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

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

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

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

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

Two guiding principles he mentions in his book are “bent nail research” and “getting rid of the rats.” He learned that a good doctor won’t just treat a rat bite, but will help to get rid of the rats in the neighborhood. He thus saw the role of the doctor and psychiatrist as not a technician in an office, but as an engaged professional intervening in the world. Robert Jay Lifton calls this a “witnessing professional,” (Lifton RJ, Losing Reality: On Cultism, and the Mindset of Political and Religious Zealotry, p. 190). This role of the physician as a moral agent having a moral role is consistent with Virchow’s statement in the 19th Century, “Medicine is a social science, and politics is nothing else but medicine on a large scale,” (McNeely IF, Medicine on a Grand Scale: Rudolf Virchow, Liberalism, and the Public Health). Dr. Bell’s “bent nail research” developed when he was a kid and wanted to have a bookshelf and scavenged some boards and straightened out some bent nails.

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

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

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

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

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

Happy World Book Day!

What a great week – Earth Day and World Book Day back to back!

The Earth gives us so much to be thankful for and her beauty is even more apparent and more easily appreciated during these times of a more inward focus. It is easier to hear the birds and working from home I look out my window often to see Stellar’s Jays, Chickadees, Juncos, and today I even saw an Audubon’s Warbler!

I’m grateful to have been able to bring forth, in these books, what is within me and to release this out into the world.

“If you bring forth what is within you, what you bring forth will save you. If you do not bring forth what is within you, what you do not bring forth will destroy you.” (The Gospel of Thomas, in The Gnostic Gospels, by Elaine Pagels)

Gratitude and thanks to Joseph Rael (Beautiful Painted Arrow) who has been my co-author on these last two books: Walking the Medicine Wheel: Healing Trauma & PTSD and Becoming Medicine: Pathways of Initiation into a Living Spirituality. All my books have the word “medicine” in the title, because they are all about healing the splits within our hearts, minds, societies, environment, and world. My first book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine, calls for a counter-curriculum of re-humanization – learning practices that help us connect to, develop, and sustain our inner spiritual humanity; and also was an open call for everyone to join the compassion revolution – bringing the heart and caring back into our work with people in the world.

A Bowl Full of Ideas for Inventive Minds, Joseph Rael (BPA) 2009

Joseph and I are working on our next book together which will be a book of initiation and instruction for 10-12 year old children, drawing on Joseph’s experiences and what he thinks it is important for human beings growing up into this world to know about the world and themselves. We are calling it, A Bowl Full of Ideas for Inventive Minds. More to come…

May the books of all of the authors of the world contribute to realizing our inner spiritual humanity, our outer spiritual democracy, and helps us to remove obstacles and division to allow us all to live in peace, peace within our hearts and peace within the world.

Aho.

A Tree with A Lot to Teach Us, D. Kopacz (2020)

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.