This is the title of my presentation from May, 2012, at the Royal Australian New Zealand College of Psychiatrists annual meeting, held in Hobart, Tasmania, Australia. This is a timeless topic and applies as much as ever to us as we work to come out of this pandemic which has changed how we relate to others and how we relate to ourselves. The struggle to “stay human” in medicine is an ongoing practice and we can learn from the life & works of PKD.
Perspectives on Personal Growth, Psychosis & Spirituality:
Carl G. Jung’s Red Book & Philip K. Dick’s Exegesis
I presented this paper at the International Society for Psychological and Social Approaches to Psychosis, New Zealand/Australia annual conference, August 2012 in Auckland, New Zealand. I thought I would share the slides from the talk.
As we enter into a new phase of the pandemic, I worry about myself and my colleagues in health care – how will we come out of this? How will health care change? When will we feel like we have recovered from the constant changes and worries about our personal and collective health?
I’ve been working for a while on a workbook adaptation of Re-humanizing Medicine. I’ve been seeing if I can get this published or figure out a way to get it out to the larger world as a resource for caring for ourselves & others. I’m not sure exactly what form this will take, but in the meantime, I thought it might be worth revisiting some of the concepts and topics of Re-humanizing Medicine: A Holistic Framework for Transforming Yourself, Your Practice, and the Culture of Medicine that I published in 2014.
I’d like to give a few quotes from the book and put them out into the world as a small offering to address the suffering, burnout, compassion fatigue, soul loss, and moral injury of health care colleagues. The experience of dehumanization is all to prevalent in contemporary medicine and the need for re-humanization is just as needed as ever! Here is the introduction to the book:
Only connect! … Live in fragments no longer.
The great error of our day in the treatment of the human body is that physicians first separate the soul from the body.
Dehumanization in Contemporary Medicine
This book takes on the task of re-humanizing medicine. We start by recognizing that there is a problem with how medicine is currently practiced: it dehumanizes staff and clients, creating dissatisfaction, suffering, poor performance and medical errors. Dehumanization is an iatrogenic effect of the dominant paradigms in contemporary medicine – the economic/business model and the reductionist and materialistic approach of biomedicine. In the day-to-day practice of medicine, doctors are expected to see more patients in less time and to efficiently reduce people to symptoms, diagnostic codes, prescriptions, procedures and billing codes. This leaves little time or space for people – physician or patient.
Future doctors are attracted to medicine for idealistic and humanitarian reasons, but through training they often lose this idealism.3,4 How can we preserve idealism and humanitarianism in medicine? Practicing physicians have high rates of burnout and job dissatisfaction. How can we reinvigorate the practice of medicine and make it sustainable?
A Counter-Curriculum of Re-Humanization
In medical school, I realized that I had to engage in a parallel education process in addition to the standard scientific curriculum. We could even call this a ‘counter-curriculum’, focusing on re-humanization. At times I found teachers, mentors, and fellow students who practiced this counter-curriculum, but often I had to seek it out on my own in order to balance my education. This book is about that counter-curriculum of re-humanization. Science and evidence-based interventions are one paradigm of medicine, but as human beings working with human beings, we must have a human framework as well as a scientific one.
As a medical student, the first research project I worked on was with Deb Klamen and Linda Grossman at the University of Illinois at Chicago. Our study examined symptoms of Posttraumatic Stress Disorder (PTSD) in relation to medical training and found that 13% of trainees in the study reported sufficient symptoms (relating to their internship year) to potentially qualify for a PTSD diagnosis.5 The findings provide evidence supporting the need to change postgraduate medical education to reduce stress and to enhance the well-being of trainees. I went on to work with Linda and Deb on three other papers that examined medical students’ beliefs and their attitudes toward the controversial issues of homosexuality, abortion, and AIDS.6,7,8 These papers examined how medical student beliefs can shape attitudes that adversely impact medical care. The studies also allude to the fact that people are not purely rational beings, and beliefs, fears and stigma can undermine scientific reasoning or professional ethics. Even my student research experience was concerned with the counter-curriculum of exposing dehumanization and seeking re-humanization.
To re-humanize medicine, the people who work in medicine must be well-rounded, well-developed human beings, as well as safe and effective technicians. A great deal of time, energy, and money is spent in making sure that physicians are good technicians, but are they good human beings? Being a good technician (objective, detached, unaffected by emotion, protocol-driven) can actually interfere with being a good human being. Clinicians should not stop being technicians or scientists, but they have a responsibility to attend to their own humanity, as well as that of the client. The counter-curriculum provides a holistic framework for being a human being, for working with human beings, and for creating systems that deliver care by human beings to human beings.
A Holistic Framework for Medicine
A holistic framework is founded on multiple interacting and mutually influencing sub-systems. Scientific medicine and the objective, observable body make up just one dimension of human health. Sometimes the physical dimension is primary, for instance in physical trauma and surgery. Sometimes other human dimensions are more important. Emotion, mind, love, self-expression, intuition, spirituality, context and time all play a role in health and illness.
A holistic framework is a paradigm for understanding and interacting with human beings. It is a human systems approach and a way of being in the world. Holistic medicine is a philosophy, or a paradigm for understanding what it is to be human, to suffer, to be ill, to be healthy; what it is to change, grow and live. It helps us understand how disconnection can lead to suffering and how connection can lead to healing. Holistic medicine is not defined by using an herb instead of a medication, or by any specific technique or intervention. Being a good technician (whether biomedical or ‘natural’) is part of being a good physician, but being a good physician is more than just being a good technician.
It is hard work to maintain a complex identity that includes being a technician and a human being, but that is what being a medical professional involves: balancing different roles for the purpose of alleviating suffering and treating disease. Re-humanization reconnects the art and science of medicine, the heart and the mind. A holistic framework encourages integration.
When you start to connect in a different way, you change the health care delivery system in which you work. What starts as personal dissatisfaction can become personal transformation, which changes systems. Institutions will always drift toward promoting their own interests over human interests. It is the responsibility of health professionals to ensure that they stay human, help their clients stay human, and ensure that health care delivery systems promote humanization rather than dehumanization.
Intended Audience and Purpose of the Book
I wrote this book for people who are looking for different ways of thinking about and practicing medicine. Dehumanization in medicine occurs throughout the world, particularly as business models replace humanitarian models of care. Many of the examples in the book are specific to the United States or New Zealand, drawing on my experience of practicing medicine in various settings in both countries; but whether dehumanization results from the profit motive of an insurance company (as in the US) or the bureaucratic processes of a national health system (as in New Zealand), the effect is the same. Re-humanizing medicine is a universal need.
This book is written specifically for clinicians, doctors, and physicians,9 who face daily humanitarian10 challenges in their roles, but is of interest to any health care professional or administrator. There are many fields where the application of a trained technique interferes with human connection, so teachers, trainers, educators and business people will find it relevant too. Of course, so will anyone interested in being a whole human being!
Since holistic medicine is a philosophy and a mode of being, I do not list diagnoses and alternative treatments. There are already a number of excellent books that review various complementary, alternative, and integrative medical techniques. The foundation of a holistic medical practice is you, not the services and techniques that you offer. Therefore, this is a book for people who are willing to change at a personal level in order to be better doctors and clinicians.
Contemporary medicine and holistic medicine are not inherently in conflict. My hope is that by defining holistic medicine as a paradigm, rather than as a specific technique, its benefits can be integrated with those of contemporary medicine. My primary argument is that the human elements of medicine need to be valued so that technical interventions occur within a human context.
Holistic Medicine, Re-humanization and the Quality Revolution in Health Care – A Convergence?
There is a worldwide trend in health care that, interestingly, overlaps with the philosophy of holistic medicine. This trend is a focus on quality, efficacy and safety, stimulated by the continual increase in the cost of health care. Experts are calling for a ‘revolution in health care delivery,’11 and ‘system-wide change.’12
Many of the suggestions involve cost-cutting and standardization of treatment. The ‘Quality Revolution’ also raises issues related to re-humanization, such as putting the patient at the center of treatment, making decisions collaboratively, and establishing a ‘continuous healing relationship.’13 These are the strengths of a holistic framework – not only is it patient-centered, but it includes the concept of healing in addition to treatment, and it often encourages low-cost, low-risk lifestyle changes and preventative medicine. It may be that it is time for a Compassion Revolution and a Quality Revolution to join forces in order to make medicine more affordable, safe and effective, as well as more compassionate, caring and human.
Structure of the Book
The book is divided into five major parts. The first discusses the underlying paradigms of the biomedical and economic models of contemporary medicine and how these models have side effects of dehumanization. This critique does not mean that there is no benefit in the contemporary paradigm; rather it is an examination of the strengths and weaknesses of the underlying paradigms of the current system. The second part describes the paradigm of holistic medicine as a way of understanding the whole person. The third part is a ‘self-help’ section that outlines how you, as a clinician, can develop a more holistic and deeper sense of your own humanity. The fourth part is a ‘how-to’ component that describes how to create a holistic practice in any setting and how to re-humanize your practice. The last part describes the benefits of a holistic paradigm for re-humanizing the culture of medicine.
My sister, Karen, and I presented at last month’s Toward a New Way of Being with Plants conference.
The video of our presentation is available here.
Our overall presentation was called, “Remembering Our Living Relationship with Plants,” my talk was entitled “Toward an Ancient Way of Being with Plants,” and we also featured video that Karen created with Joseph Rael, “Becoming Medicine Initiation Ceremony,” and Karen’s talk was “Shifting Into a Relational Mindset With Nature.”
The conference was great! Very interesting, bringing together scientists, artists, poets, writers, and naturalists from around the world. There is a YouTube channel for the conference where you can watch the presentations.
Thanks to all the organizers and people who brought this great event together! It was very enjoyable, inspirational, and educational.
By David R. Kopacz, MD & Joseph Rael (Beautiful Painted Arrow)
About Place Journal from the Black Earth Institute
We have a new article published at About Place Journal for their Geographies of Justice Issue – Volume VI, Issue III, May 2021! We are very excited to be published in this excellent and important journal.
We look at the relationships between land and health, private land/private health, and public land/public health.
When I spoke with Joseph about the topic of Geographies of Justice he immediately resonated with it. “All humans are looking for that – some justice, a just place where we can feel adjusted and feel safe. A just place is where you are adjusted to justice,” he said. Here are a few excerpts of Joseph’s thoughts on Geographies of Justice:
“There are a lot of resources on the land that we take care of and they take care of us.
We need to start with the origin of the land, the place before everything broke apart – Pangea. We start at 1 – that’s Pangea. Then the scientists say the continents broke apart, and then people came out of Africa, then the Indians walked across the Bering Strait into the Americas – that’s how the scientists tell it.…
We can learn from our environment, from our geographies. We cannot have justice unless we learn from our geographies. Pangea was created and all around it was Panthalassa, the great ocean. Then Pangea spilt and you had the Pacific and the Atlantic Oceans eventually, and the Americas, North, South, Central, and then you had all these tribes in North America, and you had tribes in South America. For all these tribes, their religion was based on geography. The Eskimos had igloos and they would have ceremonies that reflect where they live, all the tribes would have ceremonies that reflect where they live.
There are different areas of land. You become your place before you live in your Mom and Dad’s house because they come from the land and you come from them. They teach you about the weather. The ceremonies are related to the climate of their place. First there was Pangea, and then it split and you had Europeans and Americans, but we are all from Pangea, we are all related...”
“Justice is right here in the room with me and it is right there in the room with you and it is right there in the room for all the people on the planet – it is here.“
To read the whole article, follow this link to “Making America Healthy Again: Indigenous Perspectives on Land & Health” in About Place Journal.
I have a new article posted, “The Social Determinants of Clinician Health,”
at CLOSLER: MOVING US CLOSER TO OSLER A MILLER COULSON ACADEMY OF CLINICAL EXCELLENCE INITIATIVE, Johns Hopkins.
Here are some opening quotes and the first paragraph…
“Every system is perfectly designed to get the results it gets,”—W. Edwards Deming
“An abnormal reaction to an abnormal situation is normal behavior.”—Victor Frankl
“Many believe burnout to be the result of individual weakness when, in fact, burnout is primarily the result of health care systems that take emotionally healthy, altruistic people and methodically squeeze the vitality and passion out of them.”— Swenson and Shanafelt, Mayo Clinic Strategies to Reduce Burnout: 12 Actions to Create the Ideal Workplace
If every system is perfectly designed to get the results it gets, then many healthcare systems around the world are designed to create high levels of burnout and compassion fatigue in the people who work within them. Maybe burnout isn’t a lack of resilience or coping skills in clinicians, but an iatrogenic effect of modern healthcare.
I am very excited to announce that I will be speaking at the Toward a New Way of Being with Plants conference on June 18th! This is an online conference and registration is free.
I will be presenting along with my sister, Karen Kopacz. Our talk is called “Remembering Our Living Relationship with Plants“ and is from 1:20 pm-2:05 pm US Central Time.
My part of the talk is called “Toward an Ancient Way of Being with Plants“ and will review some of my work with Joseph Rael (Beautiful Painted Arrow).
The center of our talk will feature a video of Joseph Rael Becoming Medicine Initiation Ceremony video (5:16) that we filmed and Karen produced.
Karen’s talk is called “Shifting Into a Relational Mindset With Nature.”
Maybe we will see you there!
Also, I just had a post up on CLOSLER, “Making the Most of Your Daily Nervous Breakdown,” where I write about taking a mini-rest cure connecting back to nature.
Listen to Part 3 of Alice’s interview with me on the Holistic Psychiatrist podcast. This segment shifts to looking at the importance of medical activism and our social responsibility for professionals.
Whidbey Island poet, Judith Adams’ new book of poems, A Place Inside, covers the full range of human emotions & experiences, bearing witness to the tragedies and celebrating the joys of life.
Poems such as “Visit to the Doctor” and “Letter to my CPA” bear witness to the dehumanizing mania of turning human beings into numbers. The poems are rooted in the earth, not only in harvesting potatoes in “Pommes de Terre,” but walks through the ferns and forest with grandchildren, rescuing a hummingbird that got into the house, and a poem “For Mary Oliver.” Death and life come into full circle relationship in poems such as “Two Reasons for Weeping,” when attending a Covid-era “circular drive-by” funeral, the poet gets a call from her daughter about new life, “Mom, I’m having a girl.” The poems look backward and forward, remembering the pain of leaving a mother behind in the UK, burying her under quince tree, and the birth of granddaughter, Brigid.
What could be more natural and human than giving birth and dying, gardening, mourning, rejoicing, kayaking―the land, the body, roots and bones, growth and hibernation? “All the things I have loved, as I love the human face,” ends the poem, “Roots.” The poet imagines a God who wants you to have “a wild night on the town” and not to try to get into Heaven with “love letters/you never sent,” (“Love Letters Only”). The poet reminds us that we need the trickster as much as the saint to keep us human and sane in a world that tries to classify the complex interweaving of suffering & joy into the question, “What is my pain level out of ten?” To the young doctor/computer technician, asking questions to quantify and reduce complexity to certainty, “Her fast fingers wait to classify my/existence on a screen,” while “oblivious/to the bend I have just rounded,” the poet suggests questions instead that open and deepen into life:
“Ask me instead who I am,
what my mornings are like,
if I am working towards a future,
who in my life has just died?
If you don’t have time, and you are
backing out of the room with your computer,
at least ask me if I drink alone.”
Judith Adams knows what healing and comforting the soul is, in contrast to the often cold, heartlessness of contemporary medicine. She created The Poetic Apothecary project, offering “poems for healing and comfort,” throughout Washington State via the Humanities Washington program. A video of this talk can be found on Judith Adams’ website.
The center of the book, and the title as well, is “A Place Inside,” a poem, brief and wonderful, which embodies a love of life, bringing inside/outside, human/divine, and body/spirit together.
“You have a place inside you
no one can touch.
It’s where your tools are kept.
In this divine workshop
you chisel at a raw day
in deep devotion to yourself,
and there you allow some unruliness,
your share of sore complaint.
And there you follow
your own footsteps
through the dark”
(A Place Inside)
A Place Inside is a wonderful book that reminds it what it is to be human, to be alive, to be grounded in the Earth, and to breathe starlight.
Watch for an interview I did with Judith Adams to be up on The-POV soon!
The second part of Alice Lee’s interview of me is up on her Holistic Psychiatrist Podcast!
This second part covers transforming suffering, the Hero’s Journey, the movie Groundhog Day, Joseph Rael’s teachings on the Medicine Wheel, and a discussion of circular models of healing.
Part 1 is available through the same link.
Part 3 will air next week. While you are on the site you can check out some of Alice’s other podcast interviews!