A Great Pair of Books to Teach Kids about Living in Harmony with the Earth!

Si’ahl and the Council of Animals: A Story of Our Changing Climate for Children and Their Parents

Si’ahl & Friends Activity and Coloring Book

Jane Lister Reis and her sister, Margie Lister Muenzer have created a great book for kids on listening to the environment and caring for it. When the animals of the forest begin to suffer from the changing climate, Si’ahl, a bald eagle, calls a council of the animals. (The authors engaged in dialogue with the Duwamish Tribe about using the name Si’ahl, which is the Duwamish name of Chief Seattle, and honor him with this story). When the animals cry out for help, one family learns to listen to the animals and to work to care for our common home, Mother Earth. The book is illustrated with line drawings by Andrea Hoitis and it could be used as a small coloring book – although there is a larger “Si’ahl & Friends Coloring and Activity Book,” that is a great companion to the story book.

The Activity & Coloring Book has puzzles, mazes, even a grid for backyard birdwatching!

Jane Lister Reis lives in Seattle and is the founder of First Light Farms & Learning Center in Carnation, WA.

Great Book about Healing by Returning to the Land of War to Find Peace

John Wesley Fisher, DC, asked if I would review and write an endorsement for his new book, Dak To Rx: A Travelogue – A Veteran Returns to the Land of His Nightmares. John is a Vietnam veteran and the Founding Director of CORE (Community Reconciliation)Viet Nam. Dak To is the name of a town in Vietnam that John had been in during the Vietnam War. Returning to engage with the land and the people, now from a state of peace, rather than war, leads to healing and the formation of many friendships. One Vietnamese veteran tells John, “Now all survivors are the same…we didn’t kill each other, so now we can be friends and teach the world about peace together.” Here is my endorsement of the book:

Dak To RX is just what the doctor ordered for healing PTSD and coming home from war to peace. John Wesley Fisher is a man of many places and roles: seeker, chiropractor, surfer, traveler, and Vietnam Veteran.

Dak To RX is a journal of his journeys throughout Vietnam in 2011-2012 where he finds compassion, acceptance, peace, and healing from the people he meets and the places where he walks up on the land. His nightmare becomes a dream of peace and healing.

Fisher notes that it is “a sacred time being on the road,” and his journey is a sacred journey of healing. He meets many Veterans (both former allies and enemies) and survivors of the American War in Vietnam along the way. What he learns from one former enemy is, “Now all survivors are the same…we didn’t kill each other, so now we can be friends and teach the world about peace together.”

David R. Kopacz, MD

Psychiatrist, Seattle VA
National VA Education Champion – Office of Patient Centered Care & Cultural Transformation
Assistant Professor, University of Washington

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

Words create worlds,” said Rabbi Abraham Joshua Heschel.[1]

Are we in a fight for humanity? You bet your life we are. In 1973 Bob Marley & Peter Tosh wrote the lyrics:

 Get up, stand up, stand up for your rights!

Get up, stand up, stand up for your rights!

Get up, stand up, stand up for your rights!

Get up, stand up, don’t give up the fight![2]

Is fight the right word? Maybe there is a time to fight, even if you are a pacifist, but what does it mean to fight?

Maybe fight is not the right word, as it conjures up opposition and separation – and that is the very thing that we are “fighting” against. There is a quote, often attributed to Mother Teresa, “I was once asked why I don’t participate in anti-war demonstrations. I said that I will never do that, but as soon as you have a pro-peace rally, I’ll be there.”[3] This captures the danger of fighting against something. Nietzsche warns us, “Whoever fights monsters should see to it that in the process he does not become a monster. And when you look long into an abyss, the abyss also looks into you.”[4] And yet, how do we respond to the growing fascism in the world and our history of colonialism and racial oppression and genocide? We have never recovered from racism, we have never fully addressed it. We are in the midst of a pandemic from Coronavirus COVID-19, and yet we are suffering from a re-infection of “the plague bacillus” of fascism.[5] Are not the risks of racism and fascism such that all human beings with a heart must necessarily “Get up, stand up, stand up for your rights?”

Tree, Lime Kiln State Park, WA, D. Kopacz (2015)

Carl Jung’s 1946 essay, “The Fight Against the Shadow,” actually argues not so much for a fight against something outside in the world, but rather an internal struggle to acknowledge, own, and integrate one’s own shadow. While Jung comments on mass psychology and group psychosis following a fascist leader. He wrote that Hitler had an “unadapted, irresponsible, psychopathic personality, full of empty, infantile fantasies, but cursed with the keen intuition of a rat or a guttersnipe.” He also wrote that the reason that Hitler was so successful was because he “represented the shadow, the inferior part of everybody’s personality…and this was another reason why they fell for him.”[6] Jung seems to assume that the fight had to be done in the outside world, but that the cause and the ultimate cure had to do with each individual’s inner fight against their own shadow, to acknowledge, to accept, and to integrate so that one is conscious of this inner darkness within the heart of humanity rather than unconsciously acting it out in the world. He calls this a “moral evaluation,” and an “ethical responsibility.” He notes that the people who are capable of this are often not the political leaders, but the “moral leaders of mankind.” The “maintenance and further development of civilization depends on such individuals” to act in these roles of moral evaluation and ethical responsibility.[7] Jung’s defense against mass movements and collective psychosis resides in the strength of individuals to face their own darkness, for only one who has stood up to one’s own darkness can stand up to another’s darkness. As Jung wrote, “One does not become enlightened by imagining figures of light, but by making darkness conscious. The latter procedure, however, is disagreeable and therefore not popular.”[8]

Jung reorients us to the inner fight as well as the outer fight. From this perspective, we are the barbarians, they are not out there. The word barbarian originally meant “all that are not Greek,” and came from the Proto-Indo-European  root “*barbar- echoic of unintelligible speech of foreigners.”[9] A barbarian was originally just someone “other” than you whose speech you were to ignorant to understand. Somewhere along the way, though, we projected our shadow onto the other and imagined they were the ignorant and dangerous one. Look at the murder and pillage that the colonial empires of Europe let forth upon the world. When Jung met Ochwiay Biano (Mountain Lake) of the Taos Pueblo in Southwestern United States, he was told how the non-European sees the European.

“See…how cruel the whites look. Their lips are thin, their noses sharp, their faces furrowed and distorted by folds. Their eyes have a staring expression; they are always seeking something. What are they seeking? The whites always want something; they are always uneasy and restless. We do not know what they want. We do not understand them. We think they are mad.”[10]

Binding Sites of Coronavirus Covid-19, D. Kopacz (2020)

Perhaps Western civilization is not only barbaric and mad, but also sick. We evaluate the health of countries primarily by their economies. Economies are not people. As we have seen with the Coronavirus COVID-19, our health care systems, educational systems, our systems of justice, even our economic systems – were all in ill health and fractured. A few weeks of interruption of the economic machine and everything was revealed to be so very fragile and weak where we thought it was strong. “Civilized” people look with disdain and horror at earlier civilizations that sacrificed animals or people to the gods, however the Economy demands human sacrifices – homelessness, underfunded health care systems, underfunded education systems, the rape of the environment. If another civilization comes after this one, surely they will see us as mad, primitive, barbaric, worshipping false idols of money and profit at all costs, even the cost of our own humanity and our own home, Mother Earth.

Rebecca Solnit writes “Who Will Win the Fight for a Post-Coronavirus America?” in The New York Times, 3/29/20:

Every disaster shakes loose the old order: The sudden catastrophe changes the rules and demands new and different responses, but what those will be are the subject of a battle. These disruptions shift people’s sense of who they and their society are, what matters and what’s possible, and lead, often, to deeper and more lasting change, sometimes to regime change. Many disasters unfold like revolutions; the past gives us many examples of calamities that led to lasting national change.

How can we fight against this inner and outer madness that is the very structure of our economic civilization? As Charles Eisenstein writes, all the problems that we are facing are all part of one root problem: separation; and the only solution is that we need to move from separation to “interbeing.”

This book is a guide from the old story, through the empty space between stories, and into a new story. It addresses the reader as a subject of this transition personally, and as an agent of transition—for other people, for our society, and for our planet. Like the crisis, the transition we face goes all the way to the bottom. Internally, it is nothing less than a transformation in the experience of being alive. Externally, it is nothing less than a transformation of humanity’s role on planet Earth.[11]

Jung and Eisenstein point out that we do not know who we are and this ignorance is killing us – it leads to fascism, racism, plundering the environment, it leads to us seeing human beings and the environment as “other” as we only focus on this littlest, meanest little part of our larger humanity, our ego. We do not know who we are and this ignorance is killing us and turning our lives and world into a living hell.

Rob Riemen picks up this theme that we have forgotten our humanity. His book, To Fight Against this Age: On Fascism and Humanism takes on the task of a response to the growing rise of fascism and the response being to reinvest in a kind of spiritual humanism. Perhaps, then, our fight is not against fascism so much as it is for every individual to have the right to choose the human, to choose humanism. This is not the kind of humanism that fundamentalists fear – although I am not exactly sure what they have to be afraid of, other than losing control of control.

Our true identity is determined not by nationality, origin, language, belief, income, race, or any way in which people differ from one another, but precisely by what unites us and makes the unity of mankind possible: universal spiritual values that shape human dignity and that every man can adopt.[12]

This kind of humanism recognizes our sacred nature – a sacred humanism, a sacralizing of humanity. Riemen writes that some of the ways we can continue to rehumanize ourselves is through the arts, the humanities, and by learning from history. He also writes that we must have qualitative values, valuing the things that can be felt, but cannot be counted. He critiques a purely business or scientific view of humanity reduced to dollars, numbers, and percentages.

The religions tell us about the sacred, but if a religion leaves out the sacredness of humanity, it literally has no place on Earth. In promoting the idea of a sacred humanity, I am not speaking of one people’s religion, I am speaking of the religion of One people, a religion of humanity that recognizes the sacred in all human beings, in all beings, and in all the Earth.

I am working with Joseph Rael (Beautiful Painted Arrow) over the last six years. The kind of work I do with him is listening, writing, and reading. The work that is most important to him is world peace and he was recognized by the United Nations for this work. Joseph’s grandfather used to say to him, “work is worship,” and that is the kind of work we do together – worship.

When Joseph had his vision of a Sound Peace Chamber in 1983 (a circular structure, half above ground, half below, with men and women sitting in a circle and chanting for world peace), he took a year looking for the best place to build it. After one year, the Spirit Elders came to him and asked why he hadn’t built it yet. Joseph said he was looking for the perfect place. The response was a beam of light that came from the Heavens to Earth and landed in his backyard. It turns out that the work for peace begins at home – in your own backyard!

Joseph learned, in the Tiwa language of Picuris Pueblo, that the name for God is Wah-Mah-Chi, which translates as Breath-Matter-Movement. This tells us that our breath, inspiration and expiration is sacred and holy. This also tells us that our matter, far from being dead or a neutral resource, is alive as well, and full of vital spirit. Movement, too, all of our movements and the way we touch each other is meant to be inspired and full of divinity. In the Tiwa linguistic world, everything is God – just as in the non-dual philosophies such as tantra and Non-dual Shaivism. God is not out there, God is everywhere. The question then is on what do we place value? What do we invest in?

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

Our contemporary civilization invests in money, economic growth, building capital. While the United States of America is often considered by many to be a “Christian” nation, it is actually a nation of heretics if money is placed before God and before humanity, because humanity is one of the homes of God on Earth. In The Heart of Darkness, Joseph Conrad wrote, “This also has been one of the dark places of the earth.” The question is what “this” refers to – is it inner Africa; up river; is it the pagan African people who are physically “dark;” is it King Leopold’s Ghost, the colonial conquest of Africa; or is it simply the darkness in our own hearts when we cease to honor the spiritual humanity of ourselves and others?

Psychoanalyst Robert Stoller describes the motivation behind dehumanization and objectification of others: “we anatomize them … we deprive others of their fullness.”[13] As I wrote in Re-humanizing Medicine,

“Stoller believes that reducing the other to a body part or replacing a relationship with an object is a psychological defense against the anxiety of relationship. The risk is that the process of dehumanization goes both ways. One cannot dehumanize someone and remain human oneself. It is not a human action to treat someone else as an object.”[14]

Stoller writes that the act of dehumanizing another “dehumanizes the dehumanizer.”[15] The colonial project of conquest, plundering resources, slavery, forced conversion to Christianity, the outlaw of indigenous languages and religions, and genocide, both cultural and literal, against indigenous peoples created a vast dead zone on the planet Earth, a vast zone of dehumanization and de-spiritualization, a hell on Earth. What does it matter if one is rich if one lives in hell? The outlaw of indigenous languages and spiritual practices, as in the United States until 1978, was a war against words because it was known on some level that words create worlds. The colonizers took the words right out of the indigenous peoples’ mouths and substituted their own words as they renamed and over-named the landscape in an attempt to make pale copies of the places they came from and from rulers, kings, and queens. Colonizers and colonized were both, thus, dehumanized.  

How do we fight against dehumanization? Is it ever human to fight? Or is the method, rather to get up, stand up, stand up for your rights – your human rights? We must choose the human, not the dehumanized. We must choose to re-invest in humanity by seeing the divinity within Breath-Matter-Movement. Is it possible to get up, stand up, stand up for your rights without turning it into a fight? What does it mean to fight?

fight (v.)

Old English feohtan ”to combat, contend with weapons, strive; attack; gain by fighting, win” … from Proto-Germanic *fe(u)hta … probably from PIE *pek- (2) “to comb, to pluck out” wool or hair (source also of Lithuanian pėšti”to pluck,” Greek pekein ”to comb, shear,” pekos ”fleece, wool;” Persian pashm ”wool, down,” Latin pectere ”to comb,” Sanskrit paksman- ”eyebrows, hair”). Apparently the notion is “pulling roughly,” or “to tear out one another’s hair.”[16]

How do we make sense of the etymology of the word, fight, referring to pulling hair? We can turn to Ayenwathaaa or Aiionwatha, whom we know in English as Hiawatha. While his life and words and legend belong to the Haudenosaunee, the six nations of the Iroquois Confederacy: Mohawk, Onondaga, Oneida, Cayuga, Seneca, and Tuscarora peoples, The Great Law of Peace (Kayanerenkó:wa) is said to be one of the inspirations for the Constitution of the United States of America (See the enlightening new book by Glenn Aparicio Parry, Original Politics: Making America Sacred Again).[17]

War & peace, fighting & working are all tangled up. Hiawatha can be translated as “He Who Combs.” He is called this because he was tasked with helping Great Peacemaker bring the New Mind, the Great Law of Peace, to the minds of humanity – however, he must first comb the snakes out of the greatest opponent to the New Mind, Atotarho.[18] Hiawatha was living a life of dehumanization and depravity prior to meeting Great Peacemaker, in some version of the story he was even a cannibal – a thing that feeds on humanity. When Great Peacemaker explained the Great Law of Peace to him, Hiawatha said, “I take hold, I grasp it. . . . Now what work is there for us to do?”[19] The work he takes on is to bring the New Mind of to those who have become dehumanized, who have lost their connection and memory of their own divinity. There are no enemies to the Great Law of Peace, only opponents, because once a human being makes the choice to be a spiritual human, to grasp a hold of the New Mind and the Great Law of Peace, that person becomes a carrier of Peace. Jacob Needleman, in discussing this story, writes that “man must experience himself as the force that resists the good.”[20] The beauty of this story, and by story I do not mean fiction, I mean medicine,[21] is that no one is forever lost, even the most depraved has the hope of redemption. As Joseph Rael says, Wah-Mah-Chi holds back a place of goodness in our hearts, no matter what we have done, no matter what we have seen.[22] Needleman sees in Hiawatha’s struggle to re-find this goodness within his heart the struggle that we, as citizens of the United States of America, must go through as well for our crimes against humanity.

Here…the legend speaks of a human crime for which no ordinary action can atone. Here the story may well be heard as speaking to our own remorse as we see in a clear light what has been done to an entire people. And here the tale echoes the constitutive legend of our own culture—the crime for which no ordinary action can atone, a level of self-remorse which demands of man an action of an entirely new quality. And for this action the man needs now to turn to the greatness he has seen in himself.[23]

In Joseph Campbell’s hero’s journey model one of the stages before being able to return home is atonement, or as Campbell sometimes wrote, at-one-ment. We must do the work of the heart to atone for our own sins as well as those of our ancestors and culture. To do this means we must become at-one with them, we must bring together both sides of the wound, as was done in the Truth & Reconciliation work in South Africa after apartheid. Perhaps this is a way to look at our culture and society know, the places where we see separation are really two sides of the whole which the wound has cut apart. To pull further from each other only leads to deeper wounding. Also, continuing with this metaphor, we cannot simply force the edges of the wound together, without cleaning and what surgeons call “approximating” the edges of the wound, full-thickness from the base of the wound to the superficial edges – together. We are all wounded and we are all part of the wound and our healing cannot be done individually, it is only through collective healing that we can bring the division of the wound back together into a whole. Needleman and Hiawatha learn that the wound will be healed through the new idea of peace, an idea that is a power.

The New Mind has come to you . . . and you are miserable because the New Mind does not live at ease with old memories . . . Now you will work with me to bring justice and peace to those places where you have done injury to man. We will work together to bring to the earth the new idea of the peace that is power. Such is the work given to man by the Creator of Life.[24]

Needleman sees that we need a re-spiritualization of ourselves as human beings and or our democracy. Joseph Rael and I talk about the idea of Spiritual Democracy, in our book, Becoming Medicine: Pathways of Initiation into a Living Spirituality. I came across this term in Steven Herrmann, Spiritual Democracy: The Wisdom of Early American Visionaries for the Journey Forwardand Herrmann found it in Walt Whitman’s writing.

Adopting the big idea of Spiritual Democracy, the realization of oneness of humanity with the universe and all its forces, can help people feel joy, peace, and interconnectedness on an individual basis. It can also inspire us to undertake sacred activism, the channeling of such forces into callings that are compassionate, just, and of equitable heart and conscience, and give us some tools to start solving some of these grave global problems, while uniting people on the planet.[25]

“The written word, the spoken word,” writes psychiatrist Paul Fleischman, “is like a hand feeling its way into a dark room, looking for a switch.”[26] The switch that we are looking for is the one that turns on and illuminates our shared sacred humanity. We are not alone in this quest, as Fleischman writes in his book, Cultivating Inner Peace: Exploring the Psychology, Wisdom and poetry of Gandhi, Thoreau, the Buddha and Others

Shakers corresponded with Count Leo Tolstoy. Tolstoy’s book was one that transformed Gandhi, and Shaker and Gandhian ideas re-molded Count Tolstoy into a Christian peasant Tolstoy. Whitman and Thoreau met and influenced each other, and Thoreau’s “Civil Disobedience” became the manifesto for Gandhi’s social action. Scott and Helen Nearing read Whitman and Thoreau, as did Rabindranath Tagore. Tagore and Gandhi had a long relationship. John Muir’s favorite author was Thoreau. Thoreau “carried Leaves of Grass around Concord like a red flag.” Seekers of peace read each other, write to each other, influence each other. The quiet life of inner peace isn’t a vacuum.[27]

In Walking the Medicine Wheel: Healing Trauma & PTSD, Joseph told us that we are all brothers and sisters. He says, “I am my brother’s keeper,” thus contradicting the first documented murder in the Biblical tradition. After Cain has killed his brother, Abel, God asks Cain where his brother is. Cain says “Am I my brother’s keeper?” Joseph would say, “Yes, I am my brother’s keeper!” In Becoming Medicine, we move from us being brothers and sisters to us all being One, an identity of non-duality.

Joseph told me, when we were working on Walking the Medicine Wheel for veterans, that every veteran should get their DNA analyzed through National Genographic’s program, so that they would learn that we are all brothers and sisters, we all originally come from Africa. We know this is true through genetic science and the migrations of peoples. We also, literally, all have common human ancestors. We are all the sons and daughters of Mitochondrial Eve, who lived in Africa about two hundred thousand years ago. We also are all the sons and daughters of Y Chromosome Adam who lived between 150,000 and 300,000 years ago. Mitochondrial Eve’s initials are ME – this reminds us that we are all not just one family, but we are all One. Mother Earth’s initials are also ME, thus we are all relatives of the Earth and are One with the Earth. We are made of the Earth and the Earth moves from place to place through our Breath-Matter-Movement.[28]

Mother Earth Dreaming all of the Two Leggeds into Beauty, J. Rael (2006)

We all come from Africa and Joseph says that when he was growing up the Pueblo people would refer to Black people as “our ancestors,” recognizing that we are all related and honoring the Black people and Africa as our common homeland. And where did Africa come from? Africa and all the continents were once all part of One continent, Pangea, which slowly broke apart and is slowly coming back together to reunite in Pangea Ultima.[29]

We have a choice in this life, do we want to be Lumpers and Splitters? This is a concept Charles Darwin described in determining whether two individuals are part of one species or two different species. He noticed that some biologists tended to focus on small difference and others focused on large similarities. Science works, largely, through separation and differences. When you are doing science, it can be good to be a Splitter. However, when you are doing humanity, it is better to be a Lumper, and to see our common spiritual humanity. Another word for “doing humanity” is mysticism. Mysticism is the spiritual practice of being a Lumper, of attaining a sense of peace and unity – what is sometimes called, non-duality. Joseph Rael and I have chapters devoted to becoming a visionary, becoming a shaman, and becoming a mystic and really all of these are about another thing that Joseph often says, becoming a true human.

We must reinvest in our humanity, in our spiritual humanity. To reinvest means we need to take what we consider “mine” and we need to think of it, instead as “ours.” We are out of balance. We have too much energy going into separation, isolation, and hoarding. Our view of the economy and life as always moving toward some imagined future of better profits and no pain is obsolete. Our economy and civilization is based upon expansion. There never was any “empty” land to expand into, it was only other people’s land that we took, stole, signed treaties for and then broke later when convenient. Western civilization has stolen, pilfered, raped, and mutilated the earth and in doing this we have tortured and distorted our own humanity. Who will stand up for humanity? Who will get up, stand up for humanity. We must re-invest in humanity and that begins with you, that begins with me, that begins with us.

But if you know what life is worth

You will look for yours on earth

And now you see the light

You stand up for your rights. Jah![30]

I have been writing on this topic of how our “words create worlds” in relation to our spiritual and political situation. In working with Joseph Rael, writing Becoming Medicine: Pathways of Initiation into a Living Spirituality, I felt compelled to write about the responsibility of mystical, visionary, and shamanic experience—that we must work toward “Spiritual Democracy.” At its deepest point, mystical experience leads to an awareness that we are all one and this comes with a responsibility to challenge words of separation which ultimately lead to fascism. Mystical experience is a pathway that leads us to question who we are and gives us a responsibility to use our words wisely to create worlds where we are becoming the medicine that our world needs. As Rumi says, “We are pain and what cures the pain.”[31]


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

[2] Bob Marley & Peter Tosh, “Get Up, Stand Up,” from the album, Burnin’ (1973).

[3] This quote is popularly attributed to Mother Teresa. The Mother Teresa of Calcutta Center site says that it is falsely attributed to her and that it is “significantly paraphrased versions or personal interpretations of statements Mother Teresa made; they are not her authentic words.” However the page does not say what the original quote or statement was. https://www.motherteresa.org/08_info/Quotesf.html She did speak out for peace, as in this letter to George Bush and Saddam Hussein in January 1991, “Please choose the way of peace… In the short term there may be winners and losers in this war that we all dread. But that never can, nor never will justify the suffering, pain and loss of life your weapons will cause.” “10 inspiring quotes by Mother Teresa,” curated by Jessica Durando, USA Today, published August 26, 2014, https://www.usatoday.com/story/news/nation-now/2014/08/26/mother-teresa-quotes/14364401/

[4] Nietzsche, Beyond Good and Evil, p. 134? What edition? Kaufmann translation?

[5] Camus, The Plague, 308.

[6] Carl G. Jung, “The Fight Against the Shadow,” Civilization in Transition, Second Edition, CW20, page 223.

[7] Ibid., 221.

[8] Carl G. Jung, Alchemical Studies, CW13, pages 265-266.

[9] https://www.etymonline.com/word/barbarian

[10] Ochwiay Biano, quoted in Carl G. Jung, Memories, Dreams, Reflections, 247-248.

[11] Charles Eisenstein, The More Beautiful World Our Hearts Know Is Possible, 6.

[12] Rob Riemen, To Fight Against This Age, 67.

[13] Robert Stoller, Observing the Erotic Imagination (New Haven:Yale University Press, 1992), 32.

[14] David R. Kopacz, Re-humanizing Medicine: A Holistic Framework for Transformation of Your Self, Your Practice, and the Culture of Medicine, 2014, 34-35.

[15] Stoller, 32.

[16] https://www.etymonline.com/word/fight

[17] Glenn Aparicio Parry, Original Politics: Making America Sacred Again. New York: Select Books, 2020.

[18] Needleman, Jacob. The American Soul: Rediscovering the Wisdom of the Founders. New York: Jeremy P. Tarcher/Putnam, 2003., 225

[19] Needleman, 225.

[20] Needleman, 230.

[21] see Kopacz & Rael, chapter “Story Medicine,” in Becoming Medicine: Pathways of a Living Spirituality, 2020.

[22] Kopacz & Rael, Walking the Medicine Wheel: Healing Trauma & PTSD, 254.

[23] Needleman, 223-224.

[24] Needleman, 224.

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

[26] Fleischman, Cultivating Inner Peace, 101–02.

[27] Ibid., 101–02.

[28] See Kopacz & Rael, Becoming Medicine, 368, 424-425.

[29] See Kopacz & Rael, Becoming Medicine, 361-379.

[30] Bob Marley & Peter Tosh, “Get Up, Stand Up,” from the album, Burnin’ (1973). “‘Get Up, Stand Up’ was also the last song Marley ever performed on stage, on 23 September 1980 at the Stanley Theater, now the Benedum Center in Pittsburgh, Pennsylvania,” (Wikipedia, “Get Up, Stand Up,” https://en.wikipedia.org/wiki/Get_Up,_Stand_Up, accessed 6/6/20.

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

Words Create Worlds.3

This essay first appeared in The Badger, Year 6, Volume 6, Issue 1 (4/4/20). Thanks to The Badger for permission to reprint.

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

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

Remembering the Past & Learning from History

“Those who cannot remember the past are condemned to repeat it.” (George Santayana)[2]

Are we witnessing a rise of fascism and totalitarianism? Many say we are, and it is worth looking at what these words mean and if they apply to our current situation, which Rebecca Solnit calls a linguistic crisis.[3]

Are we justified in using such a strong word as “fascism” for the language and ideas that are being tossed about under the guise of a resurgent nationalism? The Director of the McMaster Centre for Research in the Public Interest, Henry Giroux, believes so.

“I have no apologies whatsoever for using the word fascist politics. And I think that people who are afraid to do that become complicit with the very politics they condemn. Because if you can’t learn from history, then it seems to me that you end up in the dark,” (Henry Giroux).[4]

In this next installment of the Words Create Worlds series, we will turn to the work of two authors who warn us against a global movement into fascism. Both authors have familial roots in the persecution of the Jewish people during the holocaust and the Soviet take over of Eastern Europe after World War II. We will first discuss former US Secretary of State, Madeleine Albright’s book, Fascism: A Warning. Then we will turn to Yale professor, Jason Stanley’s book, How Fascism Works: The Politics of Us and Them. I do not intend this to be polemical, partisan politics, but rather to objectively document the current resurgence of fascistic rhetoric, in the United States and globally, in light of the history of fascism in the 20th Century.

“Crow Flying through Cosmos,” D. Kopacz

Fascism: A Warning

Former US Secretary of State, Madeleine Albright published her book by this name in 2018. She starts with describing her family’s experience with fascism, escaping to London in 1939 from the Nazi invasion of Czechoslovakia. The family returned to Czechoslovakia after the war, only to have to flee in 1948 from the communists, this time to the USA. The family lost numerous members to the Holocaust.

Albright sees a worldwide movement of leaders “intentionally undermining the institutions and democratic principles that have held the world together,” (xvii). She has chapters focusing on the rise of Hitler in Germany, Mussolini in Italy, Franco in Spain, Stalin in the Soviet Union, Putin in Russia, Erdoğan in Turkey, Milošević in the former Yugoslavia, Chávez in Venezuela, Orbán in Hungary, Kaczyński in Poland, the Supreme Leaders in North Korea, and Trump in the USA. She defines a fascist as “someone who claims to speak for a whole nation or group, is utterly unconcerned with the rights of others, and is willing to use violence and whatever other means are necessary to achieve the goals that he or she might have,” (245-246).

Albright includes Trump in this group of leaders leaning into fascism as “we have not had a chief executive in the modern era whose statements and actions are so at odds with democratic ideals,” (5). She points out that he has “systematically degraded political discourse in the United States, shown an astonishing disregard for facts, libeled his predecessors, threatened to ‘lock up’ political rivals, referred to mainstream journalists as ‘the enemy of the American people,’ spread falsehoods about the integrity of the US electoral process, touted mindlessly nationalistic economic and trade policies, vilified immigrants and the countries from which they come, and nurtured a paranoid bigotry toward the followers of one of the world’s foremost religions,” (5).

Albright notes that, in 2016, “fascism” was the most searched for word in the online Merriam-Webster Dictionary, except for the word “surreal,” showing a popular interest in understanding the meanings of these words. She describes the history of the word fascism, going back to Mussolini’s revival of the Roman consul’s emblem, the fasces, a “bundle of elm rods coupled with an ax,” (19-20). Mussolini is also credited with coining the term, “drain the swamp” (drenare la palude) by firing 35,000 civil servants (20). Albright traces the history of the words, “America First,” back to Charles Lindbergh and the America First Committee of 1940, which included “Nazi sympathizers” to resist entry into World War II (216). One of the things we are looking at in this column is how words create worlds and to echo and mimic the words of a fascist is to risk recreating a fascist state. She quotes George Orwell’s one-word description of a Fascist, a “bully,” (209). We can look to see if the current president of the United States qualifies as a bully – does he call people names, does he push people around and try to intimidate them and always get his way?

The question is whether what we are seeing in the United States, which seems to resonate on larger geopolitical trends, deserves to be called fascism. Albright states that “Trump is the first antidemocratic president in modern U.S. history,” and that on “too many days, beginning in the early hours, he flaunts his disdain for democratic institutions, the ideals of equality and social justice, civil discourse, civic virtues, and America itself. If transplanted to a country with fewer democratic safeguards, he would audition for dictator, because that is where his instincts lead,” (246). She writes that leaders around the world “observe, learn from, and mimic one another,” and that they see “where their peers are heading, what they can get away with, and how they can augment and perpetuate their power,” (246). She describes how this happened historically in the Twentieth Century and she fears that history is repeating itself and that “the herd is moving in a Fascist direction,” (246). Albright is issuing a warning, as her book’s subtitle states, she feels that in the US, we “are not there yet, but these feel like signposts on the road back to an era when Fascism found nourishment and individual tragedies were multiplied millions-fold,” (224).

Albright’s Antidotes to Fascism

Albright mentions a few antidotes to fascism, such as “caring about others” and “the proposition that we are all created equal” which neutralizes the “self-centered moral numbness that allows Fascism to thrive,” (66). She also says that we need to develop world views that see similarities, rather than us and them, that we need “a way of looking at the world that recognizes the humanity that we share with one another, and the interests that nations have in common,” (187). This is similar to the idea of “spiritual democracy” that Joseph Rael and I develop in our forthcoming book, Becoming Medicine: Pathways of Initiation into a Living Spirituality.

“Medicine Wheel of Dark Matter,” D. Kopacz

How Fascism Works: The Politics of Us and Them

Jason Stanley is a Yale professor and author of the book, How Propaganda Works and his recent How Fascism Works: The Politics of Us and Them. Stanley was born in the US, but his parents fled Europe as Jewish refugees. His father lived through Kristallnacht in Germany and his mother, from Eastern Poland, was in a Siberian labor camp during the war.

Stanley also speaks of the history of the America First movement (“the public face of pro-fascist sentiment”) and its roots in anti-immigration policy. He defines fascism as “ultranationalism of some variety,” with the nation “represented in the person of an authoritarian leader who speaks on its behalf,” (xiv). As does Albright, he sees the United States in a dangerous moment. A hallmark of fascist politics “comes from the particular way in which it dehumanizes segments of the population,” which leads to limiting “the capacity for empathy among other citizens, leading to the justification of inhumane treatment, from repression of freedom, mass imprisonment, and expulsion to, in extreme cases, mass extermination,” (xv). He points out that dehumanization can exist without overt fascism, but that “it should concern all Americans that as a candidate and as president, Donald Trump has publicly and explicitly insulted immigrant groups,” (xv).

Dehumanization

Dehumanization is the process of treating a person as a thing, as something less than human. I have written about this process in medical and health care settings in my book, Re-humanizing Medicine. Dehumanization can spread like an epidemic. Psychoanalyst, Robert Stoller, has written that the act of dehumanizing another “dehumanizes the dehumanizer,”[5] (Stoller, 32). The dehumanized individual has lost touch with what it means to be human and thus treats others as objects rather than as people. This recalls Martin Buber’s distinction between the I-Thou and the I-It relationships. The I-It relationship is a dehumanized relationship, it is profane and materialistic, treating human beings as raw material. The I-Thou relationship, on the other hand, sacralizes and spiritualizes the relationship between two human beings, it is a subject-subject relationship.[6] The reason that fascism is a spiritual as well as political issue is because fascism despiritualizes human beings and the world. Just as I called for Re-humanizing Medicine, we need a Re-humanizing Politics, and a Re-spiritualizing Politics after the resurgence of fascist rhetoric and action. Two of the antidotes that I describe in Re-humanizing Medicine are developing a personal counter-curriculum of re-humanization (an action plan to reinvest in one’s being fully human: body, emotions, mind, heart, creativity, intuition, and spirituality), and to join the compassion revolution – a global movement of bringing heart back into health care. We could use these processes in our current geopolitical climate.

Stanley’s 10 Common Features of Fascism:

  1. Political invocation of a mythic past – e.g. “Make America Great Again”
  2. Propaganda – to distort reality and create alternate narratives and “realities” of control
  3. Anti-intellectualism – “the liberal New York Times,” casting free speech and scholarship as liberal agendas
  4. Unreality – “fake news” and “alternative facts,” creating a state news organ
  5. Hierarchy – us/them, the deserving and the undeserving
  6. Victimhood – seeing oneself as a victim can lead to victimizing others before they victimize you
  7.  Law and order – warn about dangerous “others” and the need to control and contain “them”
  8. Sexual anxiety – fears of racial purity and appeal to need for “strong men” for protection
  9. Sodom and Gomorrah – decadent “coastal elites”
  10. Arbeit Macht Frei – This German phrase, meaning “work will set you free” was inscribed over the entrance to the Nazi concentration camp, Auschwitz[7]
“Out of One, Many,” D. Kopacz

Stanley’s book follows chapters on each of these different topics, but he reminds us that:

“The most telling symptom of fascist politics is division. It aims to separate a population into an ‘us’ and a ‘them,’” (xvi).

The antidote to fascism can also be found in the poison of it. Stanley writes that the “suffering of strangers can solidify the structure of fascism,” but that “it can also trigger empathy once another lens is clicked into place,” (xix).

This is the much-needed compassion revolution. I often find myself musing about what would happen if all these politicians who are spreading hatred and division simply asked themselves before they spoke, “Am I speaking from the heart and out of love?” Stanley sees the root power of fascism in the separation of people into us and them. Many spiritual practices cultivate the opposite of us and them, seeking states of peace, unity, and interconnection. For example, the Tibetan Buddhist practice of tonglen and Loving Kindness focus on breaking down the barriers between self and other. Hindu Kashmiri Shaivism seeks the understanding and experience that all is Śiva, that we are all God, and that there is no “us and them.” In our forthcoming book, Becoming Medicine: Pathways of Initiation into a Living Spirituality,[8] Joseph Rael (Beautiful Painted Arrow) and I discuss the concept of Spiritual Democracy, of cultivating different ways that we can move from self and other, to brother and sister, and even further to the non-dual point where we are all one. Through exploring different pathways of initiation we come to the conclusion that the spiritual path leads to a state of oneness and from this state of oneness, one feels a responsibility for all life. After seeking initiation, comes finding & receiving wisdom, and this wisdom comes with the responsibility to return to the world and to find ways of giving compassion and wisdom to others. 

Sun Through Trees Near Sol Duc River, Washington state, D. Kopacz (2019)

In the next installment of Words Create Worlds we will be, “The Fight for Humanity – or should we say – Working for Humanity.” Throughout 2019 I was writing these Words Create Worlds essays that appeared in The Badger. In working with Joseph Rael, writing our next book, Becoming Medicine: Pathways of Initiation into a Living Spirituality, I felt compelled to write about the responsibility of mystical, visionary, and shamanic experience—that we must work toward “Spiritual Democracy.” At its deepest point, mystical experience leads to an awareness that we are all one and this comes with a responsibility to challenge words of separation which ultimately lead to fascism. Mystical experience is a pathway that leads us to question who we are and gives us a responsibility to use our words wisely to create worlds where we are becoming the medicine that our world needs. As Rumi says, “We are pain and what cures the pain.”[9]


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

[2] “‘Those Who Do Not Learn History Are Doomed To Repeat It.’ Really?” Nicholas Clairmont, Big Think, 7/31/13, https://bigthink.com/the-proverbial-skeptic/those-who-do-not-learn-history-doomed-to-repeat-it-really

[3] Rebecca Solnit, Call Them by Their True Names. Chicago: Haymarket Books, 2018, pg 4.

[4] “Henry Giroux: Will Trump’s Deliberate Racist Rhetoric Lead Us to Fascism?” Interview with Marc Steiner, Big Think, 7/18/19. https://truthout.org/video/trumps-racist-rhetoric-is-deliberate-will-it-lead-us-to-fascism/

[5] Robert Stoller, Observing the Erotic Imagination (New Haven: Yale University Press, 1992), 32.

[6] Robert Audi ed., ‘Martin Buber,’ The Cambridge Dictionary of Philosophy, 104.

[7] These are the chapters from, Jason Stanley, How Fascism Works: The Politics of Us and Them. New York: Random House, 2018. I have provided my own brief elaborations after the topic headings of Stanley’s chapters. For a quick review of Stanley’s 10 elements of fascism, which also comments on the rise of Hindutva in India, see “The ten indicators of fascist politics,” Kanishk Tharoor, The Hindu Business Line, 5/17/19, https://www.thehindubusinessline.com/blink/talk/the-ten-indicators-of-fascism/article27158525.ece

[8] David Kopacz and Joseph Rael. Becoming Medicine: Pathways of Initiation into a Living Spirituality. Seattle & Marvel: Condor & Eagle Press, 2020.

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

Words Create Worlds.1

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

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

Words Create Worlds.1

A Memoriam for those Killed in the Christchurch Mosque Shootings

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Medical Activism: A Draft of a Working Paper

Activism: A Foundational Element of Professional Identity

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

Abstract:

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

Introduction:

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

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

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

What it Means to be a Professional

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

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

De-professionalism

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

Witnessing Professional

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

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

The New Professional

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

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

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

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

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

The Practice of Medicine as Continual Revolution & Reform

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

The Structure of Scientific Revolutions

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

Semmelweis

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

Virchow

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

Social Determinants of Health

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

Moral Determinants of Health

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

Refounding: Reinvigorating the Founding Principles of Health Care

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

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

Cultural Models of Medicine within Contemporary Health Care

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

Examples of Health Care Critique & Reform

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

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

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

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

Medicine in the World – Possible sections

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

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

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

Bullet points to more fully develop examples:

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

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

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

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

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

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

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

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

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

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

Spiritual Democracy

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

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

Sacred Activism

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

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

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

Conclusion

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Racism & Narcissism: The Work of Carl Bell, MD

I reviewed Dr. Carl Bell’s collected papers, The Sanity of Survival: Reflections on Community Mental Health and Wellness in a previous blog (all quotes referenced by page number are from this book). This volume includes two papers that are worth dealing with at length as so many people are trying to understand how racism in the United States could be getting so much support from elected officials and even the president. Dr. Bell published “Racism, Narcissism, and Integrity” in the Journal of the National Medical Association 1978; (70):89-92 and “Racism: A Symptom of Narcissistic Personality Disorder” in the Journal of the National Medical Association, 1980; (72):661-665. Dr. Bell was not looking at politically motivated and politically encouraged racism, but racism in general. We will circle back around to the issue of politics, racism, and narcissism at the end of this paper.

One of Dr. Bell’s many interests, during his career, was whether racism should be considered a form of mental illness. In these papers he addresses racism as an expression of narcissism.

“Covert racism is a psychological attitude and as such, should fall under the scrutiny of psychiatry as a psychopathological symptom of personality disturbance,” (406).

“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,” (406).

Dr. Bell draws on the theoretical and clinical work of Kohut, Masterson, and Kernberg and sees the core lack of the development of empathy as common to “racists…murderers, child abusers, child molesters, and sadists” he has treated, (407). The behavior of these kind of crimes against humans has its roots in dehumanization and a lack of “respect for human life,” (407). Racism, says Dr. Bell, can thus lead to “violation of basic human rights” secondary to the racist individual’s “grandiosity, lack of self-boundaries, and dehumanization,” which are traits of narcissistic personality disorder, (407).

What’s Mine is Mine and What’s Your’s is Mine, Too

Dr. Bell noticed that, “Territoriality or boundaries are paramount for racists because of their lack of self-definition and tendency to extend their boundaries, which thus motivates them to make anything foreign a stimulus for protective action,” (407). This could explain the preoccupation with building walls and keeping out the “bad guys.” Even keeping medical supplies and protective equipment for the “government” rather than giving it the states and people could be seen in this light (consider “Trump’s use of medical stockpile veers from past administrations, leaving states in the lurch,” Shannon Pettypiece, NBC News April 6, 2020, and Daniel Dale, “Trump administration edits national stockpile website a day after it contradicted Jared Kushner,” CNN April 3, 2020, ).

Seeing the Other as Inferior and Less Than a Whole Person

Dr. Bell points to the “narcissist’s internal fragmentation” as leading to the inability to see others as whole people – in essence projecting off fragments on to others that one is unaware of in one’s self, (408). This is the essence of what Carl Jung called “the shadow,” which, if not owned and made conscious, gets projected off on to the “other.” What should be an internal psychological issue becomes an interpersonal, and even political, issue. Dr. Bell quotes the psychiatrist and activist, Frantz Fanon, “It is the racist who creates his inferior,” (408).  

The Stress-Induced Racist, the Socially Misinformed Racist, and the Narcissistic Racist

Dr. Bell develops three categories or explanations for racist behavior: 1) the stress-induced racist (where racism arises only during stress); 2) the socially misinformed racist (due to ignorance and cultural indoctrination); and 3) the narcissistic racist, (418-420). The difference between socially-misinformed racism and that due to narcissism is in “the degree of hostility directed toward the perceived inferiors,” which stems from what is called narcissistic rage, (408).

These types of racism would require different kinds of responses. For the stress-induced racist, learning self-soothing skills from at a personal level and alleviating sources of economic stress at a collective level. For the socially misinformed racist, education and corrective experiences might suffice, if provided within a peer context. Sometimes this happens with military veterans who are acculturated into hating the “enemy” and seeing them as less than human. After returning home, the larger culture no longer supports such a degree of dehumanization of others and no longer condones using violence for problem-solving. For the narcissistic racist, none of these interventions or appeals will have any weight, because the narcissist is only motivated by self-interest.

The Narcissistic Racist

Dr. Bell mentions the work of Adorno and Allport looking at how so many people went along with fascism in World War II, for instance the work on “the authoritarian personality.” Milgram’s studies showing that study subjects were willing to punish others when told to do so by a man in a white coat (Milgram, Obedience to Authority: An Experimental View, 1974). Dr. Bell describes the symptoms of narcissistic personality disorder (as given by the DSM-III which was the edition at use at that time):

  1. Grandiose sense of self importance or uniqueness
  2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. Exhibitionistic: requires constant attention and admiration
  4. Responds to criticism, indifference to others, or defeat with either cool indifference or with marked feelings of rage, inferiority, shame, humiliation, or emptiness
  5. Two of the Following:
    1. Lack of empathy: inability to recognize how others feel
    2. Entitlement: expectations of special favors with reactions of surprise and anger when others don’t comply
    3. Interpersonal exploitiveness
    4. Relationships characteristically vacillate between the extremes of overidealization and devaluation

It may be impossible for many to read this list and not think of one person who is always in the news for the past four years or so. The risk of a narcissistic leader is that they will use the country to play out their own personal pathology. The fact that this pathology requires an “other” is similar between narcissism and fascism – as both seek to blame someone else for social problems and to strengthen us and them divisiveness. If one can magnify and increase social and personal stresses for others, stress-induce racism will increase. If one can exploit cultural narratives of racism, introducing continuous references to inferiority and superiority, one can amplify socially-misinformed racism. Dr. Bell wrote in 1980, “If the man behind the institution is a narcissist of the grandiose type, as was Hitler, then a racist institution is bound to be established,” (420). He quotes Kohut on the narcissist:

“They seem to combine an absolute certainty concerning the validity of their ideas with an equally absolute lack of empathic understanding for large segments of feelings, needs, and rights of other human beings and for the values cherished by them. They understand the environment in which they live only as an extension of their own narcissistic universe,” (Kohut, 420).

In The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess the President, Bandy Lee, MD MDiv (ed.), two of the 37 papers have narcissism in their title and the word appears 62 times throughout the volume. The papers are, “Pathological Narcissism and Politics: A Lethal Mix,” by Craig Malkin, PhD, and “Who Goes Trump? Tyranny as a Triumph of Narcissism,” by Elizabeth Mika MA, LCPC. Two papers focus on race and immigration, “Persistent Enslavement Systemic Trauma: The Deleterious Impact of Trump’s Rhetoric on Black and Brown People,” by Kevin Washington, PhD, and “Traumatic Consequences for Immigrant Populations in the United States,” by Rosa Maria Bramble, LCSW. Many of the authors and clinicians prefer to focus on dangerous behavior patterns and the question of whether professionals “duty to warn” regarding the dangerousness of a person extends to the president.

If Dr. Bell were writing these articles now, rather than in 1978 – 1980, I imagine he would have something to say about our current political situation. Perhaps he would have said it in The Dangerous Case. The DSM-III description of Narcissistic Personality Disorder is almost a biographical sketch of the current president. The Dangerous Case appeared first in 2017 and it was cautionary. It was updated in 2019 and the warnings it raised seemed to be coming true, now, in 2020, we are witnessing greater levels of the behaviors Dr. Bell described and greater levels of fascism and totalitarianism. The example this week is the use of federal law enforcement in unmarked cars being used against protesters in Portland, Oregon, with threats to use them in other cities run by Democrats, whom the president calls the “radical left,” (“Trump Sends Federal Troops to Cities Run by Democrats,” Heather Cox Richardson, Moyers on Democracy, 7/21/20).

Dr. Bell cautions us about narcissistic racism with its “features of grandiosity―lack of empathic linkage…poor self-boundaries, with a tendency to intrude upon or molest others; and an underlying mood of fragmentation with anxiety, agitation, and rage,” (413). He could be cautioning us about the United States, right now.

Carl Bell, MD: Medical Activist & Human Rights Champion with an Indomitable Fighting Spirit

The Sanity of Survival – A Review of the Collected Papers of Carl Bell, MD

The Sanity of Survival: Reflections on Community Mental Health and Wellness (2004) collects the papers of psychiatrist, Carl Bell, MD. Dr. Bell was on faculty at University of Illinois – Chicago, where I did my psychiatric education 1993-1997. I had the opportunity to hear him speak in grand rounds and other educational lectures, but I did not know him personally. I remember him as outspoken, with a keen intellect, and a person who was not afraid to challenge paradigms. Given the recent events in the United States, the death of George Floyd, and the Black Lives Matter movement, I thought back to my training and career, looking for someone who worked on racism and human rights within psychiatry and I thought of Carl Bell. I have also been doing a lot of thinking about what I am calling medical activism: the professional responsibility to go beyond the four walls of the clinic to be a moral agent promoting health & wellness in the world. Dr. Bell surely qualifies as a medical activist!

Carl Compton Bell (October 28, 1947 – August 2, 2019) was born in the Bronzeville neighborhood in Chicago, attended University of Illinois for undergraduate, Meharry Medical College, Illinois State Psychiatric Institute for psychiatric residency and then served in the Navy 1974-1976. He dedicated his life to improving the survival and health of inner city African-Americans: looking at violence as a public health issue, the effects of racism on health, educating residents on cultural sensitivity for working with Black populations, innovating programs and systems (developing day hospitals, crisis beds, outreach programs), engaging in medical activism, and focusing on health and well-being. A true renaissance man, Dr. Bell was a public health researcher, a front-line clinician, a systems innovator, a health advocate who appeared on many TV, radio, and popular magazines, and a public health policy consultant for the Department of Health & Human Services and the Surgeon General.

Two guiding principles he mentions in his book are “bent nail research” and “getting rid of the rats.” 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. Robert Jay Lifton calls this a “witnessing professional,” (Lifton RJ, Losing Reality: On Cultism, and the Mindset of Political and Religious Zealotry, p. 190). This role of the physician as a moral agent having a moral role is consistent with Virchow’s statement in the 19th Century, “Medicine is a social science, and politics is nothing else but medicine on a large scale,” (McNeely IF, Medicine on a Grand Scale: Rudolf Virchow, Liberalism, and the Public Health). Dr. Bell’s “bent nail research” developed when he was a kid and wanted to have a bookshelf and scavenged some boards and straightened out some bent nails.

“The completed bookcase leaned to one side and looked like hell! Yet it could always hold more than its share of books, and that was all that was important to me. The quality of research is very much like that bookcase. It may not be airtight scientifically because of limited resources and far-from-perfect methodology. However, our findings have been just as useful to as my bookcase was,” (xii).

These two guiding principles led to Dr. Bell’s “call for systemic interventions to address problems of the community rather than solving them on a case-by-case basis,” (xi). He describes other underlying principles of his life’s work as, “we’re all interdependent” and “states of consciousness…play a vital role in health and mental health,” (xii). This led to such things as developing a Wellness Institute, teaching Black Intrapsychic Survival Skills, researching states of consciousness in relationship to health, encouraging patients and trainees to learn martial arts, tai chi, and meditation. He expanded the concept of “combat fatigue” in veterans to “survival fatigue” in inner city African Americans exposed to daily stress of inner-city life (250-256). He sought to understand the effects of coma and brain injury on later violence, to understand and mitigate the effects of trauma on children and adults, and to understand and end inner city violence. He saw violence as a public health problem, presaging the recent move to consider gun violence as part of the “lane” or responsibility for doctors.

Violence is just one of the risks in the inner city, Dr. Bell saw the inequities in health between races in Chicago, as he wrote:

“As an African-American physician, I’ve always had a very different mission from most European-American physicians. European-American physicians are often concerned with trying to improve the ‘quality of life’ of their mainly European-American patients. Since leaving medical school, one of my major missions has been to save lives of my mainly African-American patients. Although I am interested in ‘wellness,’ until African-American life expectancy reaches that of European-Americans, I feel obligated to spend more time on ‘saving lives―making a difference’…There are very few people who value poor, mentally ill black people. As a result, resources allocated to help this population are scarce. This reality has always demanded the need to develop creative and innovative ways of effectively and efficiently serving the poor and underserved,” (50).

The title of his book, The Sanity of Survival, speaks to this focus on survival first and then sanity second – or perhaps it points out that without first dealing with the survival issues of the social (and moral) determinants of health, adverse childhood experiences, institutional racism, and violence, that there can be no sanity. Dr. Bell’s work developing programs such as day treatment and emergency housing (to help preserve community connections which can be disrupted by hospitalization), enhancing community support systems, assertive community treatment and case management, victim screening and support services, and a Wellness Institute, created an infrastructure (where there was none) to provide a spectrum of care for the whole person. He worked through Jackson Park Hospital and started the Community Mental Health Council. He also advocated for the use of “psychoanalytic theory in helping African-American patients cope with stress,” (91). He published papers on racism and narcissism and used psychoanalytic theory to understand racism, even considering whether racism, itself, should be considered a mental illness. (This is such important and relevant work that I will address it in a separate blog).

Dr. Bell’s concept of “survival fatigue” in inner city African-Americans compared the “high death rate, crime, unemployment, illness, and discrimination…inadequate housing, nutrition, education, and health and mental health care” to the stressors of combat and attendant combat fatigue, what we now call Posttraumatic Stress Disorder, (252). There is a growing awareness that another condition related to military service, moral injury, may also apply to systematic racism and Dr. Bell’s article, “Black Intrapsychic Survival Skills” could be seen as addressing moral injury. Through the cultural use of consciousness altering modalities in song and dancing in spiritual, ceremonial, and recreational settings, Dr. Bell saw resilience within the African-American community and culture. These consciousness altering techniques help to harmonize one with the environment, build community and help to process trauma and stress. These interests are part of Dr. Bell’s desire to “devise a true African-American-centered psychology,” (280). This was part of his shift to looking at “African-American strengths rather than deficits” for “cultivating resiliency” or even “resistance.” Through his clinical work and life, he concluded that, “there are two types of people when confronted with trauma: those who play funeral music deep inside and those who play adventure music,” (250-251).  Dr. Bell always tried to be a person playing adventure music for himself and his patients.

This is just scratching the surface of the life and work of Dr. Carl Bell, a psychiatrist whose holistic focus on body, mind, race, culture, society, disease, wellness, and advocacy is an outstanding example of medical activism and compassionate humanism. Dr. Stevan Weine calls him “a saint of service to African American patients, a saint of ‘bent nail’ research and ‘make it plain’ advocacy,” (Weine, “Dr. Carl Bell’s ‘Bent Nail Research,’” Psychology Today, November 5, 2019). Dr. Bell’s desire to heal the hurts of individuals and society went beyond the prescription pad and the hospital. We know that medical students tend to lose idealism during medical training and that burnout and compassion fatigue are more the norm than the exception these days. Somehow Carl Bell nurtured and developed resilience and idealism throughout his life and work. He closes his book telling us to listen to the words of the song, “Dream the Impossible Dream,” in order to develop kokoro “(indomitable fighting spirit, in Japanese),” (467). Let’s let Dr. Carl Bell have the last words and close with quotes from his afterword and I will soon write the next installment on his thoughts on racism and narcissism.

“I’ve recently realized that a major problem with psychiatry is that it’s too focused on what we were trained to do. It sometimes feels like psychiatry is stuck in a box that only recognizes diagnosis and treatment. Unfortunately, being in this box precludes psychiatrists from involving themselves with prevention and from focusing on strengths and characteristics of resilience and resistance. These are just as much a part of the human condition as is the psychopathology we were trained to identify and treat. Fortunately, some of us are blessed enough to be on the fringe, which allows us to occasionally leave the box and get a different perspective. This brings new paradigms and models that benefit the human condition.”

“I recall Dr. Boris Astrachan, former Chairman of Psychiatry at the University of Illinois at Chicago…telling me that I’m on the fringe. Psychiatrists are already on the fringe of society because we address the ills of those who are on the fringe by virtue of their psychopathology…Being on the fringe of the fringe, if you will, by virtue of being ahead of your time, is a lonely existence.”

“I also recall Dr. Astrachan telling me that the fringe was the best place to be because I could bring new ideas and have a great deal of innovative influence. I’ve often wondered why I find myself at the seat of power since I’m usually the ‘odd man out,’ and based on the depth and breadth of my work, haven’t really belonged in many rooms. With time and experience, I’ve learned that my being the ‘odd man out’ has contributed greatly to the creativity, humor, leadership, and productive dynamic tension in the room, and that we all have walked out more enriched. So, being on the fringe of the fringe has been a curse but also a huge blessing,” (466-467).

References:

Bell, Carl. The Sanity of Survival: Reflections on Community Mental Health and Wellness. Chicago: Third World Press, 2004.

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

Martin, Michelle. “Can I Just Tell You: Remembering Dr. Carl Bell.” NPR, August 18, 2019, https://www.npr.org/2019/08/18/752221085/can-i-just-tell-you-remembering-dr-carl-bell

Moffic, Steven H, MD. “For Psychiatry, Our Bell Tolls for the Loss Of Carl Bell, MD.” Psychiatric Times, August 5, 2019, https://www.psychiatrictimes.com/view/psychiatry-our-bell-tolls-loss-carl-bell-md

McNeely Ian F, Medicine on a Grand Scale: Rudolf Virchow, Liberalism, and the Public Health. London: The Wellcome Trust Centre for the History of Medicine, University of London, 2002.

Weine, Stevan. “Dr. Carl Bell’s “Bent Nail Research,” Psychology Today, November 5, 2019, https://www.psychologytoday.com/us/blog/cafes-around-the-world/201911/dr-carl-bells-bent-nail-research

Wikipedia, “Carl Bell (Physician),” https://en.wikipedia.org/wiki/Carl_Bell_(physician)

Announcing The-POV: Interviews & Conversations by Usha Akella & David Kopacz

I met Usha Akella when she was doing a keynote presentation at the Power of Words conference in 2019, put on by the Transformative Language Arts Network. We both were interested in writing, poetry, creativity, and the spiritual path. Usha has long had a dream of developing an interview site online and I have been doing various interviews for my work – so it seemed like a good fit and less than a year later The-POV was born and launched into the world!

Usha’s first new interview is with Ann Ciccolella, Artistic Director of Austin Shakespeare since 2007. One of the things Usha has been impressed with is the depth and breadth of cultural programming Ann has curated.

Usha Akella: I am delighted to finally have an opportunity to explore your creative visions, Ann. I’ve attended your plays for years in awe at your ability to cast any play in a contemporary light. Your cross-cultural productions and multi-ethnic casts contribute to dialogue and peace-making. Your productions are playful, pushing the edge yet never lacking conviction or losing a grip on the playwright’s script. You’ve managed to bring Bollywood and Texas boots, and a female Hamlet to your stage. So, let’s begin by exploring the audacity of Ann Ciccolella. Why are you compelled to rewrite/reimagine or re-vision and can we chat about some of your productions that you felt were successful and those that were not—in your opinion.

Ann Cicolella: My own playwriting is a top value for me. Writing my own adaptations is something that I have been doing in the past couple of years. I want to do more playwriting, but finding the time needed to create scripts from their inception is something that I haven’t been able to do since leading Austin Shakespeare!  So, I have been adapting classic stories. I used the plot of Homer’s epic poem The Odyssey and wrote a one-hour play version for middle and high school audiences. That experience was alternately challenging and delightful. During the rehearsal process, I try to inspire actors to create an imaginative performance, and with six actors we together created the many worlds of Homer’s The Odyssey. You see, adapting is a way to satisfy that thirst for my own playwriting.

My first interview for The-POV is with my friend and mentor, Joseph Rael (Beautiful Painted Arrow). Joseph is of the Southern Ute tribe through his mother and of Picuris Pueblo through his father. Joseph is the author of a number of books and he and I have written two books together, Walking the Medicine Wheel: Healing Trauma & PTSD (2016) and Becoming Medicine: Pathways of Initiation into a Living Spirituality (2020).

David R. Kopacz: We’re going to have a section of Becoming Medicine reprinted in Parabola magazine – Jeff Zaleski wants the sections, “Initiation of the Circle” and “Moon Woman Vision.” You have statements in those sections that we are “circle people” and “what comes around goes around” and that “everything eventually becomes its opposite.” You also say, “Look at how we move in a circle, but then look at it from the side and it looks like we are moving forward and backward, back and forth. It depends on your perspective of seeing.”

Joseph Rael – Beautiful Painted Arrow (BPA): That’s apropos for this time. That’s how it is – we move back and forth and back and forth. We move forward and then we spoil it by invalidating it. In order to get in tune with it, we need to use our feet. That’s why we have these physical feet and they are made for traveling. When we go forward we add something. But then we go backward and we forget it. In this life, you have to be constantly correcting yourself. 


That’s what my dances are supposed to do. They check everything on the list. When you are dancing you move forward and backwards in balance. You dance to cover the winter; you dance to cover the spring; you dance to cover the summer; and you dance to cover the autumn. You also dance to cover the North, South, East, West – the directions. 


I’m just being a book from the universe and showing you what to do.

You can read the full interviews at The-POV.

Spiritual Democracy – Happy Interdependence Day!

We are into the July 4th Weekend of the Pandemic. Will this weekend be any different than any other weekend of the pandemic? Social Distancing, we keep to ourselves, we turn inwards – and yet the birthday of when this nation was established (recognizing that we invaded other nations that were already here on this land) is usually about going out, barbequeing with friends, watching fireworks in crowds.

We have our independence from Britain – but what are we using it for? What are we doing with this independence? We are not independent of our acts of aggression, genocide, and slavery – those are intertwined with the founding of the United States of America.

Maybe we have taken independence as far as it can safely go. The current political regime in power in the USA gives us pause to consider this. Maybe it is time that we stopped celebrating independence and started celebrating Interdependence.

We would start by acknowleding our interdependence with Mother Earth and her children, this land that we live on which we took from our Native American brothers & sisters. Then it would lead to acknowledging our interdependence with Africa and her children whom our ancestors captured and enslaved, prospering off of their labor. Then it would lead to acknowledging our interdependence with all the people of the Earth.

This Interdependence Day weekend, we offer to you Chapter 14: Spiritual Democracy, from our book, Becoming Medicine: Pathways of Initiation into a Living Spirituality.

Earth Child of Spiritual Democracy, Joseph Rael (1997)

“Spiritual Democracy is a living connection, allowing the flow of spirituality through our lives, embracing the divinity in all creatures and the divinity of the Earth. Spiritual democracy is the way we treat others when we learn to see the divine in all things and that we, too, are part of divinity. It is a sacred way of being. Periodically, we forget that we are divine as we live in this world of matter and go through its trials and travails. We, as individuals, as well as we as people, need periodic renewal at the font of spiritual democracy.” (p. 381)

We invite you to use this holiday weekend to renew our Spiritual Democracy. Let’s put the “we” back in “We the people…”

If you’d like to read the chapter, just download the pdf below.

Happy Interdependence Day!