The Gift of Burnout: Initiation into Becoming a Healer

This is the title of a poster presentation that my good friend, Gary Orr, and I presented at the Australasian Doctors’ Health Conference in Perth, Australia, November 22nd, 2019. This conference takes place every two years, rotating through the Australian states and New Zealand. Here is a screen shot of the whole poster, it is a bit difficult to read in this format, so I’ll break down the elements and type them in below the poster…

THE GIFT OF BURNOUT: INITIATION INTO BECOMING A HEALER

David R. Kopacz, MD, ABPN, ABIHM, ABoIM, Puget Sound VA, University of Washington

Gary Orr, MB BS MSC DIC MRCPsych (UK) Dip Interior Design (Au)

HYPOTHESIS

Burnout could be a predictable rite of passage that occurs several times throughout the education and practice of being a doctor. It is part of the initiation into becoming a healer.

We should not aim to prevent burnout, but rather to expect it and plan for how to create healing inner and outer environments to support doctors through the burnout phase of initiation into becoming a healer. Currently there is a failure of moral leadership in health care institutions, resulting in moral injury (1,2) and burnout with rates upward of 50% of physicians.

This poster provides a new view of burnout, re-examining it as a process of transformational learning and initiation into the archetype of the wounded healer. We will examine the process of finding strength and compassion in our wounds and discuss how we can develop a system of mentorship that guides and supports those going through the initiatory wounding of burnout. Gary will show how the path of a healer sometimes leads out of clinical care and into larger challenges of reinventing one’s self and the effects of design on health.

Introduction:

The World Health Organization has recently defined burnout as an “occupational phenomenon.” (3)

• feelings of energy depletion or exhaustion;

• increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job;

• and reduced professional efficacy

Symptoms of burnout have been reported in over 50% of physicians (4,5). Much of the literature on burnout, implicitly or explicitly, focuses on deficits, deficiencies, or negligence of self-care of the clinician. Individual suffering is marginalized and responsibility for addressing burnout is placed upon the individual. Yet there is a growing realization that burnout is a consequence of a mismatch between the professional values and ideals of physicians and institutional demands that require physicians to compromise their values and ideals – some have begun to call this moral injury. An initiation perspective depends on the availability of elders to communalise and contextualise suffering and yet our institutions marginalize the human and silences the elders.

Burnout as Initiation

We can view burnout as a necessary step for us to grow as healers rather than a pathology to be avoided. The problem then shifts from the individual experiencing burnout to the professional community whose job it is to guide and support the burnt out clinician to become comfortable in suffering rather than to eliminate or minimize discomfort and suffering. Initiation is a form of transformational learning, which does not seek to restore a previous state, but rather the transformation of the individual, leading to a new and expanded identity.

Rather than blame the victim or search for deficits — shift to narratives of transformation and healing.

  • Intentional Suffering – approaching suffering rather than avoiding (6)
  • Initiation (6,7)
  • Hero’s Journey – Joseph Campbell (6)
  • Wounded Healer
  • Soul Loss
  • Feelings of being fragmented, apathy, lack of joy in life; the inability to make decisions; the inability to feel love for others or receive love from another, often resulting in the sense of being emotionally flat-lined. despair, suicidal ideation, addictions, and depression (8)
  • Transformational Learning & Education – Jack Mezirow,(9) Richard Katz (10)

Burnout as moral injury

Outer Environments of Burnout / Healing:

  • Contributing Factors
  • Poor physical environments
  • High levels of clinical demand
  • High staff turnover
  • High staff sickness and absence
  • High levels of violence
  • Poor personal control over day to day scheduling of calender
  • Poor clinical leadership and evidence of bullying, undermining of the professionalism of the practitioner
  • Discrimination which was dismissed by leadership

While we can view burnout as a necessary step in the growth as healers, the problem then shifts from the individual experiencing burnout to the elders of institutions and professional communities whose job it is to guide and support the wounded clinician through the initiation process. We know how to use suffering for growth, Indigenous communities have been doing this for millennia, the question is: Can our institutions and professional organizations create the ritual space for elders and sufferers to do the work of transformation, or will there continue to be failure of moral leadership?

If there is a failure of moral leadership, moral injury will be the result – where physicians are put in institutional situations in which there is cognitive dissonance between professional values and institutional priorities. If we look at recommendations on treatment for moral injury, we see the importance of community, interpersonal connection, reconnecting to meaning and purpose and reconnecting to positive aspects of identity. (11)

Lived Experience of Burn Out and Personal Reflections

Personal Reflections on Moral Injury

Finding oneself constrained in a system that is not able to reflect on its failings can lead to stagnation of the system. Then, when the incoming senior comprehends the moral failings of the system’s leadership, and then calls the leadership to account, but the leadership fails to stand to account. The incoming

senior individual becomes scapegoated, victimized, marginalised, and ostracised. If there is a lack of Elders within the service and subsequent of the Silencing of the Elders, many of whom had a personal over-identification with the service. This failure of moral leadership leads to a lack of elders within the system, and those that are there, are silenced. There are then consequences for the institution

Science – Evidence-based Reductionism

All too often, an evidence-based reductionism can lead to dehumanisation of the process of intellectually comprehending the psychodynamic underpinings of such human behaviour. This can lead to the process of devaluing an individual’s unique experience and expertise, and the individual becomes scapegoated, victimized, marginlised, and ostracised.

Institutional vs. Individual Values

Burn-out takes place when the individual is not able to reconcile the conflict between their own value system and that of the institution.

Economic vs. Individual Values

The trend of chasing multiple KPI’s as proxy measures of care, removes the process of individual’s being treated as individuals, resulting in increased stress in the work place. For example: the KPI of time to transfer from ED, can lead to rushed decision making in order to meet the KPI, rather than allowing a sensible treatment approach to take place, and safer discharge planning processes to be put in place. Increased time to be able to clearly create an effective discharge plan, can lead to an improved out for patient and staff – can there can be cost savings for the service.

Design

Healthcare environments outside of well resourced centres are often characterized by poor standards of the physical environment. Working in a poorly maintained environment has an impact on both staff and patients. There are multiple Issues of OH&S; impacting staff and patients contibuting to increase violence and aggression in the healthcare space, leading to high staff turn over and increased risk of burn out. People are less likely to respect a poorly maintained environment.

Review Procedures

These can be a helpful mechanism of independent external review and recommendations, but the impact can be limited depending on invested interests and potential issues of Elders having been silenced by higher failings of moral leadership. Grass Roots activism and lived experience groups can be a helpful alternative source of raising issues within a service.

Leave your job

Leave medicine – this was the choice that Gary made

Institutions need to Change:

Institutions need to expect burnout, and create workforce and job planning that takes account of such.

There is an opportunity for institutions to create working practices that encourage doctors to create portfolios that include variety in both clinical, leadership, academic and teaching opportunities. Create healing & supportive circles/communities of elders to support working through burnout.

There is a requirement to shift from prevention to developmental career guidance, and institutions need to take moral responsibility for contributing to burnout.

It is possible that institutions and professional organizations are incapable of morality and compassion, because those are human traits—the responsibility of the institution is to organize humans and create space and support for humans to provide moral guidance and the human wisdom of elders.

Discussion:

The fact that we cannot heal the wounded healers is an indictment of our current health care institutions and professional organizations and calls for a refounding and reorganization of the way we do medicine.

We recognize that a crisis of the individual healer is a crisis of the system.

We have allowed institutional economics and protocolised flow charts to replace human caring and moral leadership.

Our institutions have lost focus on the care in health care—no longer caring for their staff or creating

institutional spaces for the care of the patient.

Questions and Reflections:

Is this conference (ADHC) capable of caring for the souls of those who are caring for the souls of others?

Is the ADHC an organization that inspires hope, helps us find meaning & purpose, and cares for those who burnout?

Is a doctor merely a human form engaging in an AI process?

Do we have caring elders in medicine capable of guiding the younger generations through burnout and through initiation into becoming a healer?

Does Health Care still care about Caring?

What is the Economic toll of Burnout – for the individual; for institutions?

Are $’s more important than people?

Does the desire to care predispose one to burnout?

Are concepts about machines & economics good models for caring for the soul?

Are health care workers expendable equipment?

How does an institution take moral responsibility for the wounds and suffering of its workers?

How does an institution undertake reflection?

How does an institution undergo refounding?

Can we create healing circles of elders to guide physicians from wounded to wounded healer?

Remedies & Remediations

  • Recognizing burnout as the disorienting first step of transformation
  • Finding Your Soul (soul retrieval)
  • Re-envisioning Your Calling (reconnecting to your healing vision)
  • Finding Your Self (the counter-curriculum of re-humanization) (12)
  • Finding Your Tribe (mentors and guiding elders)
  • Finding Your Bliss (what brings you joy?)
  • Starting a Revolution (compassion revolution resources) (12)
  • Becoming a Medical Activist

REFERENCES:

1. ZDoggMD, “It’s Not Burnout, It’s Moral Injury,” https://zdoggmd.com/moral-injury/

2. Talbot, SG & W Dean, “Physicians aren’t ‘burning out.’ They’re suffering from moral injury. STAT, 7/26/18.

3. World Health Organization, https://www.who.int/mental_health/evidence/burn-out/en/.

4. Dzau, VJ, DG Kirch, and TJ. Nasca, M.D. “To Care Is Human — Collectively Confronting the Clinician-Burnout Crisis,” New Engl J Med, 378(4), January 25, 2018.

5. Shanafelt, TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015; 90: 1600-13.

6. Kopacz, David and Joseph Rael. Walking the Medicine Wheel: Healing Trauma & PTSD. Tulsa: Pointer Oak & Millichap Books, 2016.

7. Moore, Robert L. The Archetype of Initiation: Sacred Space, Ritual Process, and Personal Transformation. Xlibris, 2001.

8. Shared Wisdom website, Hank Wesselman and Jill Kuykendall, http://www.sharedwisdom.com/page/soul-loss

9. Mezirow, Jack. “Transformational Learning Theory,” in Jack Mezirow, Edward Taylor, and Associates (eds.), Transformative Learning in Practice. San Francisco: Jossey-Bass, 2009.

10. Katz, Richard. “Education as Transformation: Becoming a Healer Among the !Kung and the Fijians.” Harvard Educational Review, Vol. 51, No. 1, February 1981.

11. Griffin, B, N Purcell, K Burkman & S Maguen. “Can trauma cause a moral injury?” ISTSS Stresspoints, (01/01/2019) https://www.istss.org/education-research/traumatic-stresspoints/2019-januarycan-trauma-cause-moral-injury_aspx

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

This presentation was submitted as a workshop using the suffering of burnout as a process of initiation into becoming a healer however, it was accepted as a poster significantly limiting experiential and healing components. This highlights the challenge of working positively with burnout – institutional limitations interfere with the proper functioning of human beings

Circle Medicine Series on CLOSLER

Thanks CLOSLER for publishing a series of 5 short articles on Circle Medicine!

Out of One, Many – David Kopacz, 2018

I have been working on this concept of Circle Medicine since I had the realization that a number of different holistic models I was working with all included circles: the Hero’s Journey, the Medicine Wheel, the Circle of Re-humanizing Medicine, the Circle of Health, and Circle Medicine: the circle of circles.

In our forthcoming book, Becoming Medicine: Pathways of Initiation into A Living Spirituality, we have a table comparing Circle Medicine with Linear Medicine. Linear medicine is the predominant, biomedical approach in contemporary medical practice, however it misses crucial aspects of human being that are only found in holistic, circular models of medicine.

Linear Medicine Circular Medicine
Pathological Process Natural Process
Treatment          Transformation
Elimination of symptoms Acceptance of symptoms
Restoring old state    Achieving new state
Disease-based Health-based
Biomedical Model Holistic Model
Evidence-Based Medicine Human-Based Medicine
Hierarchical        Collaborative
Can Foster Dependency     Empowering

Here are links to each of the short articles:

CIRCLE MEDICINE: A HOLISTIC APPROACH TO HEALTH FOR CLINICIANS AND PATIENTS

THE HEALING CIRCLE AS A HOLISTIC FRAMEWORK

THE CIRCLE OF RE-HUMANIZING MEDICINE

THE CIRCLE OF WHOLE HEALTH

CIRCLE MEDICINE

Rainbow Medicine Wheel, David Kopacz, 2017

The Circle of Re-humanizing Medicine – new guest post at CLOSLER

Thanks again to the folks at CLOSLER for the next in a series of guest post on various forms of Circle Medicine & Circle Healing. This week’s post is titled, “The Circle of Re-humanizing Medicine.”

Here is the Takeaway summary:

We need human-based medicine in conjunction with evidence-based medicine. If we only identify as scientists and not as healers, we risk dehumanizing our patients and ourselves.

They also included the Circle of Caring for Self & Others that my sister, Karen Kopacz, designed for use with the workbook of that same name that I have been developing with Laura Merritt. It is based on my 2014 book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine.

Caring for Self & Other Circle

Next week is the last in my series of guest posts at CLOSLER, please check it out. It is on the VA Circle of Health, another holistic model of Circle Medicine.

CIRCLE MEDICINE: A HOLISTIC APPROACH TO HEALTH FOR CLINICIANS AND PATIENTS

New Zealand Landscape, 2, David Kopacz, 2011, featured in the article

It can be helpful to see the circle path of the hero’s journey as the healer’s journey, the path that we take through our lifelong medical education. For the true healer, this is not a journey we make just once, but periodically we embark on exploring new depths of the suffering of the world, reaching deep into ourselves to find new resources for healing to bring into our work and world.

Thanks to the team at CLOSLER from Johns Hopkins for publishing the first of a series of my posts on Circle Medicine! Here is a link to the full article.

Burnout as part of the healer’s journey: I have been thinking of burnout in this way. Maybe burnout is a necessary step for us to grow as healers. There are intrinsic elements in our work that change us, working with illness and death. When we get “infected” by our work, we incubate until we can find a cure and healing path. There are also extrinsic elements of burnout, such as institutional pathologies and frameworks. In modern times, healing has been regulated and institutionalized, and institutional economic and organizational demands are sometimes at odds with the demands of healing. We must continually work to reconcile the essence of our work as healers with the daily reality of the institution.”

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Re-humanizing Medicine – bringing together the science of a good technician and the spirituality of a good healer.

I just came across this old review of Re-humanizing Medicine by my friend, Lelia Kozak. I was thinking a lot about this book of mine from 2014 this past week as a neighbor was interviewing me for a health professions class. Over the years I have deepened in my understanding of how we need to be not just good technicians, but good, well-rounded human beings, in order to give the best care possible to our clients and patients. We cannot give to others what we have not first developed within ourselves. Our evidence-based medicine is new and scientific, but it needs to be integrated with a human-based medicine that reaches back to the ancient wisdom of healers throughout time immemorial. Thanks, again, for this review, Leila!

Leila compared me to Larry Dossey, which is quite an honour and a little embarrassing as well to have someone compare you to such an influential figure. In his 1999 book, Re-inventing Medicine: Beyond Mind-Body to a New Era of Healing, Dr. Dossey describes three eras of medicine, Era I (mechanical), Era II (mind-body), Era III (non-local/eternity medicine). He points out that “the path of the physician since antiquity has been considered a spiritual path,” (228). He saw Era III medicine as a blending of spiritual, mind-body, and mechanical approaches. The reinvention in medicine was as much remembering our spiritual roots as healers as it was adding anything new. What is new is blending science and spirituality.

“I used to believe that we must choose between science and reason on the one hand and spirituality on the other, as foundations for living our lives. Now I consider this a false choice, because in my own life I have found that science and spirituality can coexist and even flourish,” (Larry Dossey, Reinventing Medicine, 12).

I was lucky enough for Dr. Dossey to write an endorsement for Re-humanizing Medicine! I do see a continuity in our work, but this has more to say about connecting to ancient healing wisdom than to anything particular about me as a person. Here is what Dr. Dossey had to say about the book:

“Modern medicine is engaged in a struggle to find its heart, soul, and spirit. This task must begin with physicians themselves. Dr. David Kopacz’s Re-Humanizing Medicine is an excellent guide in how this urgent undertaking can unfold.” ~ Larry Dossey, MD, Author: Reinventing Medicine and Healing Words.

“Cultivating Caring,” my new article on CLOSLER

 

View St. Brides Bay (Bae Sain Ffraid)

Saint Brides Bay (Bae Sain Ffraid), Pembrokeshire, Wales, David Kopacz, (2018)

A short article I wrote just went up at CLOSLER, entitled “Cultivating Caring.” CLOSLER, out of Johns Hopkins, is named after Dr. William Osler, is a Miller Coulson Academy of Clinical Excellence Initiative promoting importance of the doctor-patient relationship.

The article focuses on how caring and compassion are resources that we need to attend to and cultivate, particularly in the healing professions. You can link to the article here.

International Day of Peace

Today is the International Day of Peace and I would like to speak about the peace work I have been doing with Joseph Rael (Beautiful Painted Arrow).

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Joseph Rael (Beautiful Painted Arrow) & David Kopacz, photo by Karen Kopacz ©2016

Joseph had a vision in the 1980s of a circular structure, half in the ground, half out of the ground, with men and women chanting for world peace. He brought this vision into reality and over 50 sound peace chambers have been built on four continents: North America, South America, Europe, and Australia. Joseph has been received a letter of recognition from the United Nations for his work promoting world peace.

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Sound Chamber, Mike & Marie Pedroncelli caretakers

Peace work can take many forms. In my first book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine (2014), I sought to help doctors and clinicians find a way back from dehumanization and burnout to feel more fully human and to create a health care system that addresses the whole person. I spoke of a compassion revolution that was occurring—many people in health care are working to bring the heart back into medicine.

front-cover.jpg

In our first book together, Joseph and I worked to help create a pathway from war to peace for returning veterans by walking the medicine wheel. This book is called Walking the Medicine Wheel: Healing Trauma & PTSD (2016). One of the things that Joseph talks about with veterans is that they should get their DNA tested so that they can remember that we are all brothers and sisters—because genetic and archaeological science tells us we all came from Africa originally. Scientists even tell us that we all have a common mother, Mitochondrial Eve, some 150,000 – 200,000 years ago. Many Native Americans and other indigenous people talk about Mother Earth. Mother Earth’s initials are ME—the same as Mitochondrial Eve—“ME” is the same thing that each of us call ourselves. Joseph says this just shows that everyone really is related.

Front Cover.final

In working with veterans, we wanted to help them in their walking around the medicine wheel, making the journey from being trained to protect us from the “other” to where we can all see each other as brother and sister.

Here is a link to a video of the two of us talking about peace, filmed by my sister, Karen Kopacz, from the website for the book.

I talked with Joseph this last week and he told me some things about peace. He said, “What we need to teach people about peace is open-mindedness. People are held back by their self-imposed limitations. The very thing that people are afraid of is what they should by trying to moving toward so that they can have an expanded awareness.”

I asked Joseph if he could say a few things about the dove as a symbol of peace.

Dove of Peace

Dove of Peace, Joseph Rael ©2018

“The dove is a waterbird and it is bird that flies in the air because that is what birds do. The dove of peace. It drinks water and when we drink water we are doing what birds do. When we drink water it makes the sound with every swallow “Soul. Soul. Soul.” You can listen as you swallow and you will hear it. We, ourselves, are 70% water, our blood is water that circulates through our bodies, so the dove is reminding us that we are soul and reminding us to connect to our hearts which pump the blood and water throughout our bodies. The work of the dove of peace is to bring us peace and harmony.

When someone dies at Picuris, we wash the body in the river and the soul goes out of the body and down the river. The soul goes down the river to the ocean. It goes out into the ocean, it goes out to Baja. Then from the ocean, the soul, with water goes up into the sky and then it becomes clouds, big white fluffy clouds. The dove of peace is white, just like the clouds that bring the rain. The clouds rain and the rain falls back to the earth and we say that the rain is the ancestors coming back to us because they are our caretakers.

At the beginning of many of my visions I see the white dove of peace which opens a circle of light. The circle of light gets bigger and then I am going through it and I am somewhere I have never been before and I am experiencing something other than what I can experience here. And then I am back to where I started and the circle closes but I have gone somewhere new and experienced something new.”

Joseph reminds us that peace is always right here in our hearts. Whether we are veterans or just a human being who has lost our way, we can reconnect back to what he calls a “held-back place of goodness” that we all have in our hearts. The dove of peace comes from above, falling like the rain that is our ancestors, returning to be our caretakers, reminding us that we are made of water, reminding us that we can bring peace and harmony to our souls. With every swallow of a glass of water, we make the sound “soul, soul, soul.” On this International Day of Peace, we should all remember that we are here to do the work of peace. Joseph says that his grandfather would always tell him, “work is worship,” so this work of peace is a kind of worship, in which we are trying to remind ourselves that we are all brothers and sisters of Mother Earth/Mitochondrial Eve and that we all have a “held-back place of goodness” within our hearts. The work of peace is seeking to find this reservoir of peace within our hearts and to release this into the world, like releasing a white dove from the cage of our hearts.

Dove of the Holy Spirit

Dove of the Holy Spirit, David Kopacz ©2017 

Joseph and I continue our work of peace in our forthcoming book, Becoming Medicine (due out early 2019) which plunges deep into the center of the medicine wheel, where not only are we all related, but ultimately we are all one.

2017 in Review

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Copalis Beach, Washington

2017 was a busy year with lots of things coming together and many things nationally and globally falling apart. I added a new piece to my job at the VA this year. I am speaking now, not as a federal employee, but as an independently licensed health care provider. I have a 20% position with the national VA Office of Patient Centered Care & Cultural Transformation as a Whole Health Education Champion. You can learn more about the VA Whole Health program here. This job entails traveling to different VAs throughout the country and learning how to teach the several courses the Office promotes. I traveled to Madison, Minneapolis, Little Rock, Boston, and New Jersey and I will be going to Nashville later this month. I continue working in Primary Care Mental Health Integration at the Primary Care Clinic in Seattle. With the University of Washington I have moved from an Acting role to an Assistant Professor this past year.

I continue my work with Joseph Rael (Beautiful Painted Arrow), and we are well into the work of our next book which should likely be out later in 2018. Joseph is a continual joy and inspiration to work with and is often sending artwork and ideas for us to use in the next book. We easily have enough material for several more books. Another piece of news is that Walking the Medicine Wheel is being published in Vietnamese! I have yet to see the book, though. This is very important as the land and people of Vietnam and the Vietnam War are intimately intertwined with so many of our veterans’ lives and the history of the United States.

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Joseph Rael (Beautiful Painted Arrow) walking into his garden dome to perform Arbor Day Ceremony, April, 2017

I did a book tour, of sorts, for Walking the Medicine Wheel: Healing Trauma & PTSD. I made the trip back down under and saw some old friends and made some new ones, too. I took off from Seattle, almost missed my connection in Honolulu and landed in Sydney, Australia on September 13th, 2017. I went there for the biannual Australasian Doctors Health Conference, my fourth time presenting (I blogged earlier about this here). The conference was held at Luna Park, an amusement park in North Sydney with a great view of the city. My mate, Hilton Koppe, and I presented a workshop “The Hero’s Journey of the Healer,” that used Joseph Campbell’s concept of the hero’s journey to look at burnout and mentoring in health care workers. I also presented “Circle Medicine,” bringing together the holistic approaches of the medicine wheel, the VA circle of health, and my earlier work with Re-humanizing Medicine. It was great hanging out with Hilton and co-presenting with him, it was an extra treat when he stopped through Seattle on his way to some conferences in October. Here is a link to one of Hilton’s written pieces.

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View from my hotel in North Sydney, looking out at Luna Park (lit up), the Harbour Bridge, and Sydney.

I was also able to meet Father Gerry Arbuckle, whom I had been corresponding with for a few years via email. As well as being a Catholic priest, he has a PhD in applied cultural anthropology. He is the Co-director of the Refounding and Pastoral Development program. Gerry wrote a book called Humanizing Healthcare Reforms (2013) that I found very helpful in writing my Re-humanizing Medicine book. Gerry was also kind enough to write an endorsement of Walking the Medicine Wheel. His book Fundamentalism: At Home and Abroad is highly relevant to understanding political movements in the United States and throughout the world. I wrote a review of that book that can be found here. Gerry is from New Zealand, originally, and has now lived in Australia for many years. His next book is on loneliness and picks up on themes from his book on fundamentalism. He and I had a great chat, over 4 hours, and I hope we have a chance to meet again before long.

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Berkelouw Books, Sydney

Dr. Asha Chand organised a talk for me at Western Sydney University (see earlier blog on this here). It was great to meet faculty and staff there and have a chance to talk about “Caring for Self & Others” which is an adaptation of Re-humanizing Medicine. My friend, Laura Merritt, in Seattle has done a lot of work with me on putting together a workbook version that I drew on for that presentation. WSU recorded the talk and Asha has said we can share the links to the talk for anyone who is interested:

Caring For Self & Others, Part 1Part 2, Part 3

After Australia, I flew over to Auckland, New Zealand and straight away met up with some of my best friends. I did a talk called “Life After Rehab,” at Buchanan Rehabilitation Centre, where I served as Clinical Director during my time in New Zealand. I also did a book talk at Time Out Books, where a group of us used to meet monthly for the Auckland Holistic Writer’s Group.

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View from Te Pane o Horoiwi (Achilles Point), St. Heliers, Auckland, New Zealand

My next stop was somewhere I have never been, but have wanted to travel to: Fiji. I flew into Nadi airport on the Northwest of Viti Levu, caught a short flight to the Southwest, to Suva. Dr. Neeta Ramkumar met me there and she had organised a talk and workshop for me at the University of the South Pacific. The talk was called “The Transformational Power of Stories in Clinical Work, Teaching, and Community Building,” and the following workshop was “Bringing Ancient Traditions of the Hero & the Warrior into Modern Day Life.” I very much enjoyed meeting all the wonderful people of Fiji and the University of South Pacific and felt honored to be able to speak there.

Bringing Ancient Traditions

Finally, I had a bit of a break from the speaking tour and from all the busy socializing with friends. I took a 45 minute boat trip out to Leleluvia Island and just relaxed. I snorkeled twice a day at the reef just off the island. I walked around the island several times and also kayaked around once. Such a beautiful place! I’ll share some of the photos from the trip and I hope you enjoy them!

After Leleluvia, I went back through Suva, hired a car, and drove back to Nadi, seeing the Sri Siva Subramaniya temple (which was scaffolded under construction), but I still walked around and had a nice lunch there. I also stopped for a walk through the Garden of the Sleeping Giant with its orchids prior to heading to the airport, flying back through LAX and to Seattle.

This next year promises to be quite busy again with travel: Nashville, Portland OR, Madison, and back to the Boston area two more times. Joseph Rael and I continue to work toward peace and world peace. As Joseph says, “A lot of people have tried to bring about peace, and it hasn’t worked! But you and I are too far into it to stop now, so we’ll have to keep going.” May you find peace in your heart and in your life this coming year, and may we all have some peace in this world that seems so focused on the opposite of peace at this current point in history.

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South coast of Viti Levu

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Copalis Rock, Washington Pacific Coast

Australasian Doctors Health Conference, Sydney, Australia, Sept. 15-16, 2017

I recently returned from a trip to Australia, New Zealand, and Fiji. I started in Sydney, Australia at the Australasian Doctors’ Health Conference. The conference was held at Luna Park in North Sydney with a great view of the city and the opera house.

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View of Luna Park (lit up below bridge) from the North Sydney Harbourview Hotel

I did two presentations at the conference. The first was a workshop co-facilitated with my mate, Hilton Koppe, called The Hero’s Journey of the Healer, where we looked at burnout as a necessary stage of the healer’s journey and also at the important role that mentors can play on the journey. We also made a distinction between instructors (who train you to do the technical job) and mentors (who help you find yourself in the work and sustain your humanity).

Title slide Healer Hero

circle

I have recently come across the concept of transformational learning as defined by Jack Mezirow it includes several steps that parallel the process of initiation and the hero’s journey: a disorienting dilemma, realization that disorientation is part of the growth process, and then a reintegration with a new, transformed identity.

Transformational Learning Model

The second presentation was Circle Medicine: What’s Good for the Client is Good for the Clinician. This presentation reviewed a few of the circular models of healing I have been using lately: the Hero’s Journey, Whole Health, and the Medicine Wheel. I believe that we need to include both linear medicine and circle medicine in order to best serve our clients.

Circle Medicine Title

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I had a great time at the conference, caught up with some old friends and made some new friends. I also spent a few hours speaking with Gerald Arbuckle, author of the book Fundamentalism that I recently reviewed. Gerry and I have had an ongoing correspondence since I used his models of medicine concept in my book Re-humanizing Medicine, and also he wrote an endorsement for Walking the Medicine Wheel. It was great to finally meet in person and have a really good chat!

More blog posts to follow from this trip!

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“We Need to Be Disoriented Says Psychiatrist”

Here is a link to an article, “We Need to Be Disoriented, Says Psychiatrist,” by Chris Kelly from my recent talk at Western Sydney University, Australia. The article appears in Hunter and Bligh.

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Thank you Chris Kelly and Hunter and Bligh for this article that captures the essence of transformational learning – that we need to be disoriented and lose our bearings in order to really have the opportunity for transformational learning – learning that changes who we are beyond just learning new information. Transformational learning is a concept that Jack Mezirow developed. He listed ten different steps that I have condensed down to three steps in the circle below, corresponding to the circle of initiation: separation, initiation, return. This model also fits with Joseph Campbell’s hero’s journey model in which transformation comes through transitioning between worlds, cultures, or states of consciousness.

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This was part of a 2 hour talk I did for staff and students called “Caring for Self & Others,” based on the Caring for Self & Others workbook that Laura Merritt and I have adapted from my first book, Re-humanizing Medicine: A Holistic Guide for Transforming Your Self, Your Practice, and the Culture of Medicine. We had a great discussion about creating a counter-curriculum of self-care and contributing to the compassion revolution!

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Thank you to Sneh Prasad for connecting me with Dr. Asha Chand at Western Sydney University who coordinated this event while I was in Australia for the Australasian Doctors Health Conference. Thank you everyone involved in the talk! I will be posting about the other talks I did on my trip as well as some of the photos soon…

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Dr David Kopacz speaking at Western Sydney University about anxiety and stress. Image: Christopher Kelly