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

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

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

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Medical Activism: A Foundational Element of Professional Identity

David R. Kopacz, MD

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

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

Activism can take many forms, but its essence is when professional responsibility extends beyond the individual to the community, the country, and the world. Medical activism occurs when we look up from our computer screens and electronic medical records and look outside the four walls of the clinic to be moral agents promoting health & wellness in the world. Medical activism is what Dr. Berwick is encouraging in his recent article, “The Moral Determinants of Health,” where he argues for an expansion of the role of professionals to include societal reform. “Healers are called to heal. When the fabric of communities upon which health depends is torn, then healers are called to mend it. The moral law within insists so.”[4]

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

Two broad categories of medical activism are: 1) the reform of health care delivery systems, and 2) action in the political, cultural, legal, relational, and natural environments. These can also be conceptualized as internal (delivery of care in the clinic & hospital) and external (medicine in the world).

Deprofessionalization

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

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

The idea of medical activism encompasses the role of the physician as a moral agent, a member of a profession who answers to a higher calling. A professional has a moral calling that goes beyond the marketplace of the exchange of money or the influence of power.

What it Means to be a Professional

To be a professional means that one is constantly professing – similarly if one is a profess-or. The roots of the word “profession” have to do with taking vows and declaring openly and to make public statement. The etymology of the word is related to “profess” and “prophet” going back to the ancient Proto-Indo-European root, *bha-, meaning “to speak, tell, say.”[7] What we are doing as professionals is continual professing – to declare openly and to speak, tell, say.

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

Witnessing Professional

Throughout his career, Robert Jay Lifton has written about the idea of the witnessing professional. He describes the shift toward “malignant normality,” “the imposition of a norm of destructive or violent behavior, so that such behavior is expected or required of people.”[9]

As citizens, and especially as professionals, we need to bear witness to malignant normality and expose it. We then become what I call “witnessing professionals,” who draw upon their knowledge and experience to reveal the danger of that malignant normality and actively oppose it. That inevitably includes entering into social and political struggles against expressions of malignant normality. (Lifton) [10]

The New Professional

In order to teach the next generation of doctors, healers, and clinicians, we need to provide good role models for students to emulate. This is the transmission of knowledge and wisdom that happens from one generation to the next. Without medical professionalism, students may become technically proficient and yet not be true professionals and healers. We teach students science, but we do not teach them to use what Stevan Weine calls “the witnessing imagination.”[11]

Author and educator, Parker Palmer speaks of the new professional, “a person who not only is competent in his or her discipline but also has the skill and the will to resist and help transform the institutional pathologies that threaten the profession’s highest standards.”[12]

Palmer states that “the very institutions in which we practice our crafts pose some of the gravest threats to professional standards and personal integrity. Yet higher education does little if anything, to prepare students to confront, challenge, and help change the institutional conditions under which they will soon be working.”[13]           

The notion of a “new professional” revives the root meaning of the word. This person can say, ‘In the midst of the powerful force-field of institutional life, where so much conspires to compromise the core values of my work, I have found firm ground on which to stand―the ground of personal and professional identity and integrity―and from which I can call myself, my colleagues, and my profession back to our true mission. (Palmer) [14]

An Abbreviated History of Medical Activism

Wash your hands – this seems obvious to us now – but in 1850 Semmelweis tried to convince doctors that they should wash their hands after leaving off doing autopsies and before examining mothers who had just given birth. He was ridiculed, lost his appointment, and died in a mental institution.[15]

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

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

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

Dr. Fauci.

Examples of Health Care Critique & Reform

There are many different levels of health care reform – from the way a doctor is present with a patient, to how clinics are structured, to how reimbursement occurs, and to how we, as a society, value (or de-value) health care as a human right as all other modern democracies do. An ongoing critique of the contemporary practice of medicine is a moral duty of physicians. It is up to us, as professionals, to hold true to the mission and purpose of health care: caring for people who are suffering. Institutions may have vision and mission statements but they are incapable of moral agency and compassion because those are human traits, not bureaucratic functions.

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

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

Medicine in the World

Samuel Shem, in his essay, “Fiction as Resistance,” writes of turning to fiction writing as a resistance to “brutality and inhumanity, to isolation and disconnection.” His recommendations on how to resist “the inhumanities in medicine” are four suggestions:

1) “Learn our trade, in the world” to be aware that “Medicine is part of life, not vice versa”

2) “Beware of isolation. Isolation is deadly; connection heals”

3) “Speak up…speaking up is essential for our survival as human beings

4) “Resist self-centeredness…learn empathy”[28]

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

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

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

Conclusion

We stand at a unique time in history – a global pandemic, smear campaigns against public health experts, attempts to silence or manipulate science for political ends, and the politicization of basic, scientific principles of public health. Now, more than ever, we as physicians, we as clinicians, need to re-claim activism as a core identity. We need to speak, tell, say, to speak openly, to speak publicly about the public health threats of this time in history. We have guidance of those physicians and clinicians who have gone before us and how they have spoken up for the health of the people and the public. Lifton’s witnessing professional and Palmer’s new professional give us a framework for social, moral, and political involvement of professionals as part of the practice of medicine and health care. We are called to become moral agents for social change as we diagnosis and treat the moral determinants of health and the public health threats of the day.

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hope

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

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

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

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

Vaclav Havel, Disturbing the Peace, 181-182

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

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

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

You can register for this free conference: here.

The conference is Saturday, 21 November 2020.

Against Empire – Interview with Bill Laswell

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

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

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


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

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

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

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

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

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

The Sickness of Our Health Care System

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

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

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

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

Lumpers and Splitters

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

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

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

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

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

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

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

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

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

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

     Because I was not a socialist.

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

     Because I was not a trade unionist.

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

     Because I was not a Jew.

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

Medicine and Politics

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

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

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

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

Human Rights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Night Sky (D. Kopacz 2020)

Fascism and Public Health

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

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

Snyder summarizes a number of studies that showed that:

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

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

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

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

He’s Our Bully

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

S LAWSON: Yeah, but he’s our bully.

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

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

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

Why Facts and Logic Do Not Influence Trump Supporters

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

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

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

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

Crow (D. Kopacz 2020)

“They” Are the Disease

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

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

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

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

Are Racism & Fascism Mental Illnesses?

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

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

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

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

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

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

The Mind: Tyranny’s Battleground

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

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

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

Where Democracy is Limited, Citizens Die

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

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

Edvard Munch, The Scream, Public Domain

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[23] Dean & Altemeyer, 128.

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

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

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

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

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

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

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

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

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

Words Create Worlds.7 – The Cure: Spiritual Humanity

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

Choice

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

Photo by David Kopacz (2020)

New Dogmatisms

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

Be Careful in Fighting Monsters, Lest Ye Become One

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

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

Iwauzan Azuyeya

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

The Held-back Place of Goodness

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

Heart Meditation, David Kopacz (2014)

Refounding & Refinding

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

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

Rehumanize Your Self

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

Re-Spiritualize Your Self

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

Becoming Medicine

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

Heroism & Healing

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

Gannet, Muriwai Beach, New Zealand, David Kopacz

The Sacred Hoop is Broken

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

Spiritual Democracy

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

Earth Child of Spiritual Democracy, Joseph Rael

Spiritual Humanity

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

Nobility of Spirit

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

Call Them By Their True Names

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

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

(Rumi)[5]

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

A Vocabulary of Virtues

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


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

[2] Ibid., 1.

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

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

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

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

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

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

Words Create Worlds.6 Doctors Against Fascism

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

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

“Words, he often wrote, are themselves sacred, God’s tool for creating the universe, and our tools for bringing holiness — or evil — into the world.  He used to remind us 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.”[2]

I have been writing this series, Words Create Worlds, based on the words and writing of Rebecca Solnit, Rob Riemen, Timothy Snyder, Madeleine Albright, Jason Stanley, and physicians: Bandy Lee, Robert Jay Lifton, and Judith Herman. I was inspired by these authors and particularly by Riemen’s To Fight Against this Age: On Fascism and Humanism and Rebecca Solnit’s Call Them by Their True Names and their discourse about how words shape our reality. The title for this series of essays comes from Rabbi Heschel who cautions us to be careful with the words we use. I fear that these last four years we have been over-cautious in coming to call the words of the current president of the United States of America fascist. Dr. Bandy Lee’s Twitter profile states, “Uninvolved in politics until politics invaded my area of expertise. I take my professional responsibility to protect society seriously.” Similarly to Dr. Lee, I feel compelled to speak up politically because fascism is a public health crisis. As Foucault wrote, the “first task of the doctor is therefore political: the struggle against disease must begin with a war against bad government.”[3]

The Responsibility of Spiritual Democracy

As I was working on Becoming Medicine: Pathways of Initiation into a Living Spirituality with Joseph Rael, I began to see that while the spiritual path may lead away from society at first, it eventually leads back – one returns after initiation with a new found sense of responsibility for the land and all the creatures that live on it: four-leggeds, two-leggeds, fin-ed and wing-ed. The spiritual path leads to a sense of Oneness, of non-duality. When you start to feel One with creation, you realize that you are responsible for creation. Words create worlds. The etymology of the word “responsible” goes back to a similar word, “answerable.” To be on a spiritual path, which Joseph would say is the same as the path of being a True Human Being, is to be answerable to the Earth. This led me to feel that we had to write a section of the book on the responsibility of the spiritual seeker.

Joseph Campbell taught that the hero’s or heroine’s journey had three stages: separation from the known world, initiation into the new world, and then return to the old world, but now transformed and carrying a responsibility for healing and transforming the world. For our book, this meant writing about our interrelationship with the land; about moving from “other” to “brother and sister;” about Oneness and non-difference; and about the concept of spiritual democracy – the spiritual responsibility we have for all beings. This responsibility led to us losing our publisher as the book turned out to be 500 pages long.

Joseph Rael, in the early 1980s had a vision of men and women sitting in a circular structure, half above ground, half below, singing and chanting for world peace. He followed this vision across the globe, helping to create over 60 Sound Peace Chambers on four different continents. He was recognized by the United Nations for this work on world peace. It is this spirit of peace that leads to my now needing to speak words of peace to counter the 20,005[4] divisive words of fascism.

Circle of Light Sound Chamber

Being Present with Suffering

Words Create Worlds. To be silent or neutral is to take the side of the bully. There are times that one can lose one’s humanity through inaction. Yes, it is true that one can act without humanity as well, that is a definition of fascism: actions without humanity and against humanity. When I was going through medical school in the early 1990s, struggling with the dehumanizing aspects (Perri Klass described medical school as, A Not Entirely Benign Procedure), I was also reading the Chicago Tribune regularly, trying to understand what was happening in the former Yugoslavia and Rwanda. I had read about World War II extensively when I was younger, I knew about fascism and genocide – but I struggled to make sense of what it meant to be a human being in the late 20th Century as I was immersed in learning the language of pathology and despair as I learned to diagnose and treat illness. I was overwhelmed by with the feeling that I was not being taught how to be human and present with either my suffering, my patients’ suffering, of the suffering of the world.

In The Shadow of the Slaughterhouse, D. Kopacz

In the Shadow of the Slaughterhouse: Silence is the Only Real Crime Against Humanity

I brought my friends together to write and to bear witness to the age. I was reading the Beats in those days, Kerouac, Ginsberg, Burroughs, and I loved how they created their own interpretive community and supported each other. The Beats didn’t shy away from suffering or madness, but bore witness to it, as Ginsberg wrote in Howl, “I saw the best minds of my generation destroyed by madness, starving hysterical naked…” Or as William S. Burroughs wrote to Allen Ginsberg, “Whether you like it or not, you are committed to the human endeavor. I cannot ally myself with such a purely negative goal as avoidance of suffering. Suffering is a chance you take by the fact of being alive.”[5] My friends and I put together an unpublishable manuscript that included cut-up art, multiple perspectives, and no coherent theme, other than a bunch of twenty-somethings let loose in the big city and reading a lot of books and trying to find their way in the world. I titled this collection, In the Shadow of the Slaughterhouse: Silence is the Only Real Crime Against Humanity. It included essays I wrote on the Native American genocide (from Dee Brown’s Bury My Heart at Wounded Knee) and an essay on witnessing and the survivor (from reading Terrence des Pres’ The Survivor: An Anatomy of Life in the Death Camps). In a way, these essays on Words Create Worlds are a continuation of In the Shadow of the Slaughterhouse: Silence is the Only Real Crime Against Humanity. I cannot remain silent as the shadow of fascism falls across the country.

This is not the succinct entry into the topic of Doctors Against Fascism that I envisioned – but then, the fight against fascism is not through bullets or bullet points, but through re-humanization. What is more re-humanizing than stories about human beings trying to make sense of suffering and bear witness? It is our humanity, our shared humanity, that protects us against the dehumanization of fascism. All of us, as human beings, are responsible for humanity because we are part of humanity. Similarly, as creatures of the Earth we are all responsible for the Earth, as we are part of Her.

What it Means to be a Professional

I have been thinking about the idea of medical activism and what it means to be a professional.[6] In my work on re-humanizing medicine through the compassion revolution,[7] I have argued that much of what we are taught in contemporary medicine is how to be a technician rather than on how to be a healer. A technician is not a professional, necessarily, but someone who performs a set of route protocols and techniques. A healer, on the other hand, is someone who learns techniques, but who also learns humanity – for it is our human presence that we must bring to suffering. While a technique or protocol might treat a disease, suffering needs humanity and compassion. To this end I have continued to argue that as physicians we should be good technicians, but that we must also be good human beings. To be a good medical technician, we are required to engage in Continuing Medical Education. To be a good human being we have to seek out our own Continuing Human Education – this is what I call the counter-curriculum of re-humanization.[8]

To be a professional means that we answer to a higher calling than just simply doing our jobs or staying in our lanes,[9],[10] it means that we are responsible to humanity. This means that our job does not end at the walls of our exam room – our job as healers is to attend to the public health of humanity.

Witnessing Professionals

In an interview with Bill Moyers, Robert Jay Lifton describes the concept of health care providers as “witnessing professionals” who have a responsibility to confront malignant normality (such as when lies and cruelty become normality). Lifton ends the interview with the following statement:

“I always feel we have to work both outside and inside of our existing institutions, so we have to…examine carefully our institutions and what they’re meant to do and how they’re being violated. I also think we need movements from below that oppose what this administration and administrations like it are doing to ordinary people. And for those of us who contributed to this book [The Dangerous Case of Donald Trump] — well, as I said earlier, we have to be “witnessing professionals” and fulfill our duty to warn.”[11]

As Psychiatrists We Feel Obliged to Express Our Alarm

Robert Jay Lifton is psychiatrist and psychohistorian I greatly admire, he is a living example of a witnessing professional who has worked at both the individual and the societal level for healing. He and Judith Herman (another psychiatrist I respect) wrote a letter to the editor of The New York Times March 8, 2017.[12]

“To the Editor:

“Soon after the election, one of us raised concerns about Donald Trump’s fitness for office, based on the alarming symptoms of mental instability he had shown during his campaign. Since then, this concern has grown. Even within the space of a few weeks, the demands of the presidency have magnified his erratic patterns of behavior.

“In particular, we are struck by his repeated failure to distinguish between reality and fantasy, and his outbursts of rage when his fantasies are contradicted. Without any demonstrable evidence, he repeatedly resorts to paranoid claims of conspiracy.

“Most recently, in response to suggestions of contact between his campaign and agents of the Russian government, he has issued tirades against the press as an “enemy of the people” and accusations without proof that his predecessor, former President Barack Obama, engaged in partisan surveillance against him.

“We are in no way offering a psychiatric diagnosis, which would be unwise to attempt from a distance. Nevertheless, as psychiatrists we feel obliged to express our alarm. We fear that when faced with a crisis, President Trump will lack the judgment to respond rationally.

“The military powers entrusted to him endanger us all. We urge our elected representatives to take the necessary steps to protect us from this dangerous president.” (Robert Jay Lifton & Judith Herman)

A Duty to Warn

Dr. Bandy Lee organized an April 20, 2017 conference at Yale, entitled, “Does Professional Responsibility Include a Duty to Warn?” From this conference grew the first edition of The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, and then the second edition with 37 experts, The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President. Dr. Lee and colleagues then formed the World Mental Health Coalition and published The World Mental Health Coalition Documents, which collects conference transcripts, media transcripts, letters and statements, a report on the Mueller Report, and a Prescription for Survival. Dr. Lee writes:

“Since society is one of psychiatry’s primary responsibilities, next to that of patients, there is unquestionably a duty not only to warn but to protect and to promote its wellbeing. We are bound by law in most states, as now replicated in multiple countries and even in fields outside of mental health, that we must warn even those who are not our clients in the case of danger. We also have an obligation not only to warn but to take steps to protect potential victims if security personnel will not act; safety is always first priority.”[13]

Agent 488 (aka Dr. Carl Gustav Jung)

There are precedents of psychiatrists using their skills for public health and safety. Robert Jay Lifton’s career as a psychohistorian is an example – understanding dangerous movements such as: Nazi Germany, Chinese thought reform, Aum Shinrikyō, climate deniers, and the current president of the USA. Swiss psychiatrist, Carl G Jung (aka Agent 488)[14] was recruited by the United States during World War II to provide psychological profiles of Hitler. Jung’s descriptions of Hitler’s psychology and behavior are eerily similar to the current president of the United States:

“All these pathological features— complete lack of insight into one’s own character, auto-erotic self-admiration and self-extenuation, denigration and terrorization of one’s fellow men (how contemptuously Hitler spoke of his own people!), projection of the shadow, lying, falsification of reality, determination to impress by fair means or foul, bluffing and double-crossing — all these were united in the man who was diagnosed clinically as an hysteric, and whom a strange fate chose to be the political, moral, and religious spokesman of Germany for twelve years.”[15]

Jung cautioned about Hitler’s systematic lying which he described as pseudologia phantastica. Is our current president’s 20,055 falsehoods (as of 7/9/20) another example of pseudologia phantastica?[16]

“A more accurate diagnosis of Hitler’s condition would be pseudologia phantastica, that form of hysteria which is characterized by a peculiar talent for believing one’s own lies. For a short spell, such people usually meet with astounding success, and for that reason are socially dangerous.”[17]

After World War II, many professionals wondered, “Why would so many apparently rational, even educated people, follow a fascist?”[18] Jung would say that those who do not deal honestly with their own shadow project it on to “others” who are then seen as bad, dangerous, untrustworthy. Jung saw Hitler as an inferior personality who was over-taken by his own shadow, projecting his own darkness on to the world and then trying to destroy his own darkness by destroying others. From that perspective, a fascist movement is a giant psychological experiment and a fight between those who have little self-awareness and do not take responsibility for their own darkness and those who are committed to truth and reality and are willing to introspect. Jung describes the formation of mass psychosis and mob psychology:

“Its leader will soon be found in the individual who has the least resistance, the least sense of responsibility and, because of his inferiority, the greatest will to power. He will let loose everything that is ready to burst forth, and the mob will follow with the irresistible force of an avalanche…[H]e symbolized something in every individual. He was the most prodigious personification of all human inferiorities. He was an utterly incapable, unadapted, irresponsible, psychopathic personality, full of empty, infantile fantasies, but cursed with the keen intuition of a rat or a guttersnipe. He represented the shadow, the inferior part of everybody’s personality, in an overwhelming degree, and this was another reason why they fell for him.”[19]

Untitled, D. Kopacz

The Plague of Fascism

As I have watched this regime unfold over the past four years, my early uneasiness has gradually turned to alarm. I think it is time for the Doctor to make the diagnosis: fascism, prognosis: serious.

In 1947, Albert Camus wrote his allegory on fascism, The Plague. Camus cautioned us, through his indefatigable Dr. Rieux,

“I have no idea what’s awaiting me, or what will happen when all this ends. For the moment I know this: there are sick people and they need curing. Later on, perhaps, they’ll think things over; and so shall I. But what’s wanted now is to make them well. I defend them as best I can, that’s all.”[20]

Dr. Rieux’s commitment to defend sick people as best he can reminds us of the professional commitment of Drs. Lee, Lifton, and Herman, as well as Dr. Fauci and all the frontline health care workers doing the best they can during this pandemic. Just as Lifton encourages us to be witnessing professionals, Rieux’s writing bears witness to the peoples’ suffering:

“It could only be the record of what had had to be done, and what assuredly would have to be done again in the never ending fight against terror and its relentless onslaughts, despite their personal afflictions, by all who while unable to be saints but refusing to bow down to pestilences, strive their utmost to be healers.”[21]

Camus’ choice of a plague as an allegory of fascism resonates with our current situation. We are currently in an actual viral pandemic of Covid-19 and this viral plague has further illuminated the plague of fascism. The president’s deplorable and counter-scientific handling of the pandemic has led to the United States of America, the country with the most expensive health care system in the world, and with 4% of the world population, to account for roughly 25% of the cases of Covid-19 worldwide. The president has contradicted and undermined scientists and physicians, he has encouraged the opposite of public health measures (ridiculing masks and those who wear them), he has preached economy over public health, and has spread over one-third of the global misinformation on the virus.[22] And, as of 10/2/20, the president himself is now infected with Covid-19, a carrier of the plague of the pandemic and the plague of fascism. However, we knew all along that we were electing a sick individual who is a plague – a plague of lies, a plague of bullying, a plague of divisiveness, a plague of crookedness, a plague of Covid-19 and, ultimately, a plague of fascism.

Doctors Against Fascism

The way you learn how to diagnose something in medical school is to see case after case after case – until it becomes automatic. At the first signs or symptoms, you see the incipient signs of a more serious illness. This is why we need Doctors Against Fascism – to diagnose and warn us that the fascist bacillus is starting to dehumanize our population and make it vulnerable to fulminant fascism.

The Doctor is in and has bad news for you – the prognosis of our nation’s health is serious. We are infected with fascism – it has taken hold in the brains of many of our citizens and it is spreading through our institutions. Words Create Worlds and we are surrounded by 20,055 and counting words of fascism. Every lie is an assault on reality and every bit of reality that is eroded weakens the immune system of democracy, making us vulnerable to infection with the unreality of fascism.

The Growing Stack of Books I Keep on My Desk as a Reminder

This series, Words Create Worlds, grows out of my work with Joseph Rael on peace. In 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.”[23]


[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] Ibid.

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

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

[5] William S. Burroughs, letter to Allen Ginsberg The Letters of William S. Burroughs, Vol. 1: 1945-1959, p. 227.

[6] David Kopacz, “Medical Activism: A Draft Working Paper,” (8/11/20) in the Being Fully Human Blog, https://beingfullyhuman.com/2020/08/11/medical-activism-a-draft-of-a-working-paper/.

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

[8] Ibid. Also see David Kopacz, “A Proposition for a Counter-Curriculum in Healthcare Education and Practice,” (9/10/16), Being Fully Human blog, https://beingfullyhuman.com/2016/09/10/a-proposition-for-a-counter-curriculum-in-healthcare-education-and-practice/

[9] “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.

[10] “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.

[11] http://billmoyers.com/story/dangerous-case-donald-trump-robert-jay-lifton-bill-moyers-duty-warn/

[12] Robert Jay Lifton and Judith Herman, “‘Protect Us From This Dangerous President,’ 2 Psychiatrists Say,” The New York Times, March 8, 2017, https://www.nytimes.com/2017/03/08/opinion/protect-us-from-this-dangerous-president-2-psychiatrists-say.html

[13] Bandy X Lee, “American Psychiatry’s Complicity with the State,” in Bandy Lee (ed) The World Mental Health Coalition Documents, 299.

[14] Jung was recruited by the Office of Strategic Services (OSS), the organization that eventually grew into the CIA and INR, to provide psychological profiles of political leaders, foremost among them Adolf Hitler. Deirdre Bair, Jung: A Biography. New York: Back Bay Books, 2003, pages 481-495.

[15] CG Jung, “After the Catastrophe” (1945) in CW 10 Civilization in Transition, page 203.

[16] The Washington Post Fact Checker, 7/9/20, https://www.washingtonpost.com/graphics/politics/trump-claims-database/?utm_term=.27babcd5e58c&itid=lk_inline_manual_2&itid=lk_inline_manual_2

[17] Ibid., 203-204.

[18] For a recent analysis of this question, see John Dean and Bob Altemeyer’s Authoritarian Nightmare: Trump and His Followers.

[19] CG Jung, “The Fight With the Shadow” (1946) in CW 10 Civilization in Transition, 220-223.

[20] Albert Camus, The Plague, New York: Vintage International, 1991, p. 127.

[21] Ibid., 308.

[22] Sarah Evanega, Mark Lynas ,Jordan Adams, Karinne Smolenyak, “Corona virus misinformation: quantifying sources and themes in the COVID-19 ‘infodemic’”

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

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

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

To Fight Against this Age: On Fascism and Humanism[2] by Rob Riemen

The Words Create Worlds series of essays was inspired by Rabbi Heschel’s warning of the way certain words led to the Holocaust, Riemen’s To Fight Against this Age, and Rebecca Solnit’s Call Them by Their True Names. I felt compelled as a health professional to speak up about fascism, based on the warning flags of the current US presidency and other world movements. In my youth, I was fascinated with World War II, later as a professional I became interested in trauma and the role of the trauma therapist as a moral agent – not just a neutral technician, but a human being who takes a moral stand against human rights abuses, what Robert Jay Lifton calls a “witnessing professional.”[3] As I have watched this regime unfold over the past four years, my early uneasiness has gradually turned to alarm. As physicians, we need to remember our higher calling to function as witnessing professionals for the health of society.

I think it is time for the Doctor to make the diagnosis: fascism, the prognosis: serious.

Fascism is a sickness, an illness, a disorder. It spreads through false-fixed beliefs (delusions), scapegoating (projection), and its continuous stream of lies creates unreality (impaired reality testing). Fascism infects the individual, but it spreads through the community. As a doctor, I am trained to diagnosis and treat sickness. As a doctor, I am trained to attend to individual health as well as public health. Some would say that doctors need to shut up and “stay in their lanes.”[4],[5] However, as someone who has read Nietzsche,[6] has read Robert Jay Lifton, Jason Stanley, Timothy Snyder, Rebecca Solnit, Madeleine Albright, and Rob Riemen – I have learned from history and I have studied epidemiology – people staying in their lane and just following orders leads down a deadly road. 

It is Time to Call it Fascism

Could it really be happening again? Right here in the USA? The erosion of democracy and the growth of fascism and totalitarianism. I think it is time we started calling it anti-democracy and fascism. Umair Haque thinks so, see his article “What Does it Take to Fight Authoritarianism? The One Thing Americans Still Won’t Do,” in which he writes:

“I don’t blame Americans for not getting why they have to say fascism. It’s a complex and subtle set of thoughts to understand, this responsibility.

And yet if I say ‘not calling racism or sexism racism or sexism is legitimising it,’ you get it instantly. Get exactly that logic for fascism and authoritarianism now. That moral, social, and personal responsibility.”[7]

The Leader spews a continuous stream of “false statements,” otherwise known as lies, propaganda – to confuse and disorient opposition and to mobilize a base of followers into a false-fixed state of loyalty and unreality. There are so many lies that the footnotes start to eclipse the text. During his presidency, the president of the United States had made more than 20,000 “false statements,”[8] which we should just start calling lies and propaganda because there is a method behind the madness – the method of the fascist playbook.

It sounds like a constant stream of gibberish, (just try to read this two hour speech), it makes no logical sense, but it appeals to biases and emotions. It is propaganda: “othering” and demonizing of groups of people: Mexicans, immigrants, Muslims, and women, “Antifa,” “radical leftists,” “anarchists.” Every event is amplified and weaponized to create divisiveness. He casts doubt on the institution of elections and hints that he will not honor the results or submit to a peaceful transfer of power if he loses.

And This Also Has Been One of the Dark Places of the Earth, D. Kopacz

To Fight Against This Age

Let us turn to Rob Riemen’s To Fight Against the Age: On Fascism and Humanism (2018). Riemen is the Founder, President, and CEO of the Nexus Institute, “a leading international center for intellectual reflection to inspire the Western cultural and philosophical debate,” and is the editor of the journal Nexus.

I picked up Riemen’s book, by chance, when I was traveling for work and was in Charleston, West Virginia. I found it at a nice little bookstore, Taylor Books. I bought it on impulse and then was fascinated by it and finished it on the flight home. The book consists of two essays, “The Eternal Return of Fascism,” (originally published in 2010) and “The Return of Europa.” In keeping with the theme of Words Creating Worlds, Riemen writes that “to be able to understand something,” you have to “call it by its proper name,” specifically, “populism…will not provide any meaningful understanding,” (18).  Even more specifically:

“The use of the term populist is only one more way to cultivate the denial that the ghost of fascism is haunting societies again and to deny the fact that liberal democracies have turned into their opposite: mass democracies deprived of the spirit of democracy,” (19).

Fascism Rests on Dehumanizing Others

I have personally been concerned with the objectification and dehumanization that happens in medical education and medical practice (see Kopacz, Re-humanizing Medicine – 2014). The antidote to dehumanization is quite simple in theory: re-humanization. The more difficult questions are: What is a human being? How is the soul of the human being lost? How is the soul of the human being regained? Riemen reaches a conclusion similar to mine about the limitations of numbers and the scientific method and the need for the humanities and a whole person philosophy.

“Science and technology will never be able to provide us with a complete understanding of the human being with his instincts and desires, virtues and values, mind and spirit…The humanities and the arts” provide “the only knowledge that could provide a true understanding of the human heart,” and that “the real requirements of a democratic civilization [are] the wisdom of poetry and literature, philosophy and theology, the arts and history,” (19-20).

How does fascism return to civilized democracies? Germany, itself was a democracy, Hitler was elected and then gradually did away with democratic institutions, consolidating power. Riemen puts it bluntly, “the main reason fascism can return so easily in mass democracies: ignorance,” (21). The ignorance of history. The ignorance of social psychology. The ignorance of power and fascism. If we don’t call it by its true name, as Riemen and Solnit both implore us, we will have no chance of confronting and stopping it.

Riemen takes his title of his book, To Fight Against this Age from Nietzsche, whom he paraphrases, “we should not accept the blind power of the actual and that instead of conforming to the whole noisy sham-culture of our age, we have to be fighters against this age…It is now upon us to fight against a zeitgeist that destroys the spirit of the democratic civilization,” (27).  

You Let Your Magic Tortoise Go, D. Kopacz

The Plague of Fascism

Riemen writes about Camus’ allegory of fascism, The Plague,[9] commenting on the “fascist bacillus,” he tells us that if “we want to put up a good fight, we first have to admit that it has become active in our social body and call it by its name: fascism,” (34). We must diagnose the problem before we can treat it correctly.

Riemen’s book was published in 2018. Now we have the strange juxtaposition of an actual pandemic being used as a fascist tool for promoting divisiveness and effecting the first purge of this regime, 200,000+ dead in the United States as of late September – 25% of the global deaths for 4% of the global population, at least we are “great” at something. Even stranger, now we have a president who is actually infected with a virus he is hell-bent on spreading to others.

Riemen, following Nietzsche’s critique, sees a problem with European and Western culture – that we have lost spiritual values. “With the loss of spiritual values,” he writes, “not only did morals disappear but so did culture in the original meaning of the word: cultura animi, the ‘cultivation of the soul,’” (38). We have become the barbarians. Barbarian originally meant “unintelligible speech,”[10] again, just try reading through this transcript.

This “cultivation of the soul” and the recognition of our common humanity is what humanism is founded upon. Fascism is the opposite of humanism – it is about the degradation of the soul, it is about exaggerating the differences between human beings into a false and superficial sense of sameness rather than seeing “out of many, one,” e pluribus unum.

Writing in the mid-1930s, Menno ter Braak noted that fascist movements were focused on “stimulating aggression and anger.” Riemen summarizes that a fascist movement:

“was not actually interested in finding solutions, had no ideas of its own, and did not want to solve social problems, because injustice was necessary for maintaining an atmosphere of vilification and hatred,” (51).

Lousy at Democracy, Super-Good at Fascism

If we look at the current US presidency, we might be tempted to call it incompetent – and from a perspective of democracy it would be right to do so. However, if we view the current president through the lens of fascism – he is hypercompetent. He is lousy at democracy, but he is super-good at fascist.

Menno ter Braak focused on the use of “social resentment vented on a scapegoat who was blamed for everything: the Jew.” Riemen further summarizes ter Braak’s view:

“At the same time, this movement considered itself to be the eternal victim of the ‘left’ or the ‘elite’ and harbored a deep aversion to intellectuals, cosmopolitans, and anyone who was different…[with a] continuous use of slogans and empty rhetoric…it was reactionary,” (52).

Untitled, D. Kopacz

Fascism is Semi-civilization and Promotes the Cult of Resentment

Fascism is “semi-civilization” and promotes “the cult of resentment.” These are the rules that the current US president is very good at, he consults the fascist playbook at every turn and fascism is winning and democracy is losing.

How did fascism gain hold in European democracies? By using those democracies against themselves. Both Hitler and Mussolini were voted into power. Riemen writes that both the liberals and the conservatives caved in to fascism because they thought they could gain something from it. It is the classic devil’s bargain of “the end justifies the means.” This is based, or maybe we should say de-based, on the idea that getting power or money (the ultimate materialist focus) is more important than human values, civility, decency, or humanity.

“The liberals no longer defended the freedom principle of European humanism but became interested only in the freedom of the markets: that is to say, As long as we can earn money,” (56).

We see this today – somehow the stock market in the US seems to give permission for fascism, as long as we can earn money.

“The conservatives were unprepared to unscrupulously exchange the protection of spiritual values for the preservation of their own power, under the veils of ‘tradition’ and ‘social order,’” (56).

We see this today, the conservatives going along with the president, even when it seems to violate their own principles, as long as they can preserve power and social order. This is the definition of fascism: power and order become more important than principles, ideals, more important than human beings.

After World War II, after Mussolini and Hitler were defeated, some still worried that we had not learned the lessons of history. Riemen reminds of that both Albert Camus and Thomas Mann, both Nobel Prize winners, warned of the return of fascism.

“Camus and Mann…as early as 1947…stated that fascism was a political phenomenon that had not disappeared at the end of the war and that we could now describe as the politicization of the mentality of the rancorous mass-man. It is a form of politics used by demagogues whose only motive is to enforce and extend their own power, to which end they will exploit resentment, designate scapegoats, incite hatred, hide intellectual vacuity beneath raucous slogans and insults, and elevate political opportunism into an art form with their populism,” (60).

Untitled, D. Kopacz

A Realm Where Words are Separated from their Meanings

Riemen warns us, as early as 2010, that “this is a new outbreak of the plague,” (60). But just as you cannot treat a disease you cannot name and diagnose, you cannot appropriately respond to a movement if you cannot call it by its true name – fascism. We, in the US, were sick, even before the Covid-19 pandemic, we were in the throes of a revival of an old illness – the pandemic of fascism. We entered into a realm where “words were separated from their meanings and reduced to slogans,” (61).

Again and again, throughout this essay, Riemen reminds us that the cure to fascism is the medicine of our human unity and spiritual/moral values. This is not about religion – many of the most vocal followers of the president are “religious” people who are more interested in power than in human goodness.

“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 [hu]mankind possible: universal spiritual values that shape human dignity and that every… [one]…can adopt,” (67).

“Anyone who really wants to be a humanist rejects every form of fanaticism and learns the courtesy of the heart and the art of conversation, dialogue,” (68).

What is needed is not a political solution, but a human solution. We need to remember our original instructions and the principles and tenets of spiritual democracy. While fascism is a political movement based in materialism (money and power), its cure is a spiritual movement based in humanism (soul and spirit).

Continuous Lies as Politics

Riemen describes the Party for Freedom (PVV, Partij voor de Vrijeheid) in his native Netherlands in words that sound like the current US president’s playbook. Fascism is not creative, it is not novel, it is really just the same damn thing, over and over again – the basest aspects of our material nature. It is the propagation of dehumanization through dehumanization. The PPV offers

“the shameless opposite of the Judeo-Christian and humanist traditions: vulgar materialism, oppressive nationalism, xenophobia, ammunition for resentment, a deep aversion to the arts and the exercise of spiritual values, a suffocating spiritual bigotry, a fierce resistance to the European spirit, and continuous lies as politics,” (68-69).

Doctors Against Fascism, D. Kopacz (2020)

Doctors Against Fascism

The way you learn how to diagnose something in medical school is by seeing case after case after case – until it becomes automatic, at the first signs or symptoms, you see the incipient signs of a more serious illness. This is why we need Doctors Against Fascism – witnessing professionals to diagnose and warn us that the fascist bacillus is starting to dehumanize our population and make it vulnerable to fulminant fascism. In the USA, there has been a growing concern about the signs and symptoms of fascism since 2016. Riemen has been seeing it in Europe since at least 2010 and we see it spreading all over the globe – a pandemic of fascism in Poland, Hungary, Turkey, Russia, Philippines, England, Brazil, India, and the United States of America.

The Doctor is in and has bad news for you – the prognosis of our nation’s health is serious. We are infected with fascism – it has taken hold in the minds of many of our citizens and it is spreading through our institutions. Words Create Worlds and we are surrounded by continuous lies as politics.

This essay seems to have found a natural ending-point here. I will pick up with the rest of the review of Rob Riemen’s book, To Fight Against This Age: Fascism and Humanism, in the next installment of Words Create Worlds. Perhaps I will develop this theme of Doctors Against Fascism more.

This series, Words Create Worlds, grows out of my work with Joseph Rael on peace. In Becoming Medicine: Pathways of Initiation into a Living Spirituality, I felt compelled to write about the responsibility that grows out 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 can 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.”[11]


[1] Life Between the Trees blog.

[2] Rob Riemen, To Fight Against This Age: On Fascism and Humanism, New York: W. W. Norton & Company, 2018.

[3] Robert Jay Lifton, “Foreword to the First Edition: Our Witness to Malignant Normality,” in Bandy Lee (ed) The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, New York: Thomas Dunne Books, 2019.

[4] “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.

[5] “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.

[6] Richard Huelsenbeck, German-American psychiatrist and Dada-ist who was investigated by the Nazis and forbidden to write, once said, “We are psychiatrists; we are Germans; we have read Nietzsche; we know that to gaze too long at monsters is to risk becoming one―that’s what we get paid for!” (Greil Marcus, Lipstick Traces: A Secret History of the Twentieth Century, p. 211). Marcus’ book traces the spirit of protest from punk rock back to earlier art movements that were cultural and political critiques of the times.

[7] Umair Haque, “What Does it Take to Fight Authoritarianism? The One Thing Americans Still Won’t Do.” Eudamoinia & Co, Sept 25, 2020, https://eand.co/what-does-it-take-to-fight-authoritarianism-the-one-thing-americans-still-wont-do-676dfb86794b

[8] Glenn Kessler, Salvador Rizzo, Meg Kelly, “President Trump has made more than 20,000 false or misleading claims.” The Washington Post, July 13, 2020 at 12:00 a.m. PDT

[9] Albert Camus, The Plague, New York: Vintage International, 1991.

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

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

Interview with Gerald Arbuckle on Culture, Loneliness, and Fundamentalism @The_POV

This interview from September 13, 2017 with anthropologist and Marist priest, Gerald Arbuckle, is as timely and relevant as ever. This is just a small selection from our talk and focuses on culture, loneliness, and fundamentalism.

The full article can be found at The POV website.

Here are a few quotes from Gerry:

Father Gerald Arbuckle

“the American dream, comes through as a very positive dream, but the danger is that in mythology, amnesia takes place. Mythologies can hide history. What it has hidden is the racist elements in the founding story of the United States”

“The US president is a fragmenter and a polarizer. He aims to fragment by his behavior, alliances, at all levels, international and national. Then that leads to the second stage, polarizer, where not only are they fragmented, but they are polarized. So, this is the tragedy, it is going to be extremely difficult therefore to get a rational debate in that kind of atmosphere.”

“Well, anthropologically, it all makes sense. Once you disturb a culture, even a threat to disturb a culture, and even if intellectually you accept that the culture has to be disturbed, inevitably it leads to chaos levels of intensity. And chaos can only be appeased by returning to what I feel gives me order.”

“Nationalism is a way of giving me a sense of order because it has pre-existed, it is a residual mythology, so the residual mythology comes alive. It never dies, it comes alive so that the United States, with the white rage against African Americans, that is a residual mythology that comes alive, it never died. It just happens to be quietly put aside for the time being, but is there to be used again because it gives me the comfort and sense of security and permanence. And globalization and technology are moving at such speed that our affectivities are not able to catch up with it.”

“There is a real information overload. Put that on to a global scene and the pressure of technology and everything that goes with it increasingly intensifies the chaos, it intensifies the loneliness and the need for a sense of belonging which opens up the opportunity for nationalism, it just makes sense with the intensity that we have probably never experienced before internationally, globally.”

Gerry’s concept of refounding plays prominently in Becoming Medicine: Pathways of Initiation into a Living Spirituality. I also drew from his Humanizing Healthcare Reforms in my book, Re-humanizing Medicine. This 2017 chat I had with Gerry in Sydney, Australia was the basis for what we put in the book on refounding: how organizations and cultures go through the process of reconnecting to their founding visions, while navigating the risk of fundamentalism.

I hope to put out the rest of the interview transcript in the future…but for now you can read this segment:

@ The POV