Moon Shots

The full moon this month is called the Snow Moon. Last night it was hazy, almost like an eye in the sky, looking at this blurry year of the pandemic. The light from the moon is reflected from the sun. It seems like this past year we have been fumbling in the dark, not seeing clearly, struggling with the disruption of the pandemic and the political instability.

My friend, Joseph Rael (Beautiful Painted Arrow) is always telling me, “We need to teach people that they can go to the moon – not with rocket ships and technology – with their own consciousness through visions, like I do.” Joseph tells me he has been to the moon several times. One time he was sitting in his armchair in the Southwestern United States and then, pop, he was up in space, looking at someone who was aiming a camera at the moon and he was also seeing the Little People, the elves who were on the surface of the moon preparing it for human arrival. As Joseph looked at the scene, he realized that he was trilocating: he was the person with the camera and could zoom in and out, he was the observer seeing the person with the camera, and he was the person talking to the King of the Elves on the surface of the moon. The King of the Elves told him that the elves always go ahead to prepare reality for the arrival of humans and they were quite busy on the moon. Then, pop, Joseph was back sitting in his armchair.

While many might think this sounds fantastic, or it was just Joseph’s imagination, he is adamant that this is an important part of his teachings and that people need to stop being so focused on their self-imposed limitations of the separation of the body from the Earth and the Universe. He sees human evolution as moving away from technological travel to spiritual or metaphysical travel.

Joseph has always been guided by his visions, from his formative vision in the early 1980s of buidling Sound Peace Chambers all around the world (over 65 have been built on four continents), to his visions of us entering the 5th world, the new world, and his trips to the moon.

I stepped outside into the cool Seattle night and looked up at the moon and thought about how Joseph keeps telling me we need to teach people that they can travel without technology, that they can travel in non-ordinary, visionary reality. I looked up at the moon and I was the person the with camera, zooming in through the haze to see the moon more clearly. It is a hobby of mine, trying to hold my breath, steady the camera, and seeing how clear of a photo I can get with the zoom on my camera.

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

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?

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

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)

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