he was growing up and what he thinks kids today should learn. I think kids of all ages (meaning adults, too) would find this interesting because we are always learning and growing. We started out with a working title of Journey of the Holy Beings, then moved to A Bowl Full of Ideas for Inventive Minds (we might still keep that for a younger kids book), currently the working title is Becoming Who You Are: Beautiful Painted Arrow’s Life & Lessons.

We are starting to look for publishers – young adult books are a whole different category from our past work. Let us know if you have ideas for publishers! Maybe we will get the book out within 2021!

The Art of Becoming Medicine.27

These two pieces of art work by Joseph Rael (Beautiful Painted Arrow) come from Becoming Medicine: Pathways of Initiation into a Living Spirituality, chapter 15, “Refounding.” The concept of refounding comes from Gerald Arbuckle’s work on how individuals periodically help guide institutions back to their founding values while updating the institution to the current situation.

“By refounding I mean the process of returning to the founding experience of an organization or group in order to rediscover and re-own the vision and driving energy of the pioneers. . . . To refound formation is to re-enter the sacred time of the founding of religious life itself. . . . This model of symbolic death and rebirth, which is made up of three stages – separation, transition/liminality and reaggregation – also has a powerful scriptural foundation,” (Gerald Arbuckle, From Chaos to Mission: Refounding Religious Life Formation, 3–5).

These two art pieces are from the section of the chapter entitled “Refounding Mothers of Democracy.” As I was reading background material for this chapter, I kept coming across the phrase, “founding fathers,” and I wondered why there was not more emphasis on founding and refounding Mothers of Democracy and so focused on several women artists and writers whose work has been to refound principles of democracy – musician Anoushka Shankar, writer Rebecca Solnit, and, then of course, the original founder of spiritual democracy, Mother Earth.

Anoushka Shankar wrote about her album, Land of Gold:

“Everyone is, in some way or another, searching for their own “Land of Gold”: a journey to a place of security, connectedness and tranquillity, which they can call home. This journey also represents the interior quest that we all take to find a sense of inner peace, truth and acceptance – a universal desire that unites humanity…Land of Gold is the culmination of my journey to the interior, channelling my distress at the situation in a constructive way, exploring the stories of the voiceless and dispossessed. I believe that art can make a difference – it connects us to our hearts, bringing us back to what really matters. Music has the power to speak to the soul,” (AnoushkaShankar.com).

Rebecca Solnit stands out to me in any of my thinking about the United States, as I felt reading her work, particularly A Field Guide to Becoming Lost, helped me reimagine the best of the United States and to re-become an American after living abroad in New Zealand. In Hope in the Dark, she wrote,

“To hope is to gamble. It’s to bet on the future, on your desires, on
the possibility that an open heart and uncertainty are better than gloom
and safety…We all have to place a bet, but we have no reassurance of
how it will turn out. Solnit writes that the “future is dark, with a darkness
as much of the womb as of the grave,” (Solnit, Hope in the Dark, 4, 6).

Solnit also writes about activism – not as something you do once to put things right, but more as a kind of recurrent ceremony that you do to try to correct the coarse of history that is always going off track. I have been thinking a lot about medical activism being a foundational aspect of medical professionalism and Solnit’s writing on activism has been a great influence on me.

“I use the term activist to mean a particular kind of engagement—and a specific politic: one that seeks to democratize the world, to share power, to protect difference and complexity, human and otherwise,” (Solnit, Hope in the Dark, 18).

“The question, then, is not so much how to create a world as how to keep alive that moment of creation, how to realize that Coyote world in which creation never ends and people participate in the power of being creators, a world whose hopefulness lies in its unfinishedness, its openness to improvisation and participation,” (Solnit, Hope in the Dark, 108).

Joseph’s first art work in this series is “Holy Woman” from 1995

“Holy Woman,” Joseph Rael (1995)

His next piece is “Mother Earth Dreaming All the Two Leggeds into Beauty,” from 2006.

“Mother Earth Dreaming all of the two Leggeds into Beauty,” Joseph Rael (2006)

Here is what Joseph wrote about our current time and Mother Earth:

“I believe that it is now time for the elders all over the world to talk to their people and instruct them. As elders we have more responsibility . . . a responsibility to talk about the sacredness of the Earth, and the sacredness of the people on the Earth. One of our journeys is to help the people as they walk on Mother Earth. Mother Earth is our land and she belongs to us because we are her children. She belongs to us and we belong to her. So we can take care of her the way she has been taking care of us,” (Joseph Rael, Sound, 256).

The Art of Becoming Medicine.26

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

The first is “Rainbow Makers of the (tutah) Rainbow Light,” a colorful burst that reminds us that Beautiful Painted Arrow can also mean Double Rainbow.

“Peace Makers of the (tutah) Rainbow Light, J. Rael (2005)

The next piece is the second in a series, “Candle of the World #2 – People of the Sand Place – Stars Who Live in the Heavens – They Travel to Planet Earth.” This painting reminds us of the Picuris Elders telling young Joseph that there is an equivalency between the stars in the sky and the sand on the ground. There was a movement of peoples from the stars to the sands of Earth and the destiny of the people of Earth is to return to the stars.

Candle of the World #2, J. Rael (2019)

New Realities in Times of Covid-19: A Humanistic Response – Free Symposium

We are getting close to the day!

Saturday, 21 November, 6 AM Pacific Time/ 9 AM Eastern Time

Register for this free international symposium here

The talk I am giving is “Burnout: Soul Loss & Recovery in Health Care”

Register here

Medical Activism: A Foundational Element of Professional Identity

David R. Kopacz, MD

The “first task of the doctor is therefore political: the struggle against disease must begin with a war against bad government,” (Foucault).[1]

The idea of medical activism has been criticized lately, from both inside[2] and outside[3] of the medical field. However, medical activism is a foundational element of professional identity – it defines who we are as professionals as opposed to being technicians, prescribers, protocol managers, or employees.

Activism can take many forms, but its essence is when professional responsibility extends beyond the individual to the community, the country, and the world. Medical activism occurs when we look up from our computer screens and electronic medical records and look outside the four walls of the clinic to be moral agents promoting health & wellness in the world. Medical activism is what Dr. Berwick is encouraging in his recent article, “The Moral Determinants of Health,” where he 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.”[4]

Medical activism is always needed, but sometimes it is needed more than others. The times of the Covid-19 pandemic demand that we take a fresh look at ourselves as physicians and professionals to determine the scope of our responsibilities. With political attacks, anti-public health measures, and anti-science propaganda during the pandemic, physicians and health care professionals need to speak up now more than ever. If we do not use our voices, we may lose them.

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 (delivery of care in the clinic & hospital) and external (medicine in the world).

Deprofessionalization

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.

With the rise of productivity medicine we have seen the 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 human being to human being. Individuality and humanity are extraneous and problematic variables to corporate, machine medicine. 

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.

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.”[7] What we are doing as professionals is continual professing – to declare openly and to speak, tell, say.

Our job as professionals is to be prophets of health (which is different than the profits of the health). 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 job of professionals within the system to be the moral leadership of the institution. To become moral agents in our world, we need to tear ourselves away from the never-ending demands of the Electronic Medical Records system, and raise our gaze from the computer screen to the world we all live in. To be a professional is to be more than a technician blindly following orders. To be professional means that we answer to a higher calling and we engage our hearts as well as our minds to become moral agents for public health. This is what psychiatrist Carl Bell called, “getting rid of the rats.”[8] He learned that a good doctor won’t just treat a rat bite, but will help to get rid of the rats in the neighborhood. He thus saw the role of the doctor and psychiatrist as not a technician in an office, but as an engaged professional intervening in the world.

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.”[9]

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. (Lifton) [10]

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, students may become technically proficient and yet not be true professionals and healers. We teach students science, but we do not teach them to use what Stevan Weine calls “the witnessing imagination.”[11]

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.”[12]

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.”[13]           

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. (Palmer) [14]

An Abbreviated History of Medical Activism

Wash your hands – this seems obvious to us now – but in 1850 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. He was ridiculed, lost his appointment, and died in a mental institution.[15]

In the late 1800s, Virchow was tasked by the Prussian government to research an outbreak of typhus. His prescription was social and political: elimination of social inequality.[16] He came back with recommendations regarding poverty, services, and even political recommendations. He was fired and later wrote, “Medicine is a social science and politics is nothing more than medicine on a large scale,”[17] and that doctors “are the natural attorneys of the poor.”[18]

In 2015, pediatrician Mona Hanna-Attisha noticed that the children in her practice in Flint, Michigan, had high levels of lead. She wrote about her work as a medical activist in her book, What the Eyes Don’t See.[19]

“This is a story of resistance, of activism, of citizen action, of waking up and opening your eyes and making a difference in our community…I wrote this book to share the terrible lessons that happened in Flint, but more importantly, I wrote this book to share the incredible work that we did, hand in hand with our community, to make our community care about our children.” (Hanna-Attisha) [i]

Dr. Fauci.

Examples of Health Care Critique & Reform

There are many different levels of health care reform – from the way a doctor is present with a patient, to how clinics are structured, to how reimbursement occurs, and to how we, as a society, value (or de-value) health care as a human right as all other modern democracies do. 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. Institutions may have vision and mission statements but they are incapable of moral agency and compassion because those are human traits, not bureaucratic functions.

I have written about dehumanization in medicine and the need for re-humanizing ourselves, our practices, and the culture of medicine – calling for a compassion revolution and a counter-curriculum of re-humanization in my book Re-humanizing Medicine.[20] Many others have called for bringing caring back into health care: Robin Youngson,[21] Victor Montori,[22] Arthur Kleinman,[23] Mukta Panda,[24] and Rana Awdish,[25] to name a few.

Other levels of health care reform can be found in the work of L. Gordon Moore’s idea of the micropractice,[26] and Dr. Quentin Young’s work with Physicians for a National Health Program.[27]

Medicine in the World

Samuel Shem, in his essay, “Fiction as Resistance,” writes of 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”[28]

There are many kinds of medical activism needed for our current ills, here are just a few examples:

  • Culture, Diversity, Religious Tolerance – addressing racism and intolerance
  • Human rights medicine and international trauma work
  • LGBTQ rights
  • Women’s rights & reproductive rights
  • Immigration policy
  • Public health
  • International Physicians for the Prevention of Nuclear War
  • Peace work, recovery from war and violence
  • Gun violence as a public health issue
  • Social, Climate, Environment
  • Medical student education: preserving idealism and preventing cynicism
  • Burnout and moral injury in physicians and health care workers
  • Public Safety & the Duty to Warn

Meanwhile, back at the pandemic, we just topped 160,000 new cases in one day and the United States of America has no coordinated national policy to control the pandemic. The president has come out against science,[29] has accused doctors of profiting from the pandemic by diagnosing Covid-19 to make money,[30] and there have been many coordinated political propaganda campaigns by the president and one political party to discourage people from following basic public health measures (masking and social distancing)[31],[32],[33] and have actively encouraged unhealthy behavior (large gatherings without masks or social distancing).[34] The activist response by individual physicians through social media as well as of professional medical and scientific organizations has been swift and strong.[35],[36],[37]

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, and the politicization of basic, scientific principles of public health. 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. Lifton’s witnessing professional and Palmer’s new professional give us a framework for social, moral, and political involvement of professionals as part of the practice of medicine and health care. We are called 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.

This paper only just scratches the surface of the topic of medical activism. We need classes, conferences, and an edited textbook on the topic, written by expert activists and covering the various levels of the work. Bassuk’s 1996, The Doctor-Activist: Physicians Fighting for Social Change, is a great start – but we need to move beyond the idea of medical activism as something that exceptional individuals do, to see it as a normative part of professional identity – something we all do for the health of all.


[1] Foucault M. The Birth of the Clinic. New York: Vintage Books, 1994, 38.

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

[3] Haag M. Doctors Revolt After N.R.A. Tells Them to ‘Stay in Their Lane’ on Gun Policy. 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

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

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

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

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

[8] https://beingfullyhuman.com/2020/07/18/carl-bell-md-medical-activist-human-rights-champion-with-an-indomitable-fighting-spirit/. Bell C. The Sanity of Survival: Reflections on Community Mental Health and Wellness. Chicago: Third World Press, 2004, xx.

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

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

[11] Weine S. (1996). The Witnessing Imagination: Social Trauma, Creative Artists, and Witnessing Professionals. Literature and Medicine, 15, 167 – 182.

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

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

[14] Palmer P. A New Professional: The Aims of Education Revisited. Change, Vol. 39, No. 6 (Nov-Dec, 2007), 6-12.

[15] https://www.pbs.org/newshour/health/ignaz-semmelweis-doctor-prescribed-hand-washing

[16] 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

[17] 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.

[18] 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

[19] https://www.npr.org/sections/health-shots/2018/06/25/623126968/pediatrician-who-exposed-flint-water-crisis-shares-her-story-of-resistance

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

[21] Youngson R. Time to Care: How to Love Your Patients and Your Job. Raglan: RebelHeart, 2012.

[22] Montori V. Why We Revolt: A Patient Revolution of Careful and Kind Care. Rochester: Patient Revolution, 2017.

[23] Kleinman A. The Soul of Care: The Moral Education of a Husband and a Doctor. New York: Viking, 2019.

[24] Panda M. Resilient Threads: Weaving Joy and Meaning into Well-Being. Palisade: Creative Courage Press, 2020.

[25] Awdish R. In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope. New York: Picador, 2018.

[26] Moore LG. ‘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 .

[27] https://pnhp.org/news/dr-quentin-young-selected-obituaries-stories/

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

[29] https://www.scientificamerican.com/article/trumps-5-most-ldquo-anti-science-rdquo-moves/

[30] https://www.forbes.com/sites/brucelee/2020/10/27/trump-claims-doctors-overcounting-covid-19-coronavirus-deaths-to-make-more-money/?sh=7439b2836cb9

[31] https://www.reddit.com/r/SeattleWA/comments/jduz3x/culp_antimask_propaganda/

[32] https://www.vox.com/the-goods/2020/8/7/21357400/anti-mask-protest-rallies-donald-trump-covid-19

[33] https://www.vox.com/2020/6/20/21297693/trump-rally-tulsa-masks

[34] https://apnews.com/article/donald-trump-rallies-virus-surges-50e79fabd46472c51ecc1444184082de

[35] https://www.forbes.com/sites/brucelee/2020/10/27/trump-claims-doctors-overcounting-covid-19-coronavirus-deaths-to-make-more-money/?sh=7439b2836cb9

[36] https://www.scientificamerican.com/article/leading-scientists-urge-voters-to-dump-trump/

[37] https://www.medicalnewstoday.com/articles/respected-scientific-journals-publicly-oppose-trump