This is the title of my presentation from May, 2012, at the Royal Australian New Zealand College of Psychiatrists annual meeting, held in Hobart, Tasmania, Australia. This is a timeless topic and applies as much as ever to us as we work to come out of this pandemic which has changed how we relate to others and how we relate to ourselves. The struggle to “stay human” in medicine is an ongoing practice and we can learn from the life & works of PKD.
Perspectives on Personal Growth, Psychosis & Spirituality:
Carl G. Jung’s Red Book & Philip K. Dick’s Exegesis
I presented this paper at the International Society for Psychological and Social Approaches to Psychosis, New Zealand/Australia annual conference, August 2012 in Auckland, New Zealand. I thought I would share the slides from the talk.
My sister, Karen, and I presented at last month’s Toward a New Way of Being with Plants conference.
The video of our presentation is available here.
Our overall presentation was called, “Remembering Our Living Relationship with Plants,” my talk was entitled “Toward an Ancient Way of Being with Plants,” and we also featured video that Karen created with Joseph Rael, “Becoming Medicine Initiation Ceremony,” and Karen’s talk was “Shifting Into a Relational Mindset With Nature.”
The conference was great! Very interesting, bringing together scientists, artists, poets, writers, and naturalists from around the world. There is a YouTube channel for the conference where you can watch the presentations.
Thanks to all the organizers and people who brought this great event together! It was very enjoyable, inspirational, and educational.
By David R. Kopacz, MD & Joseph Rael (Beautiful Painted Arrow)
About Place Journal from the Black Earth Institute
We have a new article published at About Place Journal for their Geographies of Justice Issue – Volume VI, Issue III, May 2021! We are very excited to be published in this excellent and important journal.
We look at the relationships between land and health, private land/private health, and public land/public health.
When I spoke with Joseph about the topic of Geographies of Justice he immediately resonated with it. “All humans are looking for that – some justice, a just place where we can feel adjusted and feel safe. A just place is where you are adjusted to justice,” he said. Here are a few excerpts of Joseph’s thoughts on Geographies of Justice:
“There are a lot of resources on the land that we take care of and they take care of us.
We need to start with the origin of the land, the place before everything broke apart – Pangea. We start at 1 – that’s Pangea. Then the scientists say the continents broke apart, and then people came out of Africa, then the Indians walked across the Bering Strait into the Americas – that’s how the scientists tell it.…
We can learn from our environment, from our geographies. We cannot have justice unless we learn from our geographies. Pangea was created and all around it was Panthalassa, the great ocean. Then Pangea spilt and you had the Pacific and the Atlantic Oceans eventually, and the Americas, North, South, Central, and then you had all these tribes in North America, and you had tribes in South America. For all these tribes, their religion was based on geography. The Eskimos had igloos and they would have ceremonies that reflect where they live, all the tribes would have ceremonies that reflect where they live.
There are different areas of land. You become your place before you live in your Mom and Dad’s house because they come from the land and you come from them. They teach you about the weather. The ceremonies are related to the climate of their place. First there was Pangea, and then it split and you had Europeans and Americans, but we are all from Pangea, we are all related...”
“Justice is right here in the room with me and it is right there in the room with you and it is right there in the room for all the people on the planet – it is here.“
To read the whole article, follow this link to “Making America Healthy Again: Indigenous Perspectives on Land & Health” in About Place Journal.
I have a new article posted, “The Social Determinants of Clinician Health,”
at CLOSLER: MOVING US CLOSER TO OSLER A MILLER COULSON ACADEMY OF CLINICAL EXCELLENCE INITIATIVE, Johns Hopkins.
Here are some opening quotes and the first paragraph…
“Every system is perfectly designed to get the results it gets,”—W. Edwards Deming
“An abnormal reaction to an abnormal situation is normal behavior.”—Victor Frankl
“Many believe burnout to be the result of individual weakness when, in fact, burnout is primarily the result of health care systems that take emotionally healthy, altruistic people and methodically squeeze the vitality and passion out of them.”— Swenson and Shanafelt, Mayo Clinic Strategies to Reduce Burnout: 12 Actions to Create the Ideal Workplace
If every system is perfectly designed to get the results it gets, then many healthcare systems around the world are designed to create high levels of burnout and compassion fatigue in the people who work within them. Maybe burnout isn’t a lack of resilience or coping skills in clinicians, but an iatrogenic effect of modern healthcare.
I am very excited to announce that I will be speaking at the Toward a New Way of Being with Plants conference on June 18th! This is an online conference and registration is free.
I will be presenting along with my sister, Karen Kopacz. Our talk is called “Remembering Our Living Relationship with Plants“ and is from 1:20 pm-2:05 pm US Central Time.
My part of the talk is called “Toward an Ancient Way of Being with Plants“ and will review some of my work with Joseph Rael (Beautiful Painted Arrow).
The center of our talk will feature a video of Joseph Rael Becoming Medicine Initiation Ceremony video (5:16) that we filmed and Karen produced.
Karen’s talk is called “Shifting Into a Relational Mindset With Nature.”
Maybe we will see you there!
Also, I just had a post up on CLOSLER, “Making the Most of Your Daily Nervous Breakdown,” where I write about taking a mini-rest cure connecting back to nature.
Whidbey Island poet, Judith Adams’ new book of poems, A Place Inside, covers the full range of human emotions & experiences, bearing witness to the tragedies and celebrating the joys of life.
Poems such as “Visit to the Doctor” and “Letter to my CPA” bear witness to the dehumanizing mania of turning human beings into numbers. The poems are rooted in the earth, not only in harvesting potatoes in “Pommes de Terre,” but walks through the ferns and forest with grandchildren, rescuing a hummingbird that got into the house, and a poem “For Mary Oliver.” Death and life come into full circle relationship in poems such as “Two Reasons for Weeping,” when attending a Covid-era “circular drive-by” funeral, the poet gets a call from her daughter about new life, “Mom, I’m having a girl.” The poems look backward and forward, remembering the pain of leaving a mother behind in the UK, burying her under quince tree, and the birth of granddaughter, Brigid.
What could be more natural and human than giving birth and dying, gardening, mourning, rejoicing, kayaking―the land, the body, roots and bones, growth and hibernation? “All the things I have loved, as I love the human face,” ends the poem, “Roots.” The poet imagines a God who wants you to have “a wild night on the town” and not to try to get into Heaven with “love letters/you never sent,” (“Love Letters Only”). The poet reminds us that we need the trickster as much as the saint to keep us human and sane in a world that tries to classify the complex interweaving of suffering & joy into the question, “What is my pain level out of ten?” To the young doctor/computer technician, asking questions to quantify and reduce complexity to certainty, “Her fast fingers wait to classify my/existence on a screen,” while “oblivious/to the bend I have just rounded,” the poet suggests questions instead that open and deepen into life:
“Ask me instead who I am,
what my mornings are like,
if I am working towards a future,
who in my life has just died?
If you don’t have time, and you are
backing out of the room with your computer,
at least ask me if I drink alone.”
Judith Adams knows what healing and comforting the soul is, in contrast to the often cold, heartlessness of contemporary medicine. She created The Poetic Apothecary project, offering “poems for healing and comfort,” throughout Washington State via the Humanities Washington program. A video of this talk can be found on Judith Adams’ website.
The center of the book, and the title as well, is “A Place Inside,” a poem, brief and wonderful, which embodies a love of life, bringing inside/outside, human/divine, and body/spirit together.
“You have a place inside you
no one can touch.
It’s where your tools are kept.
In this divine workshop
you chisel at a raw day
in deep devotion to yourself,
and there you allow some unruliness,
your share of sore complaint.
And there you follow
your own footsteps
through the dark”
(A Place Inside)
A Place Inside is a wonderful book that reminds it what it is to be human, to be alive, to be grounded in the Earth, and to breathe starlight.
Watch for an interview I did with Judith Adams to be up on The-POV soon!
The second part of Alice Lee’s interview of me is up on her Holistic Psychiatrist Podcast!
This second part covers transforming suffering, the Hero’s Journey, the movie Groundhog Day, Joseph Rael’s teachings on the Medicine Wheel, and a discussion of circular models of healing.
Part 1 is available through the same link.
Part 3 will air next week. While you are on the site you can check out some of Alice’s other podcast interviews!
“The time is always right to do the right thing.”
― Dr. Martin Luther King, Jr
The US response to the public health crisis of the pandemic and extremism has been sorely lacking. While these two infections may seem unrelated at first, there are ways that they are interconnected.
Institutional policies of inequality lead to poorer medical and social outcomes (see Wilkinson & Pickett’s The Spirit Level: Why Greater Equality Makes Societies Stronger). Inequality is also leading to higher death rates from “diseases of despair” from overdoses, suicides, and the consequences of alcoholism (see Deaths of Despair and the Future of Capitalism by Case & Deaton). In areas with higher rates of deaths of despair, there have also been “votes of despair” for nationalist, racist, authoritarian leaders.
Health is health. All health is holistically interconnected – physical, economic, social, political, moral, and spiritual.
Today, on Martin Luther King Day, I would like to give a brief review of the work of Dr. Quentin Young (9/5/1923 – 3/7/2016). I was familiar with Dr. Young’s work when I was a medical student and resident in Chicago (1989-1997) as described in Everybody In, Nobody Out: Memoirs of a Rebel without a Pause (2013). I saw him speak on Physicians for a National Health Plan and I would hear him occasionally on WBEZ Chicago Public Radio. He was a champion of Cook County Hospital and reading his book takes me back to my time in Chicago and my fond memories of clerkships at the old Cook County Hospital, Fantus Clinic, and Jorge Prieto Clinic where I did my family practice, general surgery, surgical oncology, and plastic & reconstructive surgery rotations as a medical student.
Over the past five years, I have felt a growing responsibility as a physician and a professional to speak up on what I have seen as public health risks from the attitudes, statements, policies (and lack thereof) of this presidential administration that is now in its last few hours. I have written on the need for physicians and professionals to have an identity that includes public, social, and moral responsibilities that go beyond the doors of the consulting room. (See Medical Activism: A Foundational Element of Professional Identity).
Dr. Quentin Young embodied the archetype of the physician as medical activist. He was Dr. Martin Luther King’s doctor when King was in Chicago – writing that he “became my hero…and my patient,” (53). He marched alongside Dr. King and tended his scalp laceration after being hit with a rock – after which Dr. King said, “I have to do this―to expose myself―to bring this hate out in the open,” (65). Dr. Young championed Cook County Hospital and sought to strengthen its network of community clinics when he was Chairman of Medicine there 1972-1981. Here is what he said he learned at County, “I am convinced that until we, as a nation, have a system of universal health care, including everyone―everybody in, nobody out―until we provide that, we as a society must provide care through a system like County,” (36).
Dr. Young was an active member of many different civil and human rights movements, including the Medical Committee for Human Rights where he marched and provided medical care in the South, he marched in Chicago with Dr. King, he provided medical care on the street at the 1968 Democratic National Convention, he was the founder of the Health and Medicine Policy Research Group, he served as president of the American Public Health Association, and national coordinator for Physicians for a National Health Program – to name just a few organizations. Throughout his career he worked for racial justice, universal health care, and improving the health care of the poor and marginalized. His work was as a doctor, an activist, an organizer, and a change-maker – in short, a medical activist par excellence. Dr. Young was not afraid of a good fight and his work brought him before the House Un-American Activities Committee before it disbanded in the late ‘60s.
I had heard of the term, bearing witness, from my background in trauma work. Dr. Young writes that the term, medical witness, was used in the Civil Rights movement. The work of the doctor in the Civil Rights movement was, “we bore not only our doctor’s bags, but witness,” (57).
“‘Medical witness’ was a term used in the movement to refer to bringing focus to an issue of indignity or an issue of inequity: visiting doctors offices that had ‘colored’ and ‘white’ waiting rooms, hospitals that had segregated wings and the very obvious disparities between the African American population and the white populations,” (74).
The Good Fight in the Name of a Good Cause
Dr. Young summarized a few teaching points on the good fight (pages 171-172).
- Don’t be afraid to say the same thing over and over again to lots of different audiences
- Always use sarcasm and humor
- Draw on every literary and artistic device you can from Shakespeare to the Smothers Brothers
- Always connect lots of different struggles: from struggles against racism to struggles to end the war to struggles to get resources for the community
- Always remember to draw on and recall past great heroes such as Dr. King
- Don’t be afraid to take on established offices of power, to struggle against them and make them become enabling resources for the movement
- Yes, there are great risks of selling out, like becoming the boss at County, but in this there is also opportunity to inspire and catalyze and gain support for the struggle from below
- Know when to move on
- Sometimes you need to strike a balance between long-term commitments―which are lifelong―and tactical strategies―which have to be constantly rethought
- Don’t be afraid to be labeled a radical or a socialist
Health Care in the USA is a Failed Experiment with Market Forces
Mardge Cohen and Gordy Schiff write of working with Dr. Young. For him, they say, “Organizing for political demonstrations, lobbying politicians, disrupting visits for key phone calls and meeting outside of the office, were all part of how he appreciated and served patients,” (177). They describe that Dr. Young saw that doctors and patients have to work together, saying
“the personalization of the individual and the destruction of the community, the emblems of our time, are conspicuously manifested in the role models enacted in the healthcare settings. A revised concept would envision changes in the role of physicians, nurses, and other health providers and in the role of the patient who would come to be regarded as the keeper of his or her own medical health,” (177-178).
Cohen and Schiff quote Dr. Young as saying about health care in the USA, that the “diagnosis is clear, we have a failed experiment with market forces,” (178).
Medicine is Only One of the Determinants of Health
John McKnight writes in the book,
“[At] that time Quentin and I had worked in Cuernavaca, Mexico, with Ivan Illich, the radical critic and social historian. Illich emphasized that health was not the product of medicine. Rather, medicine was one of the numerous determinants of health and that it often misled people to believe that there was something called a ‘health consumer.’ Illich argued that you could ‘consume’ medicine but it was primarily the social, cultural and economic environment that ‘produced’ health,” (199).
Everybody In, Nobody Out (203)
Dr. Young was one of the early supporters of Physicans for a National Health Program (PNHP), founded by Drs. David Himmelstein and Steffie Woolhandler. This is where I first, personally, encountered Dr. Young, seeing him speak at a conference and I quickly became a student member of PNHP. My thoughts about a national health program have fluctuated over the years. When I ran a private micropractice for 5 years, I became aware of how vast and intercalated into the health care system the insurance industry is. I also became aware that the insurance industry describes paying for someone’s health care “a loss.” This is a fundamental philosophical and linguistic problem. If health care is viewed as a loss then the obvious thing to do would be to try prevent loss – in other words, the primary motive health insurance companies is to prevent health care from occurring – that is the bottom line of health insurance companies.
Living and working in New Zealand for 3.5 years I had a chance to work and receive care in a nationalized health care system. I received care in the public and private systems (at the time around 5% of health care in New Zealand was through the private systems and private health insurance was closer to the cost of car insurance in the US). I had national health insurance, even when I had the equivalent to a green card, when I was on the permanent residency track (incidentally, as a functioning participatory democracy New Zealand law requires all citizens, permanent residents, and even those on the permanent residency track to be registered to vote). For primary care, there was a small copay based on how wealthy the community you lived in. The system worked great and people were happy with it. Everybody was in, nobody was out.
The pandemic is teaching us how “great” the US health care system is―it is not! The United States ranks 37th in the world in health care, despite spending far and away the most. Also see the arguments of PNHP for a single-payer plan. The pandemic shows us that the health of all depends upon the health of everyone. If the virus is spreading through the community, it doesn’t matter who you are if you get exposed to it. The health of the individual is the health of the community and the health of the community is the health of the individual – you cannot disconnect these things, we are all in this together. The time is right to work for health care for all. It is time to Make America Healthy Again.
Dr. Young’s Final Words: “The future can be bright, but only if we work to make it so“
“The health system isn’t working in this country―fiscally, medically, socially, morally,” (216).
“Health care is a human right. There should not be market solutions in a life-and-death game,” (217).
“We need to redouble our efforts to extirpate racism from every aspect of the U.S. life,” (240).
“We need to pass single-payer national health insurance, an improved Medicare for all. We cannot rest until everyone, without exception, has unimpeded access to high-quality care,” (240).
“We need to radically reduce the huge wealth disparities in our country, where the vast majority of our economic assets are controlled by the ‘1 percent,’” (241).
“We need to get big money out of politics and elections,” (241).
“And we need a more rational, humane foreign policy,” (241).
“Over the years, I’ve been accused by right-wing circles of being ‘un-American’ for having advocated for a more humane society. These charges have left me unfazed. I am merely an American who has exercised my constitutional rights. I remain unbowed,” (241).
“To a certain extent this book chronicles, from a health viewpoint, the evolution of the tension between these two trends―toward justice or injustice. Whichever trend prevails will define the 21st century.”
“I retain a terrible reputation for excessive optimism. The glories of humankind’s ingenuity and inventiveness have not yet been exhausted. The future can be bright, but only if we work to make it so,” (242).
Well – that is what we’ve been warning you about.
Words create worlds.
Violent words create violent acts.
Fascist words create fascist acts.
Seditious, treasonous, insurrectionist words create seditious, treasonous, insurrectionist acts.
Even after the debacle spectacle at the Capitol yesterday, 147 Republican lawmakers voted against democracy, voted to overturn the election.
I have been writing this column called, “Words Create Worlds,” about how what we say begins to create reality. Psychiatrist Robert Jay Lifton warns about malignant normality, when we gradually become desensitized to words and our reality gradually becomes malignant. Our country has become unhealthy in mind and body and spirit. We are suffering from a nearly unchecked spread of Covid-19 coronavirus pandemic – with no coordinated national public health policy and politicians actively promoting unhealth; we have also been suffering from a disease of the mind and social body: fascism. Now we have new words creating our worlds.
c. 1200, “betraying; betrayal of trust; breach of faith,” from Anglo-French treson, from Old French traison “treason, treachery” (11c.; Modern French trahison), from Latin traditionem (nominative traditio) “delivery, surrender, a handing down, a giving up,” noun of action from past participle stem of tradere “deliver, hand over,” from trans- “over” (see trans-) + dare “to give” (from PIE root *do- “to give”). A doublet of tradition. The Old French form was influenced by the verb trair “betray.”
“an uprising against civil authority,” early 15c., insurreccion, from Old French insurreccion or directly from Late Latin insurrectionem (nominative insurrectio) “a rising up,” noun of action from past participle stem of insurgere “to rise up.”
mid-14c., “rebellion, uprising, revolt, concerted attempt to overthrow civil authority; violent strife between factions, civil or religious disorder, riot; rebelliousness against authority,” from Old French sedicion (14c., Modern French sédition) and directly from Latin seditionem (nominative seditio) “civil disorder, dissension, strife; rebellion, mutiny,” literally “a going apart, separation,” from se- “apart” (see secret (n.)) + itio “a going,” from ire “to go” (from PIE root *ei- “to go”).
Meaning “conduct or language inciting to rebellion against a lawful government” is from 1838. An Old English word for it was folcslite. Less serious than treason, as wanting an overt act, “But it is not essential to the offense of sedition that it threaten the very existence of the state or its authority in its entire extent.”
Let’s return back to where this phrase originates with Rabbi Abraham Joshua Heschel.
“Words create worlds,” Rabbi Abraham Joshua Heschel.
“Words create worlds.” These are the words of Rabbi Abraham Joshua Heschel, here is the full quote, remembered by his daughter, Susannah Heschel:
“Words, he often wrote, are themselves sacred, God’s tool for creating the universe, and our tools for bringing holiness — or evil — into the world. He used to remind us thatthe Holocaust did not begin with the building of crematoria, and Hitler did not come to power with tanks and guns; it all began with uttering evil words, with defamation, with language and propaganda. Words create worlds he used to tell me when I was a child. They must be used very carefully. Some words, once having been uttered, gain eternity and can never be withdrawn. The Book of Proverbs reminds us, he wrote, that death and life are in the power of the tongue.”
Death and life are in the power of the tongue. We have a great sickness in this country and are in need of words of healing – not words of violence, not nasty words, not fascist words, not seditious words, not treasonous words, not insurrecionist words. We are in need of words of healing, words of unity, words of spiritual democracy. Let us stop creating destructive worlds through destructive words. Also, please wear your damn mask, we are in a pandemic and that is the most basic public health policy – it is not politics, it is science.
Here are the links to my essays over the past couple years on this subject: