Caring for Self & Others – before, during (and after) a Pandemic

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:

Introduction

Only connect! … Live in fragments no longer.

E.M. Forster1

The great error of our day in the treatment of the human body is that physicians first separate the soul from the body.

Plato2

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.

Becoming Medicine in Pandemic Times: Overview of Becoming Medicine, Part III

This is the third overview of Becoming Medicine: Pathways of Initiation into a Living Spirituality, writtenwith Joseph Rael (Beautiful Painted Arrow). Many of the concepts in the book seem apropos to these viral times of the pandemic. Here is a synopsis of the book in one long run-on sentence:

We start with an emptiness, a loss or a longing, a wounding or disorientation and this leads us into seeking. We embark on wonderful and terrible journeys, we descend in to the darkness in the center of our hearts, which is the center of the medicine wheel and we realize that our hearts are medicine bags, filled with sacred objects. Finding and receiving these sacred objects we learn to see light in the darkness; we are fully-filled with sacred objects and this fulfillment leads to us spilling over, returning and giving to the world the sacred medicine that we have found within ourselves. We realize that it is not our personal medicine, because the wisdom of these sacred objects of the medicine bag of our hearts teaches us that there is no self and other, it teaches us that we are all connected, it teaches us that we have a responsibility for all beings and the land and the cosmos and that we are all One.

Here is an overview of Part III of Becoming Medicine: Pathways of Initiation into a Living Spirituality.

RETURNING/GIVING

Returning to the Land

When we begin our return journey, it can be difficult to find home. Odysseus took ten years to find home in the Odyssey, after he had already spent ten years at war in the Iliad. When we left home, in our seeking, we thought we knew what home was. Now, on our return, we find that we may not fit easily back into “home.” This is because our home has become bigger than we thought of before. As Bilbo told Frodo, “It’s a dangerous business, Frodo, going out your door. You step onto the road, and if you don’t keep your feet, there’s no knowing where you might be swept off to.”

Joseph Rael describes coming home to Picuris Pueblo, after 36 years away, he said that he “rediscovered myself!” To be indigenous is to be “of the land.” While many native peoples understand the sacred relationship with the land, going through a process of initiation opens one’s eyes and heart to see that the land truly is our Mother Earth and that we should be in a proper relationship with her. We are made up of Mother Earth, our bodies, molecules and atoms come from the food that we eat and the food that we eat comes from Mother Earth. After passing through initiation, we realize that the land is our home.

Drinking from the flowering Light of Mother Nature, Joseph Rael (2005)

Spiritual Democracy

We realize that there is no such thing as “other.” In Walking the Medicine Wheel: Healing Trauma & PTSD Joseph said, “I am my brother’s keeper.” For returning war veterans we taught that one must shift from seeing “others” to seeing them as “brothers and sisters.” This naturally leads to spiritual democracy where we realize that we are all one, we are indivisible, and that it is up to us to work for justice for all. This is not just for people of one country, but we must work to become “planetary citizens,” even “cosmic citizens” Joseph tells us.

Spiritual democracy is an antidote for the current divisiveness and radical “othering” that is occurring in politics in the world. To dehumanize another is a very dangerous thing and the xenophobic fear of the “other” can lead to our country ripping itself up into smaller and smaller shreds of sub-groups of us and them. Spiritual democracy can help us move beyond what Martin Buber calls an “I-It” relationship to an “I-Thou” relationship and even to a sacred “Essential We.” We need to heal the rifts that are being torn into the fabric of the national and global community. This can only be done by realizing that we are each other’s keepers ― we are all in this together and we all are one.

Earth Child of Spiritual Democracy, Joseph Rael ( 1997)

Refounding A Living Spirituality

The subtitle of the book is Pathways of Initiation into a Living Spirituality. A living spirituality is a process of becoming, an always evolving path. Anthropologist and Catholic Priest, Gerald Arbuckle, writes of the importance of refounding in any organization. He says that institutions periodically lose touch with their founding vision and they require a refounding person to get in touch with the founding values of the organization. It seems we are in such a situation now. Arbuckle tells us that refounding synthesizes the authentic calling and mission of the organization with the realities and needs of the current time. This is different from fundamentalism, which is a rigid attempt to return to some fantasized golden age by blaming “others” for the current problems. Fundamentalism only looks backwards and is exclusionary, while refounding looks backward and forward and is inclusive. Arbuckle writes that we face “a global epidemic of fundamentalism both religious and political,” (Fundamentalism: At Home and Abroad, 28). He describes a typical fundamentalist leader as “a populist, homophobic, charismatic, authoritarian man who likes to bully,” (15). As an alternative to fundamentalist narratives he offers refounding narratives:

“Refounding is a process of storytelling whereby imaginative leaders are able to inspire people collaboratively to rearticulate the founding mythology of an institution and apply it to contemporary needs through creative dialogue with the world. The purpose of refounding narratives is to find a positive way out of trauma by allowing people to reenter the sacred time of their founding with imaginative leaders who are able to rearticulate the founding mythology in narratives adapted to the changing world.” Refounding narratives are “regenerative” and “differs from a fundamentalist narrative” which is “closed to dialogue and responsible dissent,” (Arbuckle, 93-94).

Fundamentalism is about seeing differences, whereas a living spirituality is about seeing similarities and interconnections. This begins in your own heart and then spreads outward  to transform national and global cultures. In Becoming Medicine we look at the lives, words, and works of many holy people who have put forward a vision of religious unity, such as Gandhi, Narayana Guru, Rumi, Wayne Teasdale, Llewellyn Vaughn-Lee, William Keepin, and Matthew Fox. Those who drink from the fount of Living Spirituality realize that the only real religion is interspirituality and intermysticism. There is a story about Indra’s Net from Hinduism, that there is a vast of web throughout all of reality comprised of multi-faceted gems which reflect each other. Rather than a materialistic view of ourselves as isolated organisms, we can imagine ourselves as reflective and interconnective beings.

Out of One, Many, D. Kopacz (2019)

Finding Your Inner Secret Garden of Paradise

Matthew Fox was expelled from the Catholic Church for teaching creation spirituality, which rejected the idea of “original sin” and instead focused on the “original blessing” of being incarnate in sacred relationship on the Earth. Just like Adam, he was expelled from the garden. What creation spirituality teaches us is that we actually cannot be expelled from the Garden, that it is right here, in our bodies, and in our sacred relationships with other beings and the Earth.

This is the ultimate transformation of suffering, to find the Garden of Paradise within ourselves – an ever-renewing source of revitalization for ourselves. In tasting this medicine, we are becoming this medicine, for ourselves, for our human relationships, and for our communities, ecosystems, and for the planet, herself.

Heart Radiation, D. Kopacz (2019)

The Secret Garden

Joseph says that we should pay attention to children’s stories because they contain hidden wisdom that the elders pass on to the next generation. We explore a lot of peoples of transformation’s stories throughout the book and we end with a telling of Frances Burnett’s Secret Garden. In this story, two young orphans, who are of about the age of initiation of 10-12 years old. In the story, the children are initiated into a living relationship with the land, they borrow from many different sources of spirituality, and they go through a process of healing – emotionally, physically, and spiritually. Colin, a young boy who had never been out of the old mansion in his life goes through a transformation. In the story they are talking about “magic,” but we can consider that the same thing as the way we are speaking of “medicine,” a healing and transformative force. In a ceremony in the garden Colin leads the children and animals, and the old gardener through this chant:

“The sun is shining—the sun is shining. 
That is the Magic.
The flowers are growing—the roots are stirring. 
That is the Magic.
Being alive is the Magic—being strong is the Magic. 
The Magic is in
me—the Magic is in me. 
It is in me—it is in me. 
It’s in every one of
us. . . . 
Magic! Magic! Come and help!”
Heart Radiation, D. Kopacz (2019)

Becoming Medicine During a Pandemic

Albert Camus wrote about a fascism in the guise of The Plague. Fascism is a hidden influence of our book and we hope that Becoming Medicine can be part of a cure for these times. The spread of a mental contagion is similar to that of a viral contagion – people can end up infected, spreading a disease, without even knowing they are ill. Camus wrote, “All I maintain is that on this earth there are pestilences and there are victims, and it’s up to us, so far as possible, not to join forces with the pestilences.”

The risk is that if we do not go through initiation into becoming a true human being (as Joseph calls it) or if we do not go through the process of individuation (as Carl Jung called it), we are at risk of spreading the pestilence of fascism as well as the COVID-19 Coronavirus. The sprouting fascism and fundamentalism of our times and the spreading viral pandemic can be a call to adventure for us, a call to enter into the disorienting and often painful process of initiation. This can be a call for us to transcend our “self-imposed limitations,” or as Camus wrote, “What’s true of all the evils in the world is true of plague as well. It helps men to rise above themselves.” We have no idea what the future will look like and we have no idea of what this “call” is asking of us.

Joseph Rael told me,The thing I should have said in my books is that everyone already has their medicine. The way you become a medicine person is you practice who you are because you are already medicine. No one gives it to you, you are already it.”

Camus wrote, “I have no idea what’s awaiting me, or what will happen when this all ends. For the moment I know this: there are sick people and they need curing,” (127).

Seeking, Finding, and Becoming ancient wisdom and a unifying healing force and then Giving this to all equally is what this world needs right now. The book, Becoming Medicine, is as long as it is because of the dangers of these times we live in. Originally I was conceptualizing the book as being about initiation, about the first and second parts, but as history has unfolded around us, I realized that we needed to speak of the silent land who is our Mother, we had to speak of spiritual democracy as an antidote to divisiveness and “othering,” we had to speak for a renewed and refounded sense of unity and non-duality of all beings and all life, we had to remind people that if they go into the darkness, the darkness of these times and the darkness of their own hearts, they will see the light in the darkness and they can, care-fully, bring back this light from the inner self into our current darkness in which we are all fumbling.

Blessings for Drinking from Morning Star, Joseph Rael (2000) – text added, dictated by Beautiful Painted Arrow, transcribed by David Kopacz

Staying Connected Inside & Out During the Pandemic – New Post on CLOSLER

I have a new post on CLOSLER: Moving Us Closer to Osler, a Miller Coulson Academy of Clinical Excellence Initiative of Johns Hopkins – “Staying Connected Inside and Out During the Pandemic.”

Shamanic Vision, D. Kopacz, 2016 (published in Becoming Medicine)

“Our primary public health measure at this time is not getting too physically close to one another. However, we know from research that socialization has a positive effect and isolation a negative effect on our physical, emotional, mental, and spiritual health. What we need right now, for our personal and collective health, is not social distancing, but physical distancing. We need to find ways of being social and connecting without physically touching or being in close physical proximity. We need to find ways of staying connected, inside and out.”

To read the full post, follow the link, thanks CLOSLER for all the great work you are doing on clinician wellness during these times.

RETURNING TO MEDICINE OF THE HEART DURING A PANDEMIC – New post on CLOSLER

Check out my new post on CLOSLER, “Returning to the Medicine of the Heart During a Pandemic.” CLOSLER: Moving us Closer to Osler, is a Miller Coulson Clinical Excellence Initiative out of Johns Hopkins and they have published a number of my essays in the past.

Heart Meditation, David Kopacz (2014)

How can we practice the kind of medicine that we so desperately need right now? Perhaps it is time to return to a medicine of the heart and of the soul.

In this post I look at how we can access the ever-renewable resource of hope and inspiration of the heart during these times when our minds our over-loaded with information and worry. I am trying to find something every day and every week that is positive and hopeful and I’ll be sharing these Daily Inspirations and Weekly Affirmations. Here is a Heart Meditation we can use, but really anything that brings us out of our heads and into our heart and our bodies is so necessary during these times: meditation, exercise, play, laughter, the beauty of nature.

A Heart Meditation

There are many different pathways and many different journeys that can lead you back to your heart. Here is a simple one.

Take a deep breath.

Take a deep breath and close your eyes.

Take a deep breath and bring your focus to your heart.

Remember how the heart works: accepting de-oxygenated blood, giving this to the lungs; accepting vitalized, oxygenated blood from the lungs; then giving away this goodness to the rest of the body. Remember that the heart functions by accepting the “worst” (deoxygenated blood) and giving it away; accepting the “best” (oxygenated blood) and giving it away.

Take a deep breath, feeling with your body and imagination how the heart and lungs are constantly doing transformation.

Take a deep breath, shift your focus from your mind to your heart. Take a deep breath, explore the workings of your heart.

Here is the link to “Returning to Medicine of the Heart During a Pandemic” on CLOSLER. Note that the video link is to a different song than the one I referenced by Ben Lee, “We’re All in this Together.” You can find that video here, along with a lot of other great songs by Ben Lee – who just came through Seattle and played a great show at the Sunset Lounge in Ballard.