Joseph Rael (Beautiful Painted Arrow) speaks on initiation and becoming medicine, joined by David Kopacz, MD at Joseph’s home in New Mexico. This video features an initiation ceremony in which Joseph tells the story of eagle-man who is initiated into becoming a true human being by the ancient one. The idea of becoming medicine is developed in the book, Becoming Medicine: Pathways of Initiation into a Living Spirituality by David R. Kopacz, MD & Joseph Rael (Beautiful Painted Arrow).
After seeking comes finding & receiving, but this gift transforms us in ways we could not imagine. The old falls away in what can be a painful birthing process as we are born into a new state of being – this is the initiation process.
Table of Contents for Part II:
Part II: Initiation (Finding/Receiving)
7 / Story Medicine
8 / Entering the Doorway
9 / Guhā: Cave of the Heart
10 / Enlightenment & Endarkenment
11 / Initiation
0 / Na-yo ti-ay we-ah (We Do Not Exist)
Transformation is difficult to put into words and that is why stories are so often used to capture that which cannot be explained and yet somehow it can and must be told. We begin the second part of Becoming Medicine by telling various stories from various parts of the world. As Joseph and I write,
“There is a growing field of medicine which is not new, but is rather the rediscovering and remembering of how speaking words and listening to stories can be transformational for the individual and society,” (175).
The stories we tell each other and that we tell ourselves have real effects. Stories are where our imaginations are activated where we can contextualize suffering and learn hope and healing. As Lewis Mehl-Madrona (who incidentally wrote a wonderful foreword to the book) has written,
“I saw that we create our own world . . . if we refuse to believe in healing, healing does not exist. If we sing and dance only of molecules and drugs, then molecules and drugs determine our fate and drugs will be our only hope. What we believe in is what comes true. . . . What we sing and dance is what will be,” (Coyote Medicine, 111).
We can look at the creation stories of the world as metaphorical descriptions of becoming initiated into being fully human.
Entering the Doorway
To get from here to there, we need to find some entrance, some passageway. There are many different paths, but they only appear with seeking. A person can be a doorway, a book can be a doorway, even the solid walls of a solitary cave can become a doorway.
“When I first met Joseph Rael and thought about our writing a book together, the thought came to me: ‘We are doorways for each other.’ It was not a conscious, logical decision, more an instantaneous intuition that holds many levels of meaning. For me, Joseph is a doorway into a deeper spirituality. . . . I am able to bring elements of spirituality into our book that would be difficult to do as a psychiatrist trying to maintain a balance on the edge of medicine and healing,” (194).
When the Knights of the Round Table were setting off in search of the grail
“They thought it would be a disgrace to go forth as a group. Each entered the forest at a point that he himself had chosen, Where it was darkest and there was no path. Where there’s a way or path, It is someone else’s path; each human being is a unique phenomenon” (Joseph Campbell, in Phil Cousineau, ed., The Hero’s Journey: Joseph Campbell on HisLife and Work, viii).
Guhā: Cave of the Heart
As I was following leads and threads that sometimes disappeared into mist, or sometimes became tangled knots that seemed to lead nowhere, I came across the Sanskrit word, guhā, which can be translated as “the cave of the heart.” I stumbled upon a thread of Christian-Hindu mysticism through the writings of Wayne Teasdale, Bede Griffiths, and Abhishiktananda. All three wrote about the cave of the heart and of finding the Divine within the darkness of one’s own heart. As I thought about the heart, I realized that our physical heart, as all of our inner organs, are immersed in the darkness of the inner body. While we often think of the heart, metaphorically, as a place of light and love, it is physically and literally in the dark. One of the aspects of initiation is being able to see the light within the darkness deep within the heart. The depths of the heart also are the place where our identity shifts from individual to universal, as Wayne Teasdale wrote, “the deepest center of ourselves is one with the deepest center of the universe,” (The Mystic Heart, 53).
Joseph Rael frequently will say, “We are the microcosm of the macrocosm,” and I have always struggled to understand how the personal becomes the universal. In many ways this is the more amazing thing to me. I have come to terms with the fact that there is light in the darkness, but how incredible it is that when we go into our deepest heart center we reach the Divine and a state of non-duality/unity with all things!
In this chapter we look at various holy people who went into the darkness of caves in order to see the light: Abhishiktananda, Ramana Maharshi, Saint Benedict, Saint Francis, and Saint John of the Cross who went into the metaphorical cave of the “dark night of the soul.” In Pueblo tradition, initiates would go into the darkness of the kiva and Joseph had those experiences as he was growing up. There is also the ceremony of the sweat lodge which is done in darkness.
Joseph Rael teaches that the center of the medicine wheel is the heart and that the heart is a “medicine bag” which is an empty, dark pouch, which carries “sacred objects.” With the guhā we add the cave of the heart. Joseph told me about the meaning of the word “cave.”
“Nah au kwee leh neh is the Tiwa word for cave. Nah means ‘self.’ Au kwee – means ‘curved.’ Leh neh means ‘straight like a fence.’ Nah means that when we enter a cave, we are entering into ourselves andwe should think of the cave as our self. We should expect that when we firstenter the cave it will turn every which way and it can get confusing, buteventually it will straighten out and you will then find what you are seeking,” (210).
Enlightenment & Endarkenment
In this chapter we look at different traditions relationships to wisdom found in the light and wisdom found in the dark. Perhaps enlightenment is the transformational realization that light is found even in the dark. Joseph is always talking about what he learns about physics and astronomy and how that fits with the traditions he comes from and from his visionary experiences. We also look at dark matter and dark energy in this chapter and draw on the work of physicists like David Bohm and Stephon Alexander. Alexander wrote The Jazz of Physics: The Secret Link Between Music and the Structure of the Universe and this leads to a nice riff on physics, metaphysics and jazz and we blend in a bit about John and Alice Coltrane. From everything I have learned from Joseph and everything I have read, at the core of enlightenment is non-duality, coming into unity with all beings and creation.
Initiation represents one of the most significant spiritual phenomena in the history of humanity. It is an act that involves not only the religious life of the individual . . . it involves his entire life. It is through initiation that . . . man becomes what he is and what he should be – a being open to the life of the spirit, hence one who participates in the culture into which he was born,” (Mircea Eliade, Rites and Symbols of Initiation, 27).
The entire book, really, is about initiation. In this chapter we look at the role of ceremony in initiation, as a way of connecting two different elements or realities into one wholeness. We review the concept of liminality (the space between two states of being) and liminal beings (those like mystics, visionaries, and shamans who become at home in these in-between states and serve as guides for those being initiated).
As I worked with Joseph, I began to realize that the whole process of writing the book was an initiation.
“Writing this book is part of my initiation with Joseph. Initiation is a new state of being and a new sense of one’s interrelationship and nonduality. Initiation is to realize that each of us is “the light of the Ancient Ones shining forth into the present.” Initiation is entering into a living spirituality where there is no separation between mind and body or between spirit and matter. Initiation is not something you do once and are done with; rather it is an understanding that “we do not exist” and yet we are perpetually coming into being and being reborn every moment.”
Na-yo ti-ay we-ah (We Do Not Exist)
This is an often repeated saying of Joseph’s. In this chapter I look at it in context with concepts from Buddhism and Hinduism on the nature of reality being maya, illusion. I open the chapter with a discussion with Joseph on the word “zero” and this phrase “we do not exist.” Joseph became energized and did some heartfelt explanation, at some point saying, “There’s something going on here that I’m not even going to try to explain,” (309). While he kept on talking with only a brief pause, I am going to stop with that statement!
Next week I will publish Part III of this overview of Becoming Medicine: Pathways of Initiation into a Living Spirituality.
How can we transform suffering, fragmentation, and painful inner & outer separation? This is the central question that Joseph Rael (Beautiful Painted Arrow) and I address in our new book, Becoming Medicine: Pathways of Initiation into a Living Spirituality. Suffering is the flip side of initiation and enlightenment. If you are seeking to become enlightened, the door that you often enter through is some form of suffering, separation, and fragmentation.
Initiation is the process of becoming more fully human. It is a common process in indigenous societies and in religious traditions. Anthropologists, such as Victor Turner studied initiation, as well as scholars of world religions, for instance, Mircea Eliade. Joseph Campbell popularized the process of initiation as the Hero’s Journey, comprising three primary stages of separation, initiation, and return. Campbell sought to find a way that we “modern” people, who lack religious and sociocultural ritual frameworks for initiation, could transform suffering into personal and spiritual growth. Psychologists and psychiatrists became interested in the concept, as it applies to the presenting common concerns of those seeking psychotherapy. Carl Jung saw the need for initiation and transformation, as he wrote about throughout his career in books such as Modern Man in Search of a Soul, Memories, Dreams, Reflections, and his posthumous journal, The Red Book.
We live in a disorienting time and we seek to get our bearings again. In our first book together, Joseph Rael and I wrote about his practices of using the medicine wheel as a kind of compass for inner and outer orientation. When we find ourselves disoriented, we need some organizing framework to help us re-orient. The outer directions are North, South, East, and West. There are also the inner directions of spirit, emotion, mind, and body. Joseph also teaches that the center of the medicine wheel is the heart and embodies the principle of carrying. When we enter into the center of the medicine wheel, we realize that our hearts are medicine bags and they are filled with sacred objects. The initiation is the process of “finding the held-back place of goodness,” as Joseph called it in our book, Walking the Medicine Wheel: Healing Trauma & PTSD. Initiation is when we go into the center of the medicine wheel to find our medicine, which we come to realize is an ongoing process of becoming medicine – becoming the very thing that we so desperately need.
We structure the book around the framework of initiation that Joseph Campbell, Victor Turner, Mircea Eliade, and others have described: separation, initiation, return. However, Joseph Rael comes from what he calls a verb language tradition – a language that is full of verbs like breathing, transforming, and becoming. It is a language of connecting, rather than how he describes noun language (English and German, for example) as languages that separate our living and interconnecting world into separate and discrete: people, places, and things. (The process of turning people into things is the topic of dehumanization that I explored in my first book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine). Given Joseph’s predilection for verb language, we adapted separation, initiation, return into: seeking, finding/receiving, and giving. What one seeks with and within one’s heart, one eventually finds and receives, becoming healing medicine, and then as one is fulfilled with this, one overflows with fullness, giving to others what it was that we were seeking. In part III we examine how the personal medicine is also the universal medicine. The medicine that we become is the medicine that the world needs, and we find it through the journey of initiation into our hearts.
We live in a disorienting time and yet maybe instead of trying to go back to the way things were, we can go deeper into transformation, into the way things might be. The idea of initiation is consistent with Jack Mezirow’s model of transformative learning – that one enters into transformation through first becoming disoriented. And we have plenty of disorientation that we find ourselves in the midst of at this present time. Mezirow studied ten stages of transformation and we can break these down into three stages that parallel the stages of separation, initiation, and return. One way to understand transformation is that it is a change of who you are. This can be contrasted with simple change – where you remain the same, but you just change something you do. One can change without being transformed, but transformation is the ultimate change. Disorientation is the first step, according to Mezirow, for transformation. In that sense, maybe we are exactly where we need to be and things are exactly as they should be in order for us, as individuals and collectively, transform.
Here is the table of contents of Part I of Becoming Medicine:
Part I: Separation (Seeking) 1 / Becoming Medicine 2 / Circle Medicine 3 / Separation 4 / Becoming a Visionary 5 / Becoming a Shaman 6 / Becoming a Mystic
After studying the various forms of separation/seeking, we look at how ancient and modern people have gone through the process of initiation of becoming visionaries, mystics, and shamans. We define visionaries, shamans, and mystics broadly, with the understanding that anyone can develop these human capacities. We examine my experiences learning from Joseph, as well as Joseph’s life experiences. We review a number of different spiritual teachers, musicians, and healers and their processes of initiation and becoming, including Carl Jung, Henry Corbin, Hildegard of Bingen, Miles Davis, Ben Lee, Evelyn Underhill, Dorothee Soelle, Juan Mascaró, Krishnamurti, and Matthew Fox.
In the next blog post, I will give a brief overview of Part II: Initiation (Finding/Receiving).
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
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.
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)
Hero’s Journey – Joseph Campbell (6)
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:
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.
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.
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.
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)
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.
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
“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.“
“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.”