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).

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

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

The Art of Becoming Medicine.25

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

The first work is “Rain Cloud and Oceanus.” Although Joseph grew up in the high desert of southern Colorado and northern New Mexico, he has a special relationship with the oceans. One of his formative visions was of meeting Oceanus, the Lord of the Oceans. At the Sound Peace Chambers around the world, a fire ceremony is done on the 7th of each month for the purification of the oceans.

Rain Cloud and Oceanus, J. Rael (2006)

The next painting stands at the doorway of a very important chapter of the book, which we offer as a free pdf download – Chapter 14 Spiritual Democracy. I found this concept of Spiritual Democracy in Steven Herrmann’s book, Spiritual Democracy: The Wisdom of Early American Visionaries for the Journey Forward, and he had found it in the work of Walt Whitman. This concept resonated with me and for Joseph also. The painting below is an older one from 1997 that was called Earth Child, but Joseph added to the painting, making it “Earth Child of Spiritual Democracy.” I think of this fellow as the heart of our book, a seed to planted in the soil of the soul of the human being that blooms as spiritual democracy.

Earth Child of Spiritual Democracy, J. Rael (1997)

Here is what Joseph has to say about Spiritual Democracy:

“Religious liberty happens to every single human baby child when the human being swallows and drinks the milk from its mother’s breast at feeding time. Thus the American soul is in the making stage.


“What I am saying is we have to start at the foundation of what makes a human being to grow up in that religious liberty. That is the only way it is going to work if we are really going to follow the real way that we become individuals. If we don’t start at the beginning. . . .


“So I am telling you now as I am reading your paper that the idea of religious freedom was already being educated through the sound, and the being and vibration of every single swallow of swallowing-ness every time the baby was drinking its mother’s milk. This is my contribution to the idea of spiritual democracy and religious freedom,” (Joseph Rael, Becoming Medicine, 382).

Hope

Clouds of Hope over USA.3, 11.2.2020 (D. Kopacz)

“I should probably say first that the kind of hope I often think about (especially in situations that are particularly hopeless, such as prison) I understand above all as a state of mind, not a state of the world. Either we have hope within us or we do not; it is a dimension of the soul, and it’s not essentially dependent on some particular observation of the world or estimate of the situation. Hope is not prognostication. It is an orientation of the spirit, an orientation of the heart; it transcends the world that is immediately experienced, and it is anchored somewhere beyond its horizons. I do not think you can explain it as a mere derivative of something here, of some movement, or of some favorable signs in the world. I feel that its deepest roots are in the transcendental, just as the roots of human responsibility are, though of course I cannot – unlike the Christians, for instance – say anything concrete about the transcendental. An individual may affirm or deny that his hope is so rooted, but this does nothing to change my conviction (which is more than a conviction; it’s an inner experience). The most convinced materialist and atheist may have more of this genuine, transcendentally rooted inner hope … than ten metaphysicians together.

Clouds of Hope over USA.2, 11.2.2020 (D. Kopacz)

“Hope, in this deep and powerful sense, is not the same as joy that things are going well, or willingness to invest in enterprises that are obviously headed for early success, but, rather, an ability to work for something because it is good, not just because it stands a chance to succeed. The more unpropitious the situation in which we demonstrate hope, the deeper the hope is. Hope is definitely not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out. In short, I think that the deepest and most important form of hope, the only one that can keep us above water and urge us to good works, and the only true source of the breathtaking dimension of the human spirit and its efforts, is something we get, as it were, from ‘elsewhere.’ It is also this hope, above all, which gives us the strength to live and continually try new things, even in conditions that seem as hopeless as ours do, here and now.”

Vaclav Havel, Disturbing the Peace, 181-182

Clouds of Hope over USA.3, 11.2.2020 (D. Kopacz)

Vote: The Anti-dote to the Anti-doctor

What is a Doctor?

  • A doctor heals you when you are sick.
  • A doctor is someone you trust, trust with your life.
  • A doctor holds your hand & tells you the hard truth of your diagnosis.
  • A doctor brings healing when you are wounded.
  • A doctor weaves the twin strands of the ancient art of medicine & the modern science of medicine around the patient.
  • A true doctor works not just for the good of the patient, but for the good of all the patient’s in the community – public health – because a good doctor knows that we are all connected and interrelated.
  • A doctor works for good.
  • A doctor is in service to others.
  • A doctor prays for healing of the sick.

What is an Anti-doctor?

  • An anti-doctor makes you sick.
  • An anti-doctor is someone you can’t trust.
  • An anti-doctor lies to you & hits you with a hard hand.
  • An anti-doctor wounds you and inspires violence & wounding.
  • An anti-doctor binds you in the twin strands of the ancient art of lying & the modern barrage of social media.
  • An anti-doctor works against the good of the individual & against the good of the community – by dividing, separating, spreading lies & conspiracies, and by projecting evil on to others.
  • An anti-doctor works for no good at all, for evil, or just for his own good.
  • An anti-doctor manipulates others.
  • An anti-doctor preys on the vulnerable.

An Anti-doctor, Like all Fascists, is Anti-intellectual[1] and Anti-science.

An Anti-doctor Does Not Value Intellectual Knowledge:

I have a gut, and my gut tells me more sometimes than anybody else’s brain can ever tell me,” (Sullivan, 2018).[2]

“It was not only an unusual statement for the leader of the Free World to make but a strikingly precarious approach to take when engaging in high-stakes negotiations as with North Korea over nuclear disarmament.  Donald Trump seemed to believe that following his ‘gut’ would serve him better than any preparation, deliberation, or listening to the wisdom of his career advisers.”[3]

An Anti-doctor is Anti-science & Anti-medicine:

“Donald Trump threatens to fire Anthony Fauci after US election: President plays up to chants of ‘Fire Fauci’ at curfew-breaching Florida rally.”[4]

“Trump baselessly claims doctors are inflating coronavirus death counts for money as cases again hit record levels.”[5]

“If it were up to the doctors, they may say: ‘Let’s keep it shut down. Let’s shut down the entire world’ — because, again, you’re up to almost 150 countries [with coronavirus cases] — ‘so let’s shut down the entire world. And when we shut it down, that would be wonderful. And let’s keep it shut for a couple of years,’ ” Trump said, adding: “You know, you can’t do that. And you can’t do that with a country — especially the No. 1 economy in the world, by far.”[6]

“‘Maybe I have a natural ability’: Trump plays medical expert on coronavirus by second-guessing the professionals.”[7]

“The upshot was that the self-proclaimed medical savant came off looking less interested in his administration’s unsteady efforts to mitigate the spread of the virus than he was in bolstering his own status in a campaign year. Trump repeatedly sought to judge his administration’s performance by the numbers of how many have been shown to have contracted the virus and comparing it to other nations — and, in doing so, appeared to be making judgments based solely on that scorecard.”[8]

An Anti-doctor Gives Dangerous Advice:

“Trump Misleads on Hydroxychloroquine, Again: In revealing that he’s taking the drug to prevent COVID-19, the president distorted the facts.”[9]

“And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning? So it’d be interesting to check that…I’m not a doctor. But I’m, like, a person that has a good you-know-what”[10] [pointing to his head].

A Doctor Cares – An Anti-doctor Does Not Care

  • A doctor cares for the health of individuals and local and global communities.
  • An anti-doctor care nothing for the health of individuals or local and global communities.

We need an anti-dote to the anti-doctor.

Vote: It is just what the doctor ordered!


[1] Anti-intellectualism is one of the ten ways that fascism works described by Jason Stanley in How Fascism Works.

[2] https://www.cnn.com/2018/11/27/politics/washington-post-trump-gut/index.html

[3] Bandy X Lee, Profile of a Nation: Trump’s Mind, America’s Soul, 51.

[4] https://www.theguardian.com/world/2020/nov/02/donald-trump-threatens-to-fire-anthony-fauci-after-us-election

[5] https://www.cnn.com/2020/10/30/politics/trump-doctors-covid/index.html

[6] https://www.washingtonpost.com/politics/2020/03/23/trump-signals-he-wont-abide-by-doctors-coronavirus/

[7] https://www.washingtonpost.com/politics/maybe-i-have-a-natural-ability-trump-plays-medical-expert-on-coronavirus-by-second-guessing-the-professionals/2020/03/06/3ee0574c-5ffb-11ea-9055-5fa12981bbbf_story.html

[8] https://www.washingtonpost.com/politics/maybe-i-have-a-natural-ability-trump-plays-medical-expert-on-coronavirus-by-second-guessing-the-professionals/2020/03/06/3ee0574c-5ffb-11ea-9055-5fa12981bbbf_story.html

[9] https://www.factcheck.org/2020/05/trump-misleads-on-hydroxychloroquine-again/

[10] https://www.bbc.com/news/world-us-canada-52407177

New Realities in Times of Covid-19: A Humanistic Response – free virtual international symposium

I will be presenting “Burnout: Soul Loss & Recovery in Health Care” at this free virtual international symposium sponsored by The Doctor as Humanist, McGraw Hill, Sechenov University, and Universidad Anáhuac México.

You can register for this free conference: here.

The conference is Saturday, 21 November 2020.

Against Empire – Interview with Bill Laswell

I’ve posted a new interview with Bill Laswell about his album, Against Empire, and the role of music in political protest. You can read the interview, here at The-POV. It was conducted by phone on 9/11/20. I have an earlier interview from 2017 that I haven’t posted yet – watch for that in the next couple months…

“I’ve always seen music that way – there is a kind of rebel music and there is conservative pop music. I’ve always seen that you can express a certain sound that represents a sensibility, where you stand. At certain times it is more relevant than other times. In these times you need revolutionary music, you need rebel music, you need to make your statement with sound. I think it is totally necessary. I think people are out there, they are trying the best they can.” (Bill Laswell)

Dave: “You have these two related titles Against the Empire of Alternative Facts by Inaugural Sound Clash (for the Two Americas) with Hideo Yamaki, yourself, Raoul Björkenheim, Mike Sopko, and Dominic James. Then you also have your latest album Against Empire with Pharoah Sanders, Herbie Hancock, Peter Apfelbaum, Jerry Marotta, Chad Smith, Hideo Yamaki, Satoyasu Shomura, and Adam Rudolph.”


Bill: “Oh yeah, that Inaugural Sound Clash was with three guitars. I think it was the night of the inauguration (January 20, 2017) when we played at the Stone. That was all improv.”

Read the rest of the interview here, at The-POV

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

We are in the midst of a public health crisis – the Covid-19 coronavirus pandemic. We are also in the midst of another global public health crisis – fascism. We are in the midst of a pandemic of the body and a pandemic of the mind.

The first reported cases of Covid-19 were in Wuhan, China on December 31, 2019.[1] The first case in the United States was January 19, 2020.[2] Viruses teach us that we are all connected. As human beings we are all connected, but we are also interconnected with nature – a bat was thought to be the vector for the virus into humans through the wet markets in China. Other viruses have come through birds and pigs to humans. This is the first teaching of the virus – we are all interconnected.

Covid-19 magnified the cracks in our infrastructures of interconnection. In the US, our health system was quickly overwhelmed in areas of high virus concentration. We thought that because we have the most expensive health care system in the world that we were protected – actually our health care system is ranked 37th in the world.[3] World economies ground to a halt. We realized how many people were living paycheck to paycheck, despite the economy appearing healthy on the surface. We thought our democracy was strong and healthy – but it was already suffering since 2016, since 2001.[4] We thought we had a multi-cultural democracy, but we suffered outbreaks of xenophobia, racism, white supremacy, and nationalism.

The Sickness of Our Health Care System

There were problems with our health care system even before Covid-19, the pandemic just magnified our vulnerabilities. Timothy Snyder writes of the short-comings of commercial medicine: “We would like to think we have a health care that incidentally involves some wealth transfer; what we actually have is wealth transfer that incidentally involves some health care,” (Snyder, Our Malady, 14). Victor Montori also diagnosed the sickness in our health care system in his 2017 book, Why We Revolt: A Patient Revolution for Careful and Kind Care. He describes the cruelty of systems, policies and procedures, and greed that drives dehumanization in medicine. I wrote about the pandemic of burnout and suffering in physicians, the dehumanization of both health care workers and patients, and a way of healing our system in my 2014 book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine.

Our health care system was already sick, and then the pandemic hit, and then fascism revealed itself and turned a public health pandemic into an opportunity for consolidation of power. Montori starts his book by citing George Orwell, “Orwell proposed that one must write, among other reasons, to ‘see things as they are, to find out true facts and store them up for the use of posterity.’ This book arises out of my need to do just that,” (Montori, 1). Montori evokes facts, revolution, and caring as treatments for our health care system.

Timothy Snyder did not have Covid-19, but his journey of illness took him through five hospitals in two countries, and two states from December 2019 to March 2020. His notes and observations on his illness and recovery started with a focus on the health care system, but became inextricably entangled within the broader politics of our age. Whereas Camus wrote about a plague as an allegory for fascism. Snyder sees how fascism and health are interwoven. “Our malady is physical illness and the political evil that surrounds it. We are ill in a way that costs us freedom, and unfree in a way that costs us health. Our politics are too much about the curse of pain and too little about the blessings of liberty,” (Snyder, 4).

The health of the individual, the health of the population, the health of a country, the health of global democracy, and the health of the Earth are all interconnected. These are truths that should be self-evident, and yet we have somehow forgotten them. We have not only forgotten them, large numbers of people across the globe are embracing the opposite idea – concentration of wealth in the hands of the few, us vs them thinking, policies of exclusion, wall building, name calling, dividing and conquering rather than uniting and preserving. This philosophy of me-ism, of unbridled and unchecked capitalism, of unbalanced materialism is now blossoming forth as fascism – in the United States of America, England, Philippines, Russia, Turkey, India, Hungary, Brazil, Poland, and many countries across the globe.

Lumpers and Splitters

Charles Darwin described two contradictory approaches to natural observation. Some naturalists he described as “lumpers” and some as “splitters.” Lumpers looked at two birds and saw similarities and called them the same species. Splitters looked at two birds and saw differences and called them different species. The intellect and science functions by discrimination and division of one thing from the other. Materialism and capitalism extract numbers, in the form of dollar signs, from every possible interaction. What of the Lumpers? What is that drives some people to see similarities and other people to see only differences? We can see lumpers as holistic thinkers, systems thinkers, ecological philosophers who see the underlying similarities beneath the surface differences.

Splitting is not just something that is happening on the right, it is happening on the left as well. On the left there is also a kind of political correctness of seeing every group as so different that there is an unbridgeable gap between human beings. Splitters on the left argue that this gap is unbridgeable and compassion is an aggressive act. If this is taken to the extreme, everyone will end up isolated monads. I do not believe our healing will come through splitting. Respecting and acknowledging differences is important, but it must be balanced with acknowledging our common underlying similarities as well, our common humanity.

This hypervigilant splitting and focus on differences has been carried over to the natural world as well. Many argue that animals are so irrevocably other that we cannot presume to understand them. Those who try to bridge this gulf are accused of anthropomorphizing animals. While it is wise to be cautious to attributing your own emotions or motives to other humans or to animals, it is foolish to think that we are so different as to all live within unbridgeable and unbreachable walls. This social-intellectual wall building is dangerous, as is the real-world wall-building and caging of individuals. I don’t mean to say they are equal offences, but they both create fear, separation, isolation, and alienation.

Charles Foster, in his book Being a Beast: Adventures Across the Species Divide, is a lumper, although he recognizes and honors differences as well. He believes that we can cross the species divide. He does this through literally walking in the footsteps of the other, to live as the other, to take the perspective of the other. To this end, he builds a burrow underground and eats earthworms as a badger does, he tries to catch a fish with his hands and mouth like an otter does, he sleeps on the ground and eats out of rubbish bins as an urban English fox does. And then he tries to take the perspective of the flying swift and he still finds commonalities.

“These are facts about swifts because they are facts about the world, and swifts are part of the world, as I am. The facts indicate that no qualification other than occupancy of a shared world is necessary for me to write about swifts. That is a great relief, because swifts are the ultimate other. I can write about them only because I’m other too, or (depending on my mood) because nothing is other,” (Foster, 188).

As human beings, we have our differences, but if we stop focusing on our similarities we become dehumanized. Foster tells us with effort we can cross the species divide, if that is possible, we can definitely cross the divides and heal the splits that separate us as human beings. To only see differences leads down the slippery slope of xenophobia, fascism, and genocide.

Science fiction writer, Philip K. Dick, was concerned with two questions in his work: what is real and what is human? Both of these are relevant in our present age. Reality is under continual assault for political reasons – fake news, propaganda, and lies spew from the mouth of our current president: 20,055 lies as of July, 2020.[5] Reality is also under siege in the assault on science and the silencing of journalists. What is human is also under assault as fascism eats away at our souls, disconnecting us from other human beings and other living beings. PK Dick cautions us about becoming overly enamored with splitting and seeing ourselves as separate from the environment:

“A native of Africa is said to view his surroundings as pulsing with purpose, a life, that is actually within himself; once these childish projections are withdrawn, he sees that the world is dead and that life resides solely within himself. When he reaches this sophisticated point he is said to be either mature or sane. Or scientific. But one wonders: Has he not also, in this process, reified – that is made into a thing – other people? Stones and rocks and trees may now be inanimate for him, but what about his friends? Has he now made them into stones, too?” (PK Dick).[6]

What is it that allows us to feel alive and vibrant? What is it that allows us to feel interconnections with other human beings, to recognize us all as brothers and sisters in the human family? What is it that allows us to feel communion with nature and our animal brothers and sisters? I will call this ability: soul. I do not mean this in a religious sense and yet I do not use it in only in a metaphorical sense, for it is real. I mean it in the sense that PK Dick illustrates. We have the choice to be lumpers or splitters. True enough, we need both abilities to survive in this world – we must be able to distinguish between an oncoming bus and a friendly dog. However, for human things, we need to be able to make the choice to see our common humanity, our common shared soul. And for dealing with the Earth we need to be able to see the anima mundi, the soul of the world. These are human capacities and capabilities that we have, but first we must acknowledge their non-material reality and then we must practice them, lest we lose them and end up at the end of Martin Niemöller’s poetic warning:

First they came for the socialists, and I did not speak out—

     Because I was not a socialist.

Then they came for the trade unionists, and I did not speak out—

     Because I was not a trade unionist.

Then they came for the Jews, and I did not speak out—

     Because I was not a Jew.

Then they came for me—and there was no one left to speak for me.[7]

Medicine and Politics

Foucault wrote, the “first task of the doctor is therefore political: the struggle against disease must begin with a war against bad government.”[8] Virchow wrote, “Medicine is a social science and politics is nothing more than medicine on a large scale,”[9] and that doctors “are the natural attorneys of the poor.”[10] While it may seem radical and revolutionary, and some may say “stay in your lane,”[11],[12] the health of the individual and the health of the population are inextricably and irrevocably interconnected.

Snyder wrote from his personal experience as a patient and his professional experience as a historian of fascism and totalitarianism about the intersections of politics and health.

“Our botching of a pandemic is the latest symptom of our malady, of a politics that deals out pain and death rather than security and health, profit for a few rather than prosperity for the many…If our federal government and our commercial medicine are making us unhealthy, they are making us unfree…The struggle begins when we claim health care as a human right,” (Snyder, 16-18).

To speak of human rights brings together discussions of medicine and politics. Snyder sees that we are unfree if we are unwell and we are unfree if we are “othered.” We must strive to be brothered and sistered rather than othered. The Lakota understood this with their saying mitakuye oasin, all of our relations. Joseph Rael often tells me that we are all brothers and sisters and we write of this brotherhood and sisterhood in Walking the Medicine Wheel: Healing Trauma & PTSD. This is simple ecology – we are all related and interrelated. Genetic science tells us this through our common ancestors, who lived at different times, Mitochondrial Eve and Y Chromosome Adam. We also all come from Africa – the common home of ancient humanity. Snyder tells us, “A virus is not human, but it is a measure of our humanity,” (Snyder, 16). The virus is reminding us – we are all connected, even while the fascists say it is us versus them. When we enter the non-ordinary realm of the shaman, the visionary, the mystic – we move beyond even the separation of interconnection to the experience of non-dual Oneness. It is as the virus teaches, we are all One, what happens to another happens to us and our shared Earth.

Human Rights

Human rights recognizes us all as equal. Let us turn to the Declaration of Independence of the United States of America, July 4, 1776. While the United States cannot, by any means, show that it has enacted universal human rights for all people (women, blacks, the indigenous population were originally excluded), still this is an important document in the history of modern democracy.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.―That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed,―That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.[13]

While I initially was just going to quote the beginning of this paragraph on what unalienable Rights and self-evident truths are – equality and Life, Liberty and the pursuit of Happiness – the later part of the paragraph starts to sound a lot like our current age a long train of abuses and usurpations, which has been leading down the slippery slope toward absolute Despotism. Let’s take a look at the list of abuses and usurpations of the King against the colonies, reading with an eye toward the list of abuses and usurpations of the President against the people.

“―Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.”

“He has refused his Assent to Laws, the most wholesome and necessary for the public good.

He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public Records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved Representative Houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected; whereby the Legislative powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.

He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.

He has obstructed the Administration of Justice, by refusing his Assent to Laws for establishing Judiciary powers.

He has made Judges dependent on his Will alone, for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of New Offices, and sent hither swarms of Officers to harrass our people, and eat out their substance.

He has kept among us, in times of peace, Standing Armies without the Consent of our legislatures.

He has affected to render the Military independent of and superior to the Civil power.

For protecting them, by a mock Trial, from punishment for any Murders which they should commit on the Inhabitants of these States:

For cutting off our Trade with all parts of the world:

For taking away our Charters, abolishing our most valuable Laws, and altering fundamentally the Forms of our Governments:

He has abdicated Government here, by declaring us out of his Protection and waging War against us.

He has plundered our seas, ravaged our Coasts, burnt our towns, and destroyed the lives of our people.

He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation and tyranny, already begun with circumstances of Cruelty & perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.

He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages, whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.”[14]

Apologies to the Indigenous peoples of this land for the slur of “Indian Savages” in our Declaration of Independence and for all of the past abuses and genocides that the United States perpetrated under the guise of its own freedom.

A quick read of these offences of King George bear some resemblances to our current tyrant-in-training: subverting the laws of the land, convening people in unsafe rallies, not filling government positions, undermining government institutions, he has been impeached for “abuse of power and obstruction of Congress,”[15] he has stacked the courts with loyalists, he has pardoned criminal cronies, he has instructed witnesses to ignore requests to testify in Congress, he has sent in federal officers into states without their consent, he has attempted to decriminalize the actions of white supremacists and tried to criminalize those he disagrees with, he has interfered with trade agreements, global treaties, and membership in international organizations, he has abandoned responsibility for the country during a pandemic – denying help to those he disagrees with politically, he has excited domestic insurrections amongst us, and he has perpetuated “works of death, desolation and tyranny, already begun with circumstances of Cruelty & perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.”

In the days of the American Revolution tyranny was the word of the day. In this age we have more words to describe abuses of power: authoritarianism, totalitarianism, and fascism.

Night Sky (D. Kopacz 2020)

Fascism and Public Health

The other component to our public health crisis is fascism. It compounds the adverse health effects of the pandemic and it infects the minds of the people, undermining the health of our democracy.

Even back in 2018, before the pandemic, Freedom House reported that we were in the 13th consecutive year of decline in freedom and that “Democracy is in retreat.”[16] In 2020, Freedom House warned of the “Dropping of the Democratic Façade.”[17] That same report also documented links between lack of democracy and poorer health.

Snyder summarizes a number of studies that showed that:

“People in places wracked by opioids voted for Donald Trump. The one piece of information that best predicts whether Mr. Trump won or lost a county in November 2016 was the degree of opioid abuse,” (Snyder 53).[18]

A phenomenon has been noted in recent years called “deaths of despair”[19] in which people in certain regions in the United States are dying at younger ages, decreasing the average lifespan statistics. They are called deaths of despair because they are linked to overdose, suicide, and liver disease related to drinking. This increased mortality over the past 20 years cannot be blamed on fascism – rather it is linked to capitalism without a human face: income inequality, joblessness, unemployment and underemployment, breakdown of support mechanisms and the social safety net, social isolation, and the loss of hospitals and health care in rural areas. Scutchfield and Keck describe the political causes of this public health crisis:

“We are trapped in our culture of hyperpartisan politics in which too many of our policymakers are driven to support small government and a focus on profit before people, to the degree that developing a needed and coherent national approach to address the issues identified by the authors seems impossible. Our gerrymandered political system fueled by large amounts of dark money is ill-suited to help address the problem. Solutions to this public health crisis must start with political change—that may be the ultimate social determinant of health.”[20]

While fascism did not cause this despair, it is making good use of it and a despairing population appears to be infected with fascism, voting in an autocrat, liar, and rule-breaker. These votes of desperation still appear to be strong as the base of the current president holds despite a constant stream of lies and catastrophic mismanagement of the pandemic. This population appears to value strong talk over reality and not to value objective science or objective facts in politics and the media. Over Truth and complex reality, many prefer a “strong man” who “gets things done” (the end justifies the means).

He’s Our Bully

T LAWSON: The – most of the people I know that don’t like him, don’t like him for those very reasons – that he’s a braggart. He’s got a big mouth. He’s a bully. He bullies people.

S LAWSON: Yeah, but he’s our bully.

T LAWSON: He’s our bully. You know, I didn’t vote for Trump – I didn’t vote for him because he was a nice, gracious man. I voted for him ‘cause he got stuff done. [21]

When a little kid lords power over others in the school yard, he is a bully. When the President of the United States bullies others, he is on the slippery slope of colluding with foreign governments to get his way, authoritarianism, totalitarianism, and fascism. John W. Dean and Bob Altemeyer authored the book, Authoritarian Nightmare: Trump and His Followers. Dean, a member of the Nixon administration, testified against Nixon and helped lead to his resignation. Altemeyer is a psychologist, researcher on authoritarianism, and the author of The Authoritarians and Enemies of Freedom: Understanding Right-Wing Authoritarianism. In their book they focus more on Trump’s followers than on Trump himself – because a bully without any followers is just a loud-mouth you can ignore, but a bully with a bunch of loyalist followers is the start of a fascist movement. Dean & Altemeyer summarize the research on American authoritarianism:

  1. “Donald Trump’s supporters are, as a group, highly authoritarian compared to most Americans”
  2. “They are also highly prejudiced compared to most Americans”
  3. “You can explain the prejudice in Trump’s supporters almost entirely by their authoritarianism”
  4. “Authoritarianism is a strongly organized set of attitudes in America that will prove very difficult to reduce and control”
  5. “Far more…Double High authoritarians exist in the United States than we imagined, with most of them now affiliated with the Republican Party”
  6. “The pillars of Trump’s base, white evangelicals and white undereducated males are highly authoritarian and prejudiced”
  7. “The connections among prejudice, authoritarianism and support for Donald Trump are so strong that no other independent factor can be as important in supporting his reelection”[22]

Why Facts and Logic Do Not Influence Trump Supporters

Dean & Altemeyer describe the difficulty of bridging the divide between those using rationality and facts and those using emotionality and anger in their decision-making. They summarize research on the Right-Wing Authoritarianism Scale that persons who score highly on this scale:

  1. have “highly compartmentalized thinking”
  2. “use a lot of double standards”
  3. “believe many conflicting and even contradictory things”
  4. “have a lot of trouble deciding what is sound evidence and what is not”
  5. have “highly ethnocentric” thinking
  6. “are decidedly prejudiced in what they believe about others”
  7. “are very dogmatic about what they believe”[23]

We see then a kind of social pathology in authoritarianism that can lead to fascist behavior through demonizing and othering groups of people. This dehumanization is very concerning because it is the basic building block for violence against others and can lead to a spectrum of bigoted and racist speech, hate speech, individual violence based on ideology, the formation of vigilante justice groups,[24] to organized genocide.

Any student of history would have been worried upon hearing Mussolini’s words “drain the swamp,” and Stalin’s, Hitler’s, and Mao’s words “enemy of the people.” “Words create worlds”[25] said Rabbi Heschel, warning of how the words of a bully ended up creating genocide.

Crow (D. Kopacz 2020)

“They” Are the Disease

Authoritarianism leads to fascist action when all the ills of the world are projected on to the other.  Thus, the current president’s use of the phrases, the “Wuhan virus,” and the “Chinese virus.”[26] If the problem is out there, it can’t be in here. If I’m all good (narcissism) then if something bad happens it must be someone else’s fault. Here is how Snyder summarizes the current president’s response to the pandemic:

“This is how tyranny works: the truth tellers are banished as the sycophants huddle close. Mr. Trump then wonders aloud whether Americans should inject themselves with disinfectants.

“We did not test for coronavirus for a reason that has been understood for thousands of years, at least since Plato…an unchecked ruler never hears what he should from his yes-men; he then projects fictions, which he may actually believe, upon everyone else. This leads to suffering and death, which means more bad news, and so the cycle begins again. Once Mr. Trump made it clear that his priority was to see low counts of infected Americans, the simplest way to please the tyrant was not to count,” (Snyder, 91-92).

Welcoming Figure by Andy Wilbur, Joe Gobin & Steve Brown, Richmond Beach Saltwater Park, WA (D. Kopacz 2020)

Are Racism & Fascism Mental Illnesses?

Psychiatrist, public health advocate, and violence researcher Carl Bell thought we should consider racism as a psychological disorder.

“Covert racism is a psychological attitude and as such, should fall under the scrutiny of psychiatry as a psychopathological symptom of personality disturbance…The racist individual suffers from a psychopathological defect of developmental processes involving narcissism, which precludes the subsequent development of such qualities as creativity, empathy, wisdom, and integrity,” (Carl Bell).[27]

Snyder, in describes the current president’s apparent reasoning and illogical actions that

“Such magical thinking was tyrannical, delusive, and irresponsible…It was delusive because it confused looking away with taking action, the absence of testing with the absence of infection. Mr. Trump’s unwillingness to test did not mean we were healthy, only that we were ignorant,” (Snyder, 92).

There is a psychiatric disorder called “Delusional Disorder,” with delusions defined as “false beliefs based on incorrect inference about external reality that persist despite the evidence to the contrary; these beliefs are not ordinarily accepted by other members of the person’s culture or subculture.”[28] By this definition, if others in your sub-culture believe the same as you do, you are not delusional. Right Wing Authoritarians and Conspiracy Theorists are not delusional, in the strictest sense, even though what they believe is not true. Jung, trying to understand how so much of Europe went along with fascist dictators, used the terms “mass psychosis” and “mob psychology.”[29] He saw that entire nations could become sick and lose touch with reality.

Welcoming Figure & Crow, Richmond Beach Saltwater Park, WA (D. Kopacz, 2020)

The Mind: Tyranny’s Battleground

Forensic psychiatrist, Bandy X. Lee, was minding her own business, researching violence, until one day she found that “politics had invaded my area of expertise,” (Bandy Lee).[30] She convened a conference of mental health professionals on the topic of the president’s mental state and his risk of being a danger to self or others. They felt he was an unprecedented danger and that, under the law of “duty to warn” and under professional ethics and public health, that they were obligated to speak out. This led to the publication of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess the President, then The World Mental Health Coalition Documents, and most recently, Profile of a Nation: Trump’s Mind, America’s Soul. Duty to warn does not require making a diagnosis, it is a professional assessment of a person’s words and actions. Dr. Lee makes her statement:

“As a psychiatrist, I believe there is no greater oppression than the hijacking of the mind, and critical information at a critical time is necessary to empower the public to be able to protect itself and to act while it is still possible. It is always easier to prevent than to try to limit losses after a problem has become barely containable…professionals are supposed to act according to principles of their field as their own moral agents, not as technicians who follow fiats. The latter, a form of ceding one’s autonomy, is a formula for becoming an instrument of authoritarianism if not careful. I maintain the humanitarian goals of medicine and our practice of giving precedence to human lives and safety above all else override any etiquette I owe a public figure. This is why the Declaration of Geneva was established, and what the Nuremberg trials were for; we were never supposed to privilege a powerful political figure…above the foremost principles of medical ethics to which we have pledged. The mind is considered tyranny’s battleground because thought reform occurs through ‘milieu control,’ or the control of information in the environment. Most of this has been done through the spread of false information, but we have the chance to change it through a better understanding of truth,” (Bandy Lee, 19).

Whether we consider racism, authoritarianism, and fascism as mental disorders or not – they all occur in the mind – tyranny’s battleground and psychiatrists are the doctors of the mind. If the battle against fascism, racism, authoritarianism, and tyranny is fought in the human mind, then we need doctors against racism, doctors against authoritarianism, doctors against fascism.

Where Democracy is Limited, Citizens Die

Snyder warns us of the interconnection of health and democracy, “Our failure during a public health crisis is a sign of how far our democracy has declined,” and that “Where democracy is limited, citizens die,” (Snyder, 98). This leads us to the conclusion that fascism is a public health emergency that compounds the emergency of the pandemic. Snyder’s solutions are that, “We should regard health care as a right, take medical and local knowledge seriously, make time for children, and put doctors in charge,” (Snyder, 139).

I don’t know about you, but I voted for Dr. Howard Dean in the 2004 primaries. At that time, it was tragic that one whoop of excitement was overblown in the media and lost him the primary.[31] How different would history have been if we had a Democrat and doctor in the White House instead of the second Bush term. Torture[32] would likely have been taken off the menu. How much of where we are now started after 2001 with the advent of Homeland Security, the militarization of the police, the authorization of torture, and the Kafka-esque fate of “unlawful combatants” detained now going on decades? How ironic that Dean’s one “scream” was amplified by the media to disqualify him as unpresidential, and yet the current president spews forth an unceasing, undignified scream that leaves us all like the figure in Edvard Munch’s The Scream?

Edvard Munch, The Scream, Public Domain

Maybe the United States of America was never what we thought it was. Maybe it was always hypocritical in declaring some people free and equal and others “savages” and “slaves.” Maybe we are experiencing the unveiling of what has always been there. Maybe we go through times when we are closer to living up to the ideals of democracy and other times where we struggle with the basic foundations of what it means to be a citizen of the United States of America.

The Great Seal of the United States features an eagle with a talon gripping a bundle of arrows and talon holding an olive branch. On the seal, the eagle is looking toward the olive branch, toward peace, but the head of our eagle seems to be looking more toward the arrows lately.

How do we, collectively, turn the head of the eagle from war and division to unity and peace? Snyder, despite his concerns and warnings, feels that it is possible to heal from this crisis, to heal our health care system and to heal our democracy.

“This crisis is a chance to rethink the possible. Health care should be a right, doctors should have authority, truth should be pursued, children should see a better America. Let us begin our recovery,” (Snyder, 142).

To address this global pandemic, we need doctors. To heal our individual and collective minds, we need not just doctors against fascism and violence, we need doctors for peace and compassion.


[1] https://www.who.int/news/item/27-04-2020-who-timeline—covid-19

[2] https://www.nejm.org/doi/full/10.1056/NEJMoa2001191

[3] https://worldpopulationreview.com/country-rankings/best-healthcare-in-the-world

[4] https://www.hrw.org/report/2011/07/12/getting-away-torture/bush-administration-and-mistreatment-detainees#

[5] “In 1,267 days, President Trump has made 20,055 false or misleading claims,” Updated July 9, 2020. The Washington Post’s Fact Checker’s ongoing database of the false or misleading claims made by President Trump since assuming office. https://www.washingtonpost.com/graphics/politics/trump-claims-database/?utm_term=.27babcd5e58c&itid=lk_inline_manual_2&itid=lk_inline_manual_2

[6] Philip K. Dick, “The Android and the Human,” (1972), in The Shifting Realities of Philip K. Dick: Selected Literary and Philosophical Writings, ed. Lawrence Sutin, 183.

[7] “Martin Niemöller: ‘First they came for the Socialists…’”. Holocaust Encyclopedia. United States Holocaust Memorial Museum. Archived from the original on 23 July 2018. Retrieved 25 July 2018. Cited on Wikipedia, https://en.wikipedia.org/wiki/First_they_came_…#cite_note-3

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

[9] 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.

[10] 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

[11] “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

[12] Matthew Haag, “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

[13] https://www.archives.gov/founding-docs/declaration-transcript

[14] https://www.archives.gov/founding-docs/declaration-transcript

[15] https://www.npr.org/2019/12/10/786579846/read-articles-of-impeachment-against-president-trump

[16] https://freedomhouse.org/report/freedom-world/2019/democracy-retreat

[17] https://freedomhouse.org/report/nations-transit/2020/dropping-democratic-facade

[18] J. Wasfy et al., “Community Health Associations of Net Voting Shift in the 2016 U.S. Presidential Election,” PLOS ONE 12, no. 10(2017).

Shannon Monant, “Deaths of Despair and Support for Trump in the 2016 Presidential Election,” Research Brief, 2016.

Kathleen Frydl, “The Oxy Electorate,” Medium, November 16, 2016.

Jeff Guo, “Death Predicts Whether People Vote for Donald Trump,” Washington Post, March 3, 2016.

Harrison Jacobs, “The Revenge of the ‘Oxy Electorate’ Helped Fuel Trump’s Election Upset,” Business Insider, November 23, 2016.

[19] Scutchfield FD, Keck CW. Deaths of Despair: Why? What to Do?. Am J Public Health. 2017;107(10):1564-1565. doi:10.2105/AJPH.2017.303992 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607684/

[20] Scutchfield FD, Keck CW. Deaths of Despair: Why? What to Do?. Am J Public Health. 2017;107(10):1564-1565. doi:10.2105/AJPH.2017.303992 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607684/

[21] https://www.npr.org/2020/10/20/925895703/they-took-a-gamble-and-voted-trump-in-2016-whom-are-they-going-to-vote-for-in-20

[22] John W. Dean and Bob Altemeyer, Authoritarian Nightmare: Trump and His Followers, 224-225.

[23] Dean & Altemeyer, 128.

[24] “Trump’s ‘LIBERATE MICHIGAN!’ tweets incite insurrection. That’s illegal.” https://www.washingtonpost.com/outlook/2020/04/17/liberate-michigan-trump-constitution/

[25] Life Between the Trees blog, https://lifebetweenthetrees.wordpress.com/2012/08/06/words-create-worlds-monday-morning-parable/

[26] https://www.cnbc.com/2020/03/18/coronavirus-criticism-trump-defends-saying-chinese-virus.html

[27] Carl Bell, The Sanity of Survival: Reflections on Community Mental Health and Wellness, 406. Also see my blog post, “Racism & Narcissism: The Work of Carl Bell, MD,” https://beingfullyhuman.com/2020/07/21/racism-narcissism-the-work-of-carl-bell-md/

[28] https://emedicine.medscape.com/article/292991-overview

[29] See my blog, “Words Create Worlds.6 Doctors Against Fascism,” https://beingfullyhuman.com/2020/10/16/words-create-worlds-6-doctors-against-fascism/

[30] Bandy X. Lee, Profile of a Nation: Trump’s Mind and America’s Soul, 9.

[31] https://www.nbcnews.com/politics/meet-the-press/howard-dean-s-scream-turns-15-its-impact-american-politics-n959916

[32] https://www.hrw.org/report/2011/07/12/getting-away-torture/bush-administration-and-mistreatment-detainees

Words Create Worlds.7 – The Cure: Spiritual Humanity

These essays have been a warning about how Words Create Worlds and the dangerous words that create fascism. If words create worlds, then we have the power to create and the responsibility for creation. There are spiritual traditions in which the world is created anew – every moment, every day, every season, every year. Joseph Rael (Beautiful Painted Arrow) teaches from such a tradition. Na-yo ti-ay we-ah, “I do not exist,” “we do not exist.” To me these words of Joseph’s tell us that we do not exist when we strive to persist as fixed, permanent objects, rather, we do exist when we are flowing and changing within an infinite field of interconnected relationship. We flash into and out of existence, like Joseph’s concept of being & vibration, or the Hindu concept of spanda, the divine creative pulsation. We are ancient, but we are not a thing of the past. We are eternal, but we are always becoming. We always in a state of becoming: becoming human, becoming medicine, becoming spiritual humanity.

Choice

We have choice in every moment, in the words we use to describe ourselves and our world. Like Adam in the Garden, we are continually naming our reality and using our words to create our worlds. If Rebecca Solnit tells us that “one of the crises of this moment is linguistic,”[1] then the cure is also linguistic as well. Solnit tells us she thinks “of the act of naming as diagnosis,” and “sometimes what’s diagnosed can be cured.”[2] Diagnosis reminds us of the need for Doctors Against Fascism – but we cannot only be against something, we also need to be for something. This is when we use our words to reach deep for goodness, to use words of unity, and to speak of spiritual humanity. This essay will introduce a number of words, different ways of describing alternative word choices to fascist words – words that remind us that we are both matter and spirit, we are both body and soul, we are both shadow and light.

Photo by David Kopacz (2020)

New Dogmatisms

One more caution. We must take care that we do not create new dogmatisms in trying to fight against fascism. Our minds must be dynamic, as must our hearts. Think about the heart – four chambers, multiple valves – it keeps us alive through continual motion and adjustment. So too, our spiritual heart – it is always in a state of interrelationship, it is always balancing and adjusting.

Be Careful in Fighting Monsters, Lest Ye Become One

“Whoever fights monsters should see to it that in the process he does not become a monster. And when you look long into the abyss, the abyss also looks into you,” (Nietzsche).[3]

Nietzsche cautioned us – when you fight something you can end up becoming that very thing which you fight. He goes on to say that when you gaze into the darkness of the abyss, the abyss gazes back into you. In your fight, in your resistance, you need to continually be reconnecting to your spiritual humanity, to your inner gentle nature.

Iwauzan Azuyeya

Ceremonial Elder of the Veterans Sweat Lodge, Mike Lee, of the Blackfeet People, teaches that we are inherently gentle human beings. When we fight with others we can develop iwauzan azuyeya, “sickness as a result of being in battle with people.”[4] We are not meant to fight, we are not meant to be at war, but it is part of what occurs, as we live our lives. While Mike works with veterans and is speaking of physical battle, during these times we are in battle throughout the day. Whenever we forget our gentle nature, our original instructions, whenever we forget our spiritual humanity, we become sick with iwauzan azuyeya. We become sick through being materialists, because spiritual humanity means that we always are embodying spirit in matter, we are always materializing spirit and spiritualizing matter. Henry Corbin learned there is a word for the place that this occurs which comes from esoteric Islam, ‘ālam al-mithāl.

The Held-back Place of Goodness

In our book, Walking the Medicine Wheel: Healing Trauma & PTSD, Joseph Rael taught me that there is a held-back place of goodness in our hearts. No matter what we do, no matter what is done to us, God keeps a held-back place of goodness in our hearts. That means that we can never be wholly bad, we are never a lost cause. No matter how far off track we go, there is a source of goodness within the depths of our heart. The Hindus have a word for this place of divinity within the heart, gūha – the cave of the heart. The way that we re-humanize and re-spiritualize ourselves is through the quest to rediscover and reconnect to our divine humanity, our spiritual humanity – the held-back place of goodness within the human heart.

Heart Meditation, David Kopacz (2014)

Refounding & Refinding

Father Gerald Arbuckle, anthropologist and Marist priest, has taught me about the principle of refounding – returning, recapturing, and re-enlivening the original vision, the original instructions of an institution or organization. Refounding is a dynamic process, it is never completed once and for all. Fundamentalisms, of various forms, teach that the future is fixed by a law from the past. Fundamentalism is a distorted form of refounding. Refounding requires recognizing that the words we are using in the present are no longer living. Then there is a movement, a return, back to the past to find once again the Living Word. Fundamentalism gets stuck at this point, concretizing and solidifying the word into a rigid dogma that is used as a stick to beat people with, to divide rather than to heal and unite. Refounding has a next step, the Living Word is brought back and spoken in the present. The vision or transmission that occurred in the past now happens in the present – the Dove of the Holy Spirit is not kept in a cage, but is released like a tongue of fire to dance in the present moment, investing it with sacredness and divinity. While Gerald Arbuckle speaks of organizations needing to be re-invigorated by a refounding person, perhaps when speaking of the individual we can call this refinding – refinding the held-back place of goodness within the gūha, the cave of our heart, the place of the ‘ālam al-mithāl, the place where we are continually refinding our spiritual humanity.

Eagle – Copalis Beach, WA, David Kopacz (2018)

Rehumanize Your Self

The band, The Police, have a song called “Rehumanize Yourself” on their 1981 album Ghost in the Machine. The song is about fascism and the need to counter it by rehumanizing yourself. In 2014 I published a book called, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine. I felt that in the process of learning the words of medicine, which focus so much on pathology, I was becoming dehumanized, I was losing my soul, my sense of spiritual humanity. I developed the idea of a counter-curriculum – a curriculum of Continuing Human Education that was as necessary as our technical Continuing Medical Education. At the end of the book, I came to the conclusion that anything that separates, divides, or disconnects – takes away our humanity. To be human is to be connected (both inner & outer). I learned the word antakolouthia – that every virtue requires others to complete it. In a way, that is what this essay is about – learning a vocabulary of virtues.

Re-Spiritualize Your Self

The conclusion I came to in Re-humanizing Medicine, was that we could not appeal to concrete things like numbers and studies and objective reasons why we should strive to re-humanize ourselves. I have felt there is a need for a second book after Re-humanizing MedicineRe-spiritualizing Medicine. Medicine was once a physical practice grounded in the spiritual. When we practice only the medicine of matter, we are practicing dehumanized medicine, because human beings are more than just matter. I would say that we would be practicing veterinary medicine, but even most veterinarians treat their patients with humanity. The justification for becoming human comes from elsewhere, like Havel said of hope, it comes from beyond. The “thing” that makes us most human is not a thing. Maybe this is why Joseph Rael teaches that we do not exist – we are not things, we are processes of becoming medicine.

Becoming Medicine

In our most recent book, Becoming Medicine: Pathways of Initiation into a Living Spirituality, Joseph Rael and I introduce a lot of different words and stories. The purpose is to understand the process of initiation, which is a process of transformation. We can work at becoming visionaries, becoming mystics, becoming shamans, but what we were really getting at was that we should be working at becoming True Humans. To be a True Human is not to exist in a dogmatic fundamentalism, but to be continually refounding and refinding our gentle human nature, releasing the held-back place of goodness into the world. To return to who we are and to release it into the world is both heroic and healing.

Heroism & Healing

Heroism and healing are two virtues of the True Human Being. Yet, when you think about it, heroism is only needed when there is darkness and healing is only needed when there is wounding. These two virtues are only needed when we are wounded in the dark. We find ourselves in such a place, now, where the untrue words of fascism are darkening the world and wounding us.

Gannet, Muriwai Beach, New Zealand, David Kopacz

The Sacred Hoop is Broken

In Black Elk’s vision, the tree at the center of the Earth was sick and dying and the sacred hoop of the medicine wheel was broken. Joseph Rael often reminds me, we are all working on repairing the medicine wheel – it has been broken. He doesn’t tell me why it is broken, but it seems obvious: genocide, theft, greed, environmental degradation, selfishness, dehumanization, and now we can add fascism as well. Joseph tells me that in his visions he sees the ancestors repairing the medicine wheel. We can help in this work – by choosing our words carefully, by choosing words of heroism and healing, by choosing words of becoming medicine, by refinding our spiritual humanity and becoming True Human Beings. We can repair the sacred hoop and the good red road. We can assist humanity’s ancestor, Black Elk, in repairing the sacred hoop and tending to the tree at the center of Mother Earth until she blooms again.

Spiritual Democracy

Another word I learned in writing Becoming Medicine was spiritual democracy. I learned this word from Steven Herrmann who learned it from Walt Whitman. Joseph uses this word, too. Joseph was taught that there is a world above this world, a spirit world, and that what exists here has its counter-part there. I always think of the idea of archetypes when he talks about this, a set of ideal forms that gives rise to particulars here on Earth. I think of this as a place of goodness from which we can always draw strength. There are the various national democracies in the world, but there is also a spiritual democracy, an idea of democracy that we are all striving for. Sometimes we are struggling toward this idea, this ideal in the dark, and other times it is illuminating the way for us. Spiritual Democracy is an idea that reminds us of our spiritual humanity and it is also a place that we reach when we are refinding our spiritual humanity. Spiritual humanity is both a path and a destination. Is it a destination, though? Perhaps spiritual democracy is more like a mirage that draws us into the uncertainty of the future, or maybe spiritual democracy is like the torch of Lady Liberty, illuminating darkness. When the torch goes out, how can you re-ignite it? By speaking words of spiritual humanity – the fire that dwells in the cave of your heart.

Earth Child of Spiritual Democracy, Joseph Rael

Spiritual Humanity

To be a True Human we must be continually on the path, on the good red road. It is a path of continuous epiphany and theophany. Joseph Rael teaches that we should strive to be hollow bones – not identifying as solid matter, but matter as a vehicle for spirit to flow through. That is how a shaman heals, not be being important, but by being nothing – a space which the divine can flow through. Oddly enough, we are most spiritual when our humanity is in service of the divine, which is also the service of others. We are most human when caring for human being – and that means caring for self and others.

Nobility of Spirit

Rob Riemen’s To Fight Against This Age: On Fascism and Humanism was one of the inspirations for the words that I have been writing. It makes sense to pair fascism and humanism and to see a choice between them, as fascism could be said to be dehumanism. A good book is a doorway into other books, and so it was with To Fight Against This Age, it led me to Riemen’s earlier book, Nobility of Spirit. Here he speaks of the German word, bildung, which translates as education and self-cultivation. This word gets at the idea of spiritual humanity as a responsibility to cultivate our nature. Cultivation has no end and is continual adaptation as seasons change. To cultivate means to combine care and labor. Joseph Rael teaches us that “work is worship,” the work of humanity is spiritual. The Proto-IndoEuropean root of cultivate is *kwel, which means to revolve, move around. This reminds us of the medicine wheel, of the sacred hoop, of the refounding and refinding of our spiritual humanity.

Call Them By Their True Names

Another inspiration for these words I am writing comes from Rebecca Solnit’s Call Them By Their True Names. This book is where she writes that one of the crises we are facing is linguistic. In this 2018 book, she argues that we should call the president’s words by their true name and we call these words fascist. Solnit tells us that naming is like diagnosis. We can also say that naming is like the cure as well. In magic, such as in Ursula Le Guin’s Wizard of Earthsea books, to know someone’s true name gives power over them. Words are power, words can be disease, words can be healing, words are creative, words create worlds. This phrase comes from Rabbi Heschel and he cautions about the little words that led to big words and to the terrible word, Holocaust. Holocaust comes from the Latin holocaustum, and the Greek holokauston, and was originally a sacred offering of a thing burnt whole. Our words are sacred offerings, they come from the fire of our hearts or the divine dancing doves of flame of the Holy Spirit. Our original instructions for using our words was to focus on the whole, not to divide, to subdivide, to disconnect. To speak words of spiritual humanity is to bring together and heal. We are not meant to burn others, although many traditions teach that we are to burn ourselves, that we our bildung requires that we bake and burn, becoming hollow bones through which spirit can flow.

The whole of my life
is summed up in these three phrases:
I used to be raw
Then I was cooked
Now,
I am on fire.

(Rumi)[5]

To revivify, to cultivate our spiritual humanity, the matter of our bodies must be continually composting to become fertile ground for the seed of the spirit to sprout and take root. As Nietzsche said, humanity is something that is to be overcome.[6]

A Vocabulary of Virtues

Rumi tells us to die before you die.[7] Rumi says, “We are pain and what cures the pain.”[8] A Vocabulary of Virtues could be a Rumi poem that lists the many virtues – perhaps both the absurd and the profound. I imagine the end of this poem would say, “And of all the virtues, there is one word that contains them all, that word, and as always, is Love.”


[1] Rebecca Solnit, Call Them by Their True Names, 4.

[2] Ibid., 1.

[3] Friedrich Nietzsche, Beyond Good and Evil, transl Walter Kaufman, 89.

[4] Mike Lee in Kopacz & Rael, Walking the Medicine Wheel, 56.

[5] Rumi in Omid Safi, Radical Love: Teachings from the Islamic Mystical Tradition, xxx.

[6] Friedrich Nietzsche in The Portable Nietzsche, transl Walter Kaufman, 124.

[7] Rumi “Die Before You Die,” in The Soul of Rumi, transl Coleman Barks, 168.

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