Words Create Worlds.6 Doctors Against Fascism

“Words create worlds,” Rabbi Abraham Joshua Heschel.[1]

“Words create worlds.” These are the words of Rabbi Abraham Joshua Heschel, here is the full quote, remembered by his daughter, Susannah Heschel:

“Words, he often wrote, are themselves sacred, God’s tool for creating the universe, and our tools for bringing holiness — or evil — into the world.  He used to remind us that the Holocaust did not begin with the building of crematoria, and Hitler did not come to power with tanks and guns; it all began with uttering evil words, with defamation, with language and propaganda.  Words create worlds he used to tell me when I was a child.  They must be used very carefully.  Some words, once having been uttered, gain eternity and can never be withdrawn.  The Book of Proverbs reminds us, he wrote, that death and life are in the power of the tongue.”[2]

I have been writing this series, Words Create Worlds, based on the words and writing of Rebecca Solnit, Rob Riemen, Timothy Snyder, Madeleine Albright, Jason Stanley, and physicians: Bandy Lee, Robert Jay Lifton, and Judith Herman. I was inspired by these authors and particularly by Riemen’s To Fight Against this Age: On Fascism and Humanism and Rebecca Solnit’s Call Them by Their True Names and their discourse about how words shape our reality. The title for this series of essays comes from Rabbi Heschel who cautions us to be careful with the words we use. I fear that these last four years we have been over-cautious in coming to call the words of the current president of the United States of America fascist. Dr. Bandy Lee’s Twitter profile states, “Uninvolved in politics until politics invaded my area of expertise. I take my professional responsibility to protect society seriously.” Similarly to Dr. Lee, I feel compelled to speak up politically because fascism is a public health crisis. As Foucault wrote, the “first task of the doctor is therefore political: the struggle against disease must begin with a war against bad government.”[3]

The Responsibility of Spiritual Democracy

As I was working on Becoming Medicine: Pathways of Initiation into a Living Spirituality with Joseph Rael, I began to see that while the spiritual path may lead away from society at first, it eventually leads back – one returns after initiation with a new found sense of responsibility for the land and all the creatures that live on it: four-leggeds, two-leggeds, fin-ed and wing-ed. The spiritual path leads to a sense of Oneness, of non-duality. When you start to feel One with creation, you realize that you are responsible for creation. Words create worlds. The etymology of the word “responsible” goes back to a similar word, “answerable.” To be on a spiritual path, which Joseph would say is the same as the path of being a True Human Being, is to be answerable to the Earth. This led me to feel that we had to write a section of the book on the responsibility of the spiritual seeker.

Joseph Campbell taught that the hero’s or heroine’s journey had three stages: separation from the known world, initiation into the new world, and then return to the old world, but now transformed and carrying a responsibility for healing and transforming the world. For our book, this meant writing about our interrelationship with the land; about moving from “other” to “brother and sister;” about Oneness and non-difference; and about the concept of spiritual democracy – the spiritual responsibility we have for all beings. This responsibility led to us losing our publisher as the book turned out to be 500 pages long.

Joseph Rael, in the early 1980s had a vision of men and women sitting in a circular structure, half above ground, half below, singing and chanting for world peace. He followed this vision across the globe, helping to create over 60 Sound Peace Chambers on four different continents. He was recognized by the United Nations for this work on world peace. It is this spirit of peace that leads to my now needing to speak words of peace to counter the 20,005[4] divisive words of fascism.

Circle of Light Sound Chamber

Being Present with Suffering

Words Create Worlds. To be silent or neutral is to take the side of the bully. There are times that one can lose one’s humanity through inaction. Yes, it is true that one can act without humanity as well, that is a definition of fascism: actions without humanity and against humanity. When I was going through medical school in the early 1990s, struggling with the dehumanizing aspects (Perri Klass described medical school as, A Not Entirely Benign Procedure), I was also reading the Chicago Tribune regularly, trying to understand what was happening in the former Yugoslavia and Rwanda. I had read about World War II extensively when I was younger, I knew about fascism and genocide – but I struggled to make sense of what it meant to be a human being in the late 20th Century as I was immersed in learning the language of pathology and despair as I learned to diagnose and treat illness. I was overwhelmed by with the feeling that I was not being taught how to be human and present with either my suffering, my patients’ suffering, of the suffering of the world.

In The Shadow of the Slaughterhouse, D. Kopacz

In the Shadow of the Slaughterhouse: Silence is the Only Real Crime Against Humanity

I brought my friends together to write and to bear witness to the age. I was reading the Beats in those days, Kerouac, Ginsberg, Burroughs, and I loved how they created their own interpretive community and supported each other. The Beats didn’t shy away from suffering or madness, but bore witness to it, as Ginsberg wrote in Howl, “I saw the best minds of my generation destroyed by madness, starving hysterical naked…” Or as William S. Burroughs wrote to Allen Ginsberg, “Whether you like it or not, you are committed to the human endeavor. I cannot ally myself with such a purely negative goal as avoidance of suffering. Suffering is a chance you take by the fact of being alive.”[5] My friends and I put together an unpublishable manuscript that included cut-up art, multiple perspectives, and no coherent theme, other than a bunch of twenty-somethings let loose in the big city and reading a lot of books and trying to find their way in the world. I titled this collection, In the Shadow of the Slaughterhouse: Silence is the Only Real Crime Against Humanity. It included essays I wrote on the Native American genocide (from Dee Brown’s Bury My Heart at Wounded Knee) and an essay on witnessing and the survivor (from reading Terrence des Pres’ The Survivor: An Anatomy of Life in the Death Camps). In a way, these essays on Words Create Worlds are a continuation of In the Shadow of the Slaughterhouse: Silence is the Only Real Crime Against Humanity. I cannot remain silent as the shadow of fascism falls across the country.

This is not the succinct entry into the topic of Doctors Against Fascism that I envisioned – but then, the fight against fascism is not through bullets or bullet points, but through re-humanization. What is more re-humanizing than stories about human beings trying to make sense of suffering and bear witness? It is our humanity, our shared humanity, that protects us against the dehumanization of fascism. All of us, as human beings, are responsible for humanity because we are part of humanity. Similarly, as creatures of the Earth we are all responsible for the Earth, as we are part of Her.

What it Means to be a Professional

I have been thinking about the idea of medical activism and what it means to be a professional.[6] In my work on re-humanizing medicine through the compassion revolution,[7] I have argued that much of what we are taught in contemporary medicine is how to be a technician rather than on how to be a healer. A technician is not a professional, necessarily, but someone who performs a set of route protocols and techniques. A healer, on the other hand, is someone who learns techniques, but who also learns humanity – for it is our human presence that we must bring to suffering. While a technique or protocol might treat a disease, suffering needs humanity and compassion. To this end I have continued to argue that as physicians we should be good technicians, but that we must also be good human beings. To be a good medical technician, we are required to engage in Continuing Medical Education. To be a good human being we have to seek out our own Continuing Human Education – this is what I call the counter-curriculum of re-humanization.[8]

To be a professional means that we answer to a higher calling than just simply doing our jobs or staying in our lanes,[9],[10] it means that we are responsible to humanity. This means that our job does not end at the walls of our exam room – our job as healers is to attend to the public health of humanity.

Witnessing Professionals

In an interview with Bill Moyers, Robert Jay Lifton describes the concept of health care providers as “witnessing professionals” who have a responsibility to confront malignant normality (such as when lies and cruelty become normality). Lifton ends the interview with the following statement:

“I always feel we have to work both outside and inside of our existing institutions, so we have to…examine carefully our institutions and what they’re meant to do and how they’re being violated. I also think we need movements from below that oppose what this administration and administrations like it are doing to ordinary people. And for those of us who contributed to this book [The Dangerous Case of Donald Trump] — well, as I said earlier, we have to be “witnessing professionals” and fulfill our duty to warn.”[11]

As Psychiatrists We Feel Obliged to Express Our Alarm

Robert Jay Lifton is psychiatrist and psychohistorian I greatly admire, he is a living example of a witnessing professional who has worked at both the individual and the societal level for healing. He and Judith Herman (another psychiatrist I respect) wrote a letter to the editor of The New York Times March 8, 2017.[12]

“To the Editor:

“Soon after the election, one of us raised concerns about Donald Trump’s fitness for office, based on the alarming symptoms of mental instability he had shown during his campaign. Since then, this concern has grown. Even within the space of a few weeks, the demands of the presidency have magnified his erratic patterns of behavior.

“In particular, we are struck by his repeated failure to distinguish between reality and fantasy, and his outbursts of rage when his fantasies are contradicted. Without any demonstrable evidence, he repeatedly resorts to paranoid claims of conspiracy.

“Most recently, in response to suggestions of contact between his campaign and agents of the Russian government, he has issued tirades against the press as an “enemy of the people” and accusations without proof that his predecessor, former President Barack Obama, engaged in partisan surveillance against him.

“We are in no way offering a psychiatric diagnosis, which would be unwise to attempt from a distance. Nevertheless, as psychiatrists we feel obliged to express our alarm. We fear that when faced with a crisis, President Trump will lack the judgment to respond rationally.

“The military powers entrusted to him endanger us all. We urge our elected representatives to take the necessary steps to protect us from this dangerous president.” (Robert Jay Lifton & Judith Herman)

A Duty to Warn

Dr. Bandy Lee organized an April 20, 2017 conference at Yale, entitled, “Does Professional Responsibility Include a Duty to Warn?” From this conference grew the first edition of The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, and then the second edition with 37 experts, The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President. Dr. Lee and colleagues then formed the World Mental Health Coalition and published The World Mental Health Coalition Documents, which collects conference transcripts, media transcripts, letters and statements, a report on the Mueller Report, and a Prescription for Survival. Dr. Lee writes:

“Since society is one of psychiatry’s primary responsibilities, next to that of patients, there is unquestionably a duty not only to warn but to protect and to promote its wellbeing. We are bound by law in most states, as now replicated in multiple countries and even in fields outside of mental health, that we must warn even those who are not our clients in the case of danger. We also have an obligation not only to warn but to take steps to protect potential victims if security personnel will not act; safety is always first priority.”[13]

Agent 488 (aka Dr. Carl Gustav Jung)

There are precedents of psychiatrists using their skills for public health and safety. Robert Jay Lifton’s career as a psychohistorian is an example – understanding dangerous movements such as: Nazi Germany, Chinese thought reform, Aum Shinrikyō, climate deniers, and the current president of the USA. Swiss psychiatrist, Carl G Jung (aka Agent 488)[14] was recruited by the United States during World War II to provide psychological profiles of Hitler. Jung’s descriptions of Hitler’s psychology and behavior are eerily similar to the current president of the United States:

“All these pathological features— complete lack of insight into one’s own character, auto-erotic self-admiration and self-extenuation, denigration and terrorization of one’s fellow men (how contemptuously Hitler spoke of his own people!), projection of the shadow, lying, falsification of reality, determination to impress by fair means or foul, bluffing and double-crossing — all these were united in the man who was diagnosed clinically as an hysteric, and whom a strange fate chose to be the political, moral, and religious spokesman of Germany for twelve years.”[15]

Jung cautioned about Hitler’s systematic lying which he described as pseudologia phantastica. Is our current president’s 20,055 falsehoods (as of 7/9/20) another example of pseudologia phantastica?[16]

“A more accurate diagnosis of Hitler’s condition would be pseudologia phantastica, that form of hysteria which is characterized by a peculiar talent for believing one’s own lies. For a short spell, such people usually meet with astounding success, and for that reason are socially dangerous.”[17]

After World War II, many professionals wondered, “Why would so many apparently rational, even educated people, follow a fascist?”[18] Jung would say that those who do not deal honestly with their own shadow project it on to “others” who are then seen as bad, dangerous, untrustworthy. Jung saw Hitler as an inferior personality who was over-taken by his own shadow, projecting his own darkness on to the world and then trying to destroy his own darkness by destroying others. From that perspective, a fascist movement is a giant psychological experiment and a fight between those who have little self-awareness and do not take responsibility for their own darkness and those who are committed to truth and reality and are willing to introspect. Jung describes the formation of mass psychosis and mob psychology:

“Its leader will soon be found in the individual who has the least resistance, the least sense of responsibility and, because of his inferiority, the greatest will to power. He will let loose everything that is ready to burst forth, and the mob will follow with the irresistible force of an avalanche…[H]e symbolized something in every individual. He was the most prodigious personification of all human inferiorities. He was an utterly incapable, unadapted, irresponsible, psychopathic personality, full of empty, infantile fantasies, but cursed with the keen intuition of a rat or a guttersnipe. He represented the shadow, the inferior part of everybody’s personality, in an overwhelming degree, and this was another reason why they fell for him.”[19]

Untitled, D. Kopacz

The Plague of Fascism

As I have watched this regime unfold over the past four years, my early uneasiness has gradually turned to alarm. I think it is time for the Doctor to make the diagnosis: fascism, prognosis: serious.

In 1947, Albert Camus wrote his allegory on fascism, The Plague. Camus cautioned us, through his indefatigable Dr. Rieux,

“I have no idea what’s awaiting me, or what will happen when all this ends. For the moment I know this: there are sick people and they need curing. Later on, perhaps, they’ll think things over; and so shall I. But what’s wanted now is to make them well. I defend them as best I can, that’s all.”[20]

Dr. Rieux’s commitment to defend sick people as best he can reminds us of the professional commitment of Drs. Lee, Lifton, and Herman, as well as Dr. Fauci and all the frontline health care workers doing the best they can during this pandemic. Just as Lifton encourages us to be witnessing professionals, Rieux’s writing bears witness to the peoples’ suffering:

“It could only be the record of what had had to be done, and what assuredly would have to be done again in the never ending fight against terror and its relentless onslaughts, despite their personal afflictions, by all who while unable to be saints but refusing to bow down to pestilences, strive their utmost to be healers.”[21]

Camus’ choice of a plague as an allegory of fascism resonates with our current situation. We are currently in an actual viral pandemic of Covid-19 and this viral plague has further illuminated the plague of fascism. The president’s deplorable and counter-scientific handling of the pandemic has led to the United States of America, the country with the most expensive health care system in the world, and with 4% of the world population, to account for roughly 25% of the cases of Covid-19 worldwide. The president has contradicted and undermined scientists and physicians, he has encouraged the opposite of public health measures (ridiculing masks and those who wear them), he has preached economy over public health, and has spread over one-third of the global misinformation on the virus.[22] And, as of 10/2/20, the president himself is now infected with Covid-19, a carrier of the plague of the pandemic and the plague of fascism. However, we knew all along that we were electing a sick individual who is a plague – a plague of lies, a plague of bullying, a plague of divisiveness, a plague of crookedness, a plague of Covid-19 and, ultimately, a plague of fascism.

Doctors Against Fascism

The way you learn how to diagnose something in medical school is to see case after case after case – until it becomes automatic. At the first signs or symptoms, you see the incipient signs of a more serious illness. This is why we need Doctors Against Fascism – to diagnose and warn us that the fascist bacillus is starting to dehumanize our population and make it vulnerable to fulminant fascism.

The Doctor is in and has bad news for you – the prognosis of our nation’s health is serious. We are infected with fascism – it has taken hold in the brains of many of our citizens and it is spreading through our institutions. Words Create Worlds and we are surrounded by 20,055 and counting words of fascism. Every lie is an assault on reality and every bit of reality that is eroded weakens the immune system of democracy, making us vulnerable to infection with the unreality of fascism.

The Growing Stack of Books I Keep on My Desk as a Reminder

This series, Words Create Worlds, grows out of my work with Joseph Rael on peace. In Becoming Medicine: Pathways of Initiation into a Living Spirituality, I felt compelled to write about the responsibility of mystical, visionary, and shamanic experience—that we must work toward “Spiritual Democracy.” At its deepest point, mystical experience leads to an awareness that we are all one and this comes with a responsibility to challenge words of separation which ultimately lead to fascism. Mystical experience is a pathway that leads us to question who we are and gives us a responsibility to use our words wisely to create worlds where we are becoming the medicine that our world needs. As Rumi says, “We are pain and what cures the pain.”[23]


[1] Life Between the Trees blog, https://lifebetweenthetrees.wordpress.com/2012/08/06/words-create-worlds-monday-morning-parable/. I first came across a shorter instance of this quote in the Omid Safi reference below.

[2] Ibid.

[3] Michel Foucault, The Birth of the Clinic (New York: Vintage Books, 1994), 38.

[4] “In 1,267 days, President Trump has made 20,055 false or misleading claims,” Updated July 9, 2020. The Washington Post’s Fact Checker’s ongoing database of the false or misleading claims made by President Trump since assuming office. https://www.washingtonpost.com/graphics/politics/trump-claims-database/?utm_term=.27babcd5e58c&itid=lk_inline_manual_2&itid=lk_inline_manual_2

[5] William S. Burroughs, letter to Allen Ginsberg The Letters of William S. Burroughs, Vol. 1: 1945-1959, p. 227.

[6] David Kopacz, “Medical Activism: A Draft Working Paper,” (8/11/20) in the Being Fully Human Blog, https://beingfullyhuman.com/2020/08/11/medical-activism-a-draft-of-a-working-paper/.

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

[8] Ibid. Also see David Kopacz, “A Proposition for a Counter-Curriculum in Healthcare Education and Practice,” (9/10/16), Being Fully Human blog, https://beingfullyhuman.com/2016/09/10/a-proposition-for-a-counter-curriculum-in-healthcare-education-and-practice/

[9] “Doctors Revolt After N.R.A. Tells Them to ‘Stay in Their Lane’ on Gun Policy,” Matthew Haag, 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.

[10] “Take Two Aspirin and Call Me by My Pronouns: At ‘woke’ medical schools, curricula are increasingly focused on social justice rather than treating illness,” Stanley Goldfarb, Wall Street Journal, 9/12/19.

[11] http://billmoyers.com/story/dangerous-case-donald-trump-robert-jay-lifton-bill-moyers-duty-warn/

[12] Robert Jay Lifton and Judith Herman, “‘Protect Us From This Dangerous President,’ 2 Psychiatrists Say,” The New York Times, March 8, 2017, https://www.nytimes.com/2017/03/08/opinion/protect-us-from-this-dangerous-president-2-psychiatrists-say.html

[13] Bandy X Lee, “American Psychiatry’s Complicity with the State,” in Bandy Lee (ed) The World Mental Health Coalition Documents, 299.

[14] Jung was recruited by the Office of Strategic Services (OSS), the organization that eventually grew into the CIA and INR, to provide psychological profiles of political leaders, foremost among them Adolf Hitler. Deirdre Bair, Jung: A Biography. New York: Back Bay Books, 2003, pages 481-495.

[15] CG Jung, “After the Catastrophe” (1945) in CW 10 Civilization in Transition, page 203.

[16] The Washington Post Fact Checker, 7/9/20, https://www.washingtonpost.com/graphics/politics/trump-claims-database/?utm_term=.27babcd5e58c&itid=lk_inline_manual_2&itid=lk_inline_manual_2

[17] Ibid., 203-204.

[18] For a recent analysis of this question, see John Dean and Bob Altemeyer’s Authoritarian Nightmare: Trump and His Followers.

[19] CG Jung, “The Fight With the Shadow” (1946) in CW 10 Civilization in Transition, 220-223.

[20] Albert Camus, The Plague, New York: Vintage International, 1991, p. 127.

[21] Ibid., 308.

[22] Sarah Evanega, Mark Lynas ,Jordan Adams, Karinne Smolenyak, “Corona virus misinformation: quantifying sources and themes in the COVID-19 ‘infodemic’”

[23] Rumi, “We are the mirror as well as the face in it,” The Essential Rumi, trans. Coleman Barks, 106.

Medical Activism: A Draft of a Working Paper

Activism: A Foundational Element of Professional Identity

Over the past year I have been thinking about the idea of medical activism. I started drafting a paper and have wanted to pursue some of the sub-topics in greater depth and breadth, but I have lacked the time to put this together due to numerous other projects. Still, I believe that these ideas should be circulating at this particular time in history. I do not mean this as a definitive statement on medical activism, but rather I mean it to open a conversation.

Abstract:

The idea of medical activism has been criticized lately, from both inside[1] and outside[2] of the medical field. This paper takes the position that medical activism is a foundational element of professional identity – it defines who we are as professionals as opposed to being technicians or employees of institutions. Medical activism prioritizes caring and advocacy in the face of competing priorities of productivity and profit. Activism can take many forms, but its essence is when caring and healing extend  beyond the internal biochemistry and inner thoughts of the client to include all the factors that we know influence individual and public health: childhood history, trauma, relationships, human rights, toxin exposures, environmental influences, and access to education and self-care. 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 (medicine in the clinic & hospital: having to do with the practice and delivery of health care) and external (medicine in the world: addressing public health issues outside the clinic or hospital). Examples of health care reform that will be considered are the movements of holistic and integrative medicine, Whole Health at the VA, the recovery movement in mental health, trauma-informed care, and addressing physician and health care worker burnout and suicide. Medical activism is born, again and again, when circumstances demand, from the identity of the physician/clinician as a professional and a moral agent in society whose “lane” is to treat disease, alleviate suffering, and to promote population health and well-being at local, national, and global levels. We need to make sure that the practice of medicine remains focused on healing and not just on making healthy profits or meeting institutional needs. Since the original conceptualization of this paper, new threats have arisen to the professionalism of medicine: fascism and political attacks on science. These political events, more than ever, remind us that if we do not use our voices we may lose them. Nourishing medical activism keeps the focus on care and compassion in health care and society. We must all adopt identities of what Parker Palmer calls “the new professional” and Robert Jay Lifton calls the “witnessing professional” in which we become moral agents within our world, tearing ourselves away from the never-ending demands of the Electronic Medical Records system, raising our gaze from the computer screen to the world we all live in.

Introduction:

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.

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. In speaking of medical activism, we wish to ground our discussion in the ancient profession of medicine, however we do also want to be inclusive and also use “medicine” in a larger context of health care professionals. The term, “healthcare activism,”[3] is a much larger term encompassing grass roots and activist/organizer movements. We do not mean to neglect this critical cultural force of health and healing, however for the purposes of this paper we are concerned with the identity of health care professionals as activists and medical activists.

In this paper we will develop the idea of medical activism as a form of moral agency which is a foundational element of professional identity. While there are many different forms of medical activism, we will focus on a few forms, such as, speaking out, bearing witness, critiquing systems and practices that contribute to disease and suffering, developing innovative delivery systems, reformulating philosophies of care and treatment, and advocacy to promote the health and well-being of individuals, local, national communities, and in this ever-more connected world, the global community. More recent public health issues have arisen with the Covid-19 coronavirus pandemic, the politicizing of sound public health measures (such as wearing masks and social distancing). Another growing public health concern is the growing fascist tendencies in the United States and abroad. We have a number of diagnostic manuals on fascism and we know that fascism is a public health issue: first it affects marginalized groups (Muslims, immigrants, Native Americans, African Americans, the LGBTQ community), then it affects those deemed dangerous to the regime (the “liberal” press, intellectuals, teachers, scientists, “liberal” politicians), and then it starts infecting more and more people with side effects of racism, xenophobia, hate speech toward the above groups, and eventually violence toward the above groups. To the end of cautioning the public about the public health risks of fascism, the formation of the professional organization, Doctors Against Fascism is proposed.

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.”[4] What we are doing as professionals is continual professing – to declare openly and to speak, tell, say.

            Our job as professionals it to profess, to declare openly, to speak, tell, say, to be prophets of health (which is different than focusing on the profits of the health care industry). 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 jobs of those professionals within the system to be the moral authority, the moral leadership of the institution.

De-professionalism

            With the rise of economic and productivity medicine we have seen a 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 by individuals to individuals in the context of human relationships. Individuality and humanity are extraneous and problematic variables to corporate, machine medicine. 

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”.[7]

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.[8]

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, medical ethics, medical morals, students are left morally adrift. 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.”[9]

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.”[10]      

“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.’”[11]

Science presents itself as “value-free” but the practice of medicine is one of moral agency.

Medical students enter the profession of medicine with idealism (which we know our medical education system diminishes) and yet they also enter having cultural biases. Research has been done on medical student attitudes toward homosexuality,[12] AIDS,[13] abortion,[14] the homeless,[15] immigrants,[16] and torture[17],[18] and how those attitudes might shape clinical care decision.

The Practice of Medicine as Continual Revolution & Reform

The beginning of Western Medicine is often said to have begun with Hippocrates who, rejected supernatural causes of illness, establishing the beginning of the scientific method and initiating a revolution of the truth which vanquished the other, competing, schools of medicine. The choice of Hippocrates as the “Father of Medicine” is somewhat arbitrary, as the study of nature, health, illness, and healing is ancient and has been practiced by all cultures. Hippocrates stands out as a medical activist in the musings of writers of history, as a medical activist championing science, rationalism, empiricism, and materialism.

The Structure of Scientific Revolutions

Thomas Kuhn, in The Structure of Scientific Revolutions, describes the stages of progress in science, starting with “normal science,” which mainly consists of technical puzzle solving. There comes a time when enough anomalies accumulate which do not fit the current scientific paradigm, which eventually leads to a crisis point. At the crisis point, the majority of scientists continue to adhere to a paradigm which is no longer as helpful as it once was, while a smaller group of scientists begin exploring new paradigms. Scientific revolution occurs when a new viable paradigm arises and there is conflict between the old and the new.

Semmelweis

Before the acceptance of germ theory, in the mid-1800s, 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. Although this seems common sense to us from our vantage point, Semmelweis was ridiculed, lost his appointment, and died in a mental institution. The concept of invisible pathogens was not part of the existing paradigm of understanding disease. We can consider Semmelweis as a medical activist who tried to protect the well-being of his patients and challenged the medical establishment.

Virchow

In the late 1800s, Virchow was tasked by the Prussian government to research an outbreak of typhus, in Upper Silesia, which had a large minority of Polish people living in poverty. His prescription was social and political: elimination of social inequality.[19] He came back with recommendations regarding poverty, services, and even political recommendations. This resulted in him losing his job. He wrote, “Medicine is a social science and politics is nothing more than medicine on a large scale,”[20] and that doctors “are the natural attorneys of the poor.”[21]

Social Determinants of Health

In addressing social determinants of health, Vicente Navarro writes that “we need to broaden health strategies to include political, social and cultural interventions that touch on the social (as distinct from the individual) determinants of health,” (15).[22]

Moral Determinants of Health

Berwick’s recent article, “The Moral Determinants of Health,” 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.”[23]

Refounding: Reinvigorating the Founding Principles of Health Care

Another line of support for viewing medical activism as a core element of medical professionalism comes from anthropologist Gerald Arbuckle’s work on the concept of “refounding” in organizations. Arbuckle has observed that, over time, organizations and institutions lose touch with their original founding vision. A crisis-time comes and a “refounding individual” arises who challenges the status quo and seeks to revitalize the institution by bringing it back in line with the original, founding vision. The new state is a hybrid integration, though, of the new state of the surrounding culture and the original vision. This is to say it is not simply a return to the historic founding rules of the institution, but is a creative adaptation of the founding vision with a modern re-interpretation. An opposite way of trying to resolve the institutional crisis is a literal and rigid return to the past, which Arbuckle describes as the root of fundamentalism. Fundamentalism is reactionary and resists any change, growth, or adaptation. Refounding is a hybrid, bringing the spirit of the old into a new formulation within a new time and place. Arbuckle’s descriptions of the “refounding person” are consistent with the idea of the medical activist that we are discussing.

The ongoing health of institutions requires “refounding persons,” who remember the “original instructions” of the institution, the principles and ideals upon which the organization was founded but periodically loses its way. The refounding person is like the hero or heroine in Joseph Campbell’s hero’s journey – an individual who takes on what seems like an individual challenge that turns out to be healing for the entire community and places the people back in harmony with sacred and with the world. The refounding person is a person whose job it is to declare openly, to speak, say, tell, that we have lost our way, we have gone out of balance, and that we have to work to get ourselves back in balance, internally as individuals, in our relationships, in our community, and within our larger culture and our interrelationships with the world.

Cultural Models of Medicine within Contemporary Health Care

Interestingly, Arbuckle has worked in medical institutions as a consultant and this led to his book, Humanizing Healthcare Reforms. One of the challenges in healthcare reform, he finds, is that there are multiple cultures at play within modern medical settings and that in discussions between various clinical staff, accountants, and leadership, people bring different cultural world views, however these views are not clearly articulated and defined, so they are like invisible walls that impair discussion. He describes different cultural models of healthcare: traditional (indigenous medicine), foundational (Western values of care for the poor, sick, and suffering), biomedical (scientific, evidence-based medicine), social (living environment and inequalities), and economic rationalist (the business model of medicine with a focus on efficiency and productivity). These different cultural models of healthcare inevitably lead to cultural clash and crisis. Medical activism, or refounding,  in healthcare would be a revitalization of some of the models of medicine (e.g. the traditional, foundational, and social) that have been neglected and suffered under the dominance of the economic rationalist and biomedical models. “In healthcare,” Arbuckle writes, “the need to refocus on moral and spiritual ideals means returning to a mission based on founding values such as solidarity, equity, respect and compassion,” (16).

Examples of Health Care Critique & Reform

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 and ill. Institutions may have vision and mission statements but they are incapable of moral agency and compassion because those are human traits, not bureaucratic functions. Within this critique of contemporary medicine, we will look at several issues: burnout, physician suicide, the pressure on physicians and health care workers to become narrowly defined technicians rather than healers, and the general loss of caring within the practice of health care.

Holistic and Integrative medicine are examples of reform and refounding. Many advocates of holistic and integrative medicine have felt corporate and biological reductionistic medicine have lost touch with the heart and soul of what it means to be a healer. The science of medicine has nearly eclipsed the art of medicine.

The following are some bullet points to be more fully developed:

  • Limits of evidence-based medicine
    • Groopman, How Doctors Think
    • Beahr, The Limits of Scientific Psychiatry
    • Pathological Objectivity
      • Scientism – scientific fundamentalism
      • Defensive mechanism
      • As part of burnout triad – extreme form of emotional distancing
  • Re-humanizing Medicine
    • Healer vs. Technician
    • Counter-curriculum of re-humanization
    • Compassion Revolution
  • Holistic & Integrative Medicine
  • Recovery Model in mental health
  • Physicians for a National Health Program
  • Micropractice, Ideal Medical Practice
    • Work of L. Gordon Moore[24]
  • Burnout
    • Institutional factors
    • Danielle Ofri: “The Business of Healthcare Depends on Exploiting Doctors and Nurses” [25]
  • Physician suicide
    • 300-400 suicides/year, size of three average medical school classes

Medicine in the World – Possible sections

The “first task of the doctor is therefore political: the struggle against disease must begin with a war against bad government,” (Foucault).[30]

Samuel Shem, in his essay, “Fiction as Resistance,” writes:

“We believed that if we saw an injustice, we could organize, take action, and change things for the better…When we entered our internship, we were told to treat our patients in ways that we didn’t think were humane. We ran smack into the conflict between the received wisdom of the medical system and the call of the human heart.”[31] Shem describes 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.”[32]

Bullet points to more fully develop examples:

  • Human Rights
    • Human Rights Medicine & Psychiatry, e.g. international trauma work
    • LGBT Rights
    • Women’s Rights
    • Culture, Diversity, Religious Tolerance – addressing racism and intolerance
    • Immigration policy and public health
  • Racism
    • Black Lives Matter
  • Trauma-Informed Care
  • Judith Herman’s view of the tendency to forget trauma and the need to for those who work with traumatized populations to bear witness and be moral agents.
  • Peace/Recovery from War & Violence
    • The influence of Buddhism and Mindfulness in Health Care
    • Gun Violence
  • Preserving/Continuing Healing Traditions
    • e.g. Shamanic work, physicians working with indigenous cultures who have written on benefits of incorporating elements into contemporary medicine
    • Lewis Mehl-Madrona, in a study of Indigenous elders, learned that “Healers have to maintain some independence from political structures.”[33]
    • Medical Pluralism[34]
  • Social, Climate, Environment
    • Flint, Michigan – lead in drinking water
    • Poverty
    • Homelessness
    • Promoting the health of the Earth
  • Public Safety

A recent example of professional activism is found in the book, The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts assess the President. Many well-respected researchers and clinicians came together to raise awareness of public health and safety concerns stemming from their view of the dangerousness of the 45th president of the United States. Stephen Soldz and Brandy Lee write that

“Professionals are an important component…helping to provide checks on powerful institutions and alerting the public to wrongs. Professions operate with an implicit social contract with the broader society to contribute their special knowledge and training for the greater good.”[35]

They caution that what “is often missing from [ethics] training is any deep engagement with fundamental ethics principles and ethical thinking.” They see the comments and actions of the 45th President as a risk to public health and safety and feel that the safety risk comprises a duty to warn which overrides the past Goldwater rule which prohibits psychiatrists from diagnosing public figures.

They argue that the ethical principles of justice and universality “direct health professionals to pay attention to the wider world beyond the clinic as they call upon us to serve the broader public, not just those who become our patients. And they direct us toward the world of public policy and of ‘politics,’ broadly defined, as a way of collectively improving public health.”[36]

            Soldz and Lee mention a number of recent examples of health professional activism, including opposing the involvement of psychologists and health professionals in torture under the Bush administration; opposing the use of psychiatrists in the Soviet Union to punish dissidents; physicians against nuclear war; physicians against land mines; and physicians supporting civil rights and health equity; and physicians for a national health plan.[37] They write that these examples illustrate that “activism by health providers is compatible with and even integral to professional responsibility toward society.”[38]

            In this same volume, Robert Jay Lifton writes of the ideal of “witnessing professionals” who combine a “sense of outrage with a disciplined use of our professional knowledge and expertise.”[39] Lifton cautions that if we define ourselves too narrowly, as technicians, we lose our sense of identity as witnessing professionals. This is a caution alongside those who argue that many professions are being deprofessionalized.

  • Doctors Against Fascism
    • Proposed founding of this organization based on the systemic fascism in politics affecting public health
  • Doctors as Public Health Advocates
  • The Institute of Peace Medicine

I have long thought of writing a book called, Re-spiritualizing Medicine. This does not mean going backwards into religious fundamentalism, but rather recognizing that human beings are inherently spiritual creatures. By spirituality I do not mean religion, but rather a sense of aliveness, vitality, connection to other people, connection to the natural world, connection to something larger than our own egos. The spiritual underlies our sense of interconnectivity with humanity and all life.

Since 2016 I have been working with Southern Ute visionary artist and healer, Joseph Rael (Beautiful Painted Arrow). His work since the 1980’s building Sound Peace Chambers around the world led to him being recognized by the United Nations for his work for world peace. Ultimately, peace is a public health issue, although we do not often think of it that way. War, violence, hatred, oppression, racism – all these are the opposite of peace. Perhaps we should found an Institute of Peace Medicine to address the social and moral determinants of health, but also to promote peace, unity, and non-duality as core human principles to protect and nurture human life and the life of the planet.

Spiritual Democracy

Joseph and I borrowed the term, spiritual democracy from Steven Herrmann. This idea of spiritual democracy also addresses many of the social and moral determinants of health. It also is an antidote to fascism. Fascism is founded on division and separation of us and them and on the priority of the will of the leader, and a small group of people defined to be like the leader, over the social good of the global community. Here is what Herrmann writes about spiritual democracy:

“Adopting the big idea of Spiritual Democracy, the realization of oneness of humanity with the universe and all its forces, can help people feel joy, peace, and interconnectedness on an individual basis. It can also inspire us to undertake sacred activism, the channeling of such forces into callings that are compassionate, just, and of equitable heart and conscience, and give us some tools to start solving some of these grave global problems, while uniting people on the planet.”[40]

Sacred Activism

            The idea of spiritual democracy is related to the idea of sacred activism. This goes a step beyond professional or medical activism, but grows out of a common love and care for humanity and our environment. Herrmann credits Andrew Harvey for originating this term:

“Each of us, it seems, is guided by such a star and it varies in its fixed orbits, in different fields of sacred action, in every person’s life. A central existential task is to discover what that star is and to make its light, the inner fire of human love, burn brightly against the darkness, as a calling to live by. . . . Sacred activism is a spiritual practice for bringing about planetary changes through a receptivity to, and response to, experiences of a mysterious energy, force, or power, which move through the human body, psyche, and entire cosmos in an effort to bring about alterations of consciousness, cultural transformation, and ultimately: world peace.”[41]

World peace may seem like a big goal, but would that not bring about the greatest improvement in public, global health? The current US administration pulling out of the World Health Organization and the UN Human Rights Council is the opposite of what will heal us – as individuals, as communities, and as a stewards of the global ecosystem. Spiritual democracy, sacred activism, re-spiritualizing medicine and an Institute of Peace Medicine are logical extensions of the doctor and clinician as moral agents and profess-ors of public health.

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, the politicization of basic, scientific principles of public health. We also stand at a time when fascist words are turning into fascist behaviors.[42] We have seen these early symptoms in the 20th Century and they can become fulminant and more deadly than a viral pandemic. 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.

            We can draw on Robert Jay Lifton’s development of the witnessing professional. We can draw on Parker J. Palmer’s development of the new professional. We can draw on the moral foundations of our professions, 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.


[1] “Take Two Aspirin and Call Me by My Pronouns: At ‘woke’ medical schools, curricula are increasingly focused on social justice rather than treating illness,” Stanley Goldfarb, Wall Street Journal, 9/12/19

[2] “Doctors Revolt After N.R.A. Tells Them to ‘Stay in Their Lane’ on Gun Policy,” Matthew Haag, 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

[3] Laverack, Glenn. Health Activism: Foundations and Strategies. Sage: Thousand Oaks, 2013.

[4] Online Etymology Dictionary for “profession,” “profess,” “prophet.” https://www.etymonline.com/search?q=profession

[5] http://www.professionalsaustralia.org.au/blog/deprofessionalisation-matter/

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

[7] Lifton, Robert Jay. Losing Reality: On Cults, Cultism, and the Mindset of Political and Religious Zealotry. New York: The New Press, 2019, p. 189.

[8] Lifton, Robert Jay. Losing Reality: On Cults, Cultism, and the Mindset of Political and Religious Zealotry. New York: The New Press, 2019, p. 190.

[9] Palmer, Parker. The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life. San Francisco: Jossey-Bass, 2007, p. 202.

[10] Palmer, Parker. The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life. San Francisco: Jossey-Bass, 2007, p. 199.

[11] Palmer, Parker. “A New Professional: The Aims of Education Revisited.” Change, Vol. 39, No. 6 (Nov-Dec, 2007), pp. 6-12.

[12] Klamen, D, Grossman, L, and Kopacz, D. (1999). Medical student homophobia. Journal of Homosexuality, 37 (1): 53-63.

[13] Kopacz, D., Klamen, D., & Grossman, L. (1999). Medical students and AIDS: Knowledge, attitudes and implications for education. Health, Education & Research, 14 (1): 1-6.

[14] Klamen, D, Grossman, L, & Kopacz, D. (1996). Attitudes about abortion among second-year medical students. Medical Teacher, 18 (4): 345-346.

[15] Morrison, A., Roman, B. & Borges, N. Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes Toward Homeless Persons. Acad Psychiatry 36,211–215 (2012) doi:10.1176/appi.ap.10080112

[16] Hudelson, P, Perron, NJ, & Perneger, TV. (2010). Measuring Physicians’ and Medical Students’ Attitudes Toward Caring for Immigrant Patients. Evaluation & the Health Professions, 33(4), 452–472. https://doi.org/10.1177/0163278710370157

[17] Dubin K, Milewski AR, Shin J, Kalman TP. Medical Students’ Attitudes toward Torture, Revisited. Health Hum Rights. 2017;19(2):265–277.

[18] Bean J, Ng D, Demirtas H, Guinan P. “Medical students’ attitudes toward torture,” Torture 18/2 (2008) pp. 99–103.

[19] 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

[20] 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.

[21] 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

[22] Vicente Navarro. What we mean by social determinants of health. Global Health Promotion Vol. 16 (1):5-16; 2009

[23] Berwick DM. The Moral Determinants of Health. JAMA. 2020;324(3):225–226. doi:10.1001/jama.2020.11129.

[24] L. Gordon Moore, ‘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 .

[25] Ofri D. The Business of Healthcare Depends on Exploiting Doctors and Nurses: One resource seems infinite and free: the professionalism of caregivers. The New York Times, June 8, 2019.

[26] Dean W, Talbot S, Dean A. Reframing clinician distress: Moral injury not burnout. [published correction appears in Fed Pract. 2019 Oct;36(10):447]. Fed Pract. 2019;36(9):400-402.

[27] Norman SB. Moral Injury. National Center for PTSD website. https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp. Accessed April 27, 2020.

[28] ZDoggMD. It’s Not Burnout, It’s Moral Injury. March 18, 2019. https://zdoggmd.com/moral-injury/47 . Accessed July 30, 2020.

[29] Talbot SG, Dean W. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. STAT. July 26, 2018. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/. Accessed July 30, 2020.

[30] Michel Foucault, The Birth of the Clinic (New York: Vintage Books, 1994), 38.

[31] Shem, Samuel. Fiction as Resistance. Annals of Internal Medicine. Vol 37(11):934-937; 2002.

[32] Shem, Samuel. Fiction as Resistance. Annals of Internal Medicine. Vol 37(11):934-937; 2002.

[33] Mehl-Madrona, L. “What Traditional Indigenous Elders Say About Cross-Cultural Mental Health Training,” Explore, 2009, 5:20-29.

[34] Michael H. Cohen, Healing at the Borderland of Medicine and Religion (Chapel Hill: University of North Carolina Press,2006), 3.

[35] Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xxviii.

[36]  Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xxxi.

[37] Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xxxiv – xxxv.

[38] Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xxxv.

[39] Lee, Brandy X (ed). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, Updated and Expanded with New Essays. New York: Thomas Dunne Books; 2019, p. xlix.

[40] Steven Herrmann, Spiritual Democracy: The Wisdom of Early American Visionaries for the Journey Forward, xiii.

[41] Herrmann, Spiritual Democracy, xvii–xviii.

[42] I have been writing a series of essay under the heading, “Words Create Worlds,” in the online magazine The Badger, https://beingfullyhuman.com/?s=words+create+worlds&submit=Search.