Headed Home Fired Up

Sitting here at Dulles waiting to fly to SFO after four weeks visiting friends and helping my older sister, I’m eager to head back with a new game plan. Hopefully I’ve broken some old habits, like caffeine and television, and will form new ones, including more self-discipline and making movies.

During my travels, I’ve been reading The Book of Joy by the Dalai Lama and Archbishop Tutu. One piece of advice struck me strongly: “Everyday, think as you wake up, today I am fortunate to be alive, I have a precious human life, I am not going to waste it.”

The Buddhist meditation on mortality elaborates on that theme:

Every moment matters…. I shall always live my life with purpose. Time never remains still, and it’s up to me to use my time in the most meaningful way. I shall live in harmony with my deeper aspirations so that when my final day arrives I will be able to leave with ease and without remorse.

But how can I “use my time in the most meaningful way”? What are my “deeper aspirations”?

Since the world seems to be ever more selfish, self-centered, tribalistic, nationalistic, and militaristic, what options do we have?

When visiting with Andy Maxwell and Sara Colm, Andy suggested, “Reach out to folks and talk face-to-face.” In a follow up conversation, Andy helped me formulate a plan: Invite old, close friends to get together, one-on-one and/or in small groups, to discuss: “What do you think about the state of the world and what can we do about it?”

To my mind we need one or more national, nonviolent, compassionate, joy-filled movements in every country to help make their country more compassionate — and more willing to cooperate with other countries to make the world more compassionate — movements that focus on winnable goals and stay together over time to move onto to new goals.

I’ve long been looking for such a movement to join. Thrive East May may be incubating such an effort. So when I return, I will get engaged in that community.

In the past I would often get discouraged and become melancholy and tired and get stoned at night and watch mindless television for hours, telling myself I need to rest and take care of myself. But creative activity can generate energy rather than deplete it.

So during my week alone outside Asheville I made a list of tasks that I want to accomplish and tracked how much time I spent on each of them. That review, as well as my reflecting on my prior life in San Francisco, led me to conclude that I need to spend less time reading or watching the news, and will try to “cut the cord” on my television.

On weekends I’ll socialize with friends, commune with Mother Nature, and maybe catch some live music or watch a movie. And I hope to socialize during the week as well, especially during meals.

Monday through Friday, I tentatively plan to devote two hours to each of the following: write, read books, correspondence (email and Facebook), read the news and other articles on the Internet, exercise and miscellaneous tasks, and then late in the evening, make movies. Those look like good 12-hour workdays to me, leaving ample time for socializing, eating, and sleeping.

With approach, I believe I can monitor myself, guard against burnout, and see if it proves to be the kind of work that is energizing.

The number of people who read and react to what I post is decreasing. Readers rarely share what I post. The reasons are likely multiple. Most people do not consider my posts to be as valuable as I do. There is a  flood of information on the Internet. And I may have alienated some people with strong opinions that they disagree with.

Occasionally, that lack of support disappoints me and I feel sorry for myself and tell myself that I was too self-indulgent in my youth, failed to develop my talents, and have made too many mistakes.

Then I tell myself, “I am good enough (and will get better), I can only do what I can do, and I am not the point — the point is to do the best I can to serve others.” And I feel better, fired up, and ready to go.

Today I tell myself that even if only 10 people read what I write, I will write as if 10,000 read it.

And I will devote more time to face-to-face dialogue that will enable me to better understand others and our world, while aiming to find more truth, justice, and beauty.

The Backfire Effect

The positive reaction to my “‘Reactance’ and How to Talk” prompts me to pursue the theme by referring you to “You are not going to believe what I am going to tell you,” a remarkable, thought-provoking comic on The Oatmeal  — a site written, drawn, and coded by Matthew Inman. I recommend that you read the full, humorous comic by scrolling down from the top, and then consider my selected excerpts and comments that follow below.

No doubt there are no magic bullets that automatically lead to constructive dialog. But some methods, it seems to me, are more likely to enable us to “reach beyond the choir” in many situations — although other methods might be appropriate for a rally or a manifesto that is geared to energize the base.

Inman explores why “we soften to some ideas and not others,” and at times “dig our heels in deeper and believe more strongly in the opposing argument,” in which case “providing more evidence makes someone less likely to believe in an idea.”

He reports that some researchers call that “the backfire effect,” which is reported on more fully in the three-part podcast series discussed in “How to fight back against the backfire effect.”

Inman says:

  • The amygdala, the emotional core of your mind, responds to an intellectual threat as it responds to a physical one.
  • We are biologically wired to react to threatening information the same way we’d react to being attacked by a predator.

This applies in particular to “core beliefs,” which are

the beliefs which people cherish the most deeply…. [They] are inflexible, rigid, and incredibly sensitive to being challenged…. Your brain loves consistency…. If a new piece is introduced and it doesn’t fit, the whole house falls apart. Your brain protects you by rejecting that piece…. The backfire effect … is a biological way of protecting a worldview.

In terms of how to minimize the backfire effect, Inman recommends:

Just remember that your worldview isn’t a perfect house….. The best I can do is make you aware of it, so you can identify the backfire effect in your own brain…. The mind can’t separate the emotional cortex from the logical one.

He uses a unique trick: “I sometimes pretend the amygdala of my brain is in my pinky toe. When a core belief is challenged, I imagine it yelling insane things at me…..”

Inman concludes:

  • And then I listen.
  • And then I change.
  • Because this universe of ours is so achingly beautiful.
  • And we’re all in it together.
  • We’re all going in the same direction.
  • I’m not here to take control of the wheel.
  • Or to tell you what to believe.
  • I’m just here to tell you that it’s okay to stop.
  • To listen.
  • To change.

So once again we hear someone suggest that we talk less and listen more. Remember: the other may be experiencing a backfire effect. And, I dare say, a great way to listen is to ask non-rhetorical questions in order to better understand the other’s point of view — honest, sincere questions driven by real curiosity. But being curious requires not being self-centered, and self-centeredness is widespread, so many people simply are not very curious.

I love Inman’s conclusion: my pinky-toe amygdala is like a leaf on a tree in our achingly beautiful universe, we are all going in the same direction, and none of us need try to control the wheel. What wonderful concepts!

So it’s ok to stop and listen. Then, who knows, you may change.

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QUESTION: What methods can we use to minimize the backfire effect?

Peter Coyote, Change, and Transformation

In recent months a few items have haunted me and prompted me to reconsider my thinking and my rhetoric. One is a video of a talk by Peter Coyote, a co-founder of the Diggers (who played a major role in San Francisco’s Summer of Love) and author of two memoirs, Sleeping Where I Fall and The Rainman’s Third Cure: An Irregular Education, and the excellent essay, “Democrats Need to Clean Up Their Own House” (November 2016).

During that talk Coyote said:

The idea of a counterculture itself is a problem. The idea that you’re going to invent a culture to stand outside the majority culture and you’re going to make a world that is so appealing and so inviting and so wonderful that when this one collapses everyone is going to run over … not going to happen.

Lots of people out there didn’t want their kids to be around drugs, long haired, sexually libertine, experimental, crazy people. We missed the opportunity to organize those people by being so attached to our own freedom. So looking at it in hindsight, counter culture condemns you to marginality, to being marginalized. So I don’t think the failure of the counterculture is a problem. I actually think it is a blessing.

Because what it means is that we’re all now in the same culture together. You can’t tell who’s who. You can’t tell who’s a change agent. So every single place that any one of us touches the culture is a juncture point at which you can press for change. If you study martial arts you know that to change the adversary’s direction you have to contact him. But at the point of contact the fall goes to the most conscious not the biggest. So where we work, how we work, where we shop, how we shop, what we use, what we waste, what we don’t, all of those are actions of change agency. And we can do that as a secret practice. No one knows we’re doing it.

So I don’t think the counterculture failed…. There’s no place in the United States today that you can go and not find organic food, alternative spiritual practices, the women’s movement, environmental groups, alternative medical practices,… the slow food movement. It’s completely woven into the culture…. It’s a kind of highly invisible effect…. All of those people are out there. They’re just doing their work, practising compassion, taking care of the world, taking care of other people, invisibly…. They’ve internalized those values that their parents had to stumble through clumsily….

I think it has evolved and it’s evolved and it’s evolved and it’s still changing and in that regard I’m optimistic that we, our generation, managed to plant fundamental ideas about family, about tribe, about compassion, about taking care of other people. It’s just that we can’t see it because it doesn’t have edges. It’s like the self. It doesn’t have a definite shape. It doesn’t have a definite location. It doesn’t have a definite form. So is it real or isn’t it real? Well, we have the experience of having a self even though we can’t touch it. So I think the experience of this force that is dissipated throughout the entire culture feels pretty good. (emphases added)

Those comments suggest to me:

  1. It’s impossible to stand outside the dominant culture, because that culture is embedded within each of us. Everyone is a bundle of contradictions, a variety of all-too-human tendencies, often at odds with one another. It’s not us vs. them.
  2. Declining to identify ourselves as “outsiders” makes it easier to connect with people who identify as mainstream. Then we can be compassionate with them — and help spread compassion.
  3. The human family is experiencing  “change” and “evolution.” Compared to even fifty years ago, humanity has made progress — even more so over longer time frames. For every gain there is a loss, and for every loss there is a gain, but over time the gains have exceeded the losses — and will likely continue to do so.
  4. Hopefully that evolution will lead to “social transformation” — a significant change in the composition, structure, outward form, appearance and character of our society. Public financing of elections, for example, would be a positive structural change.
  5. But “transformation” or “revolution” strikes many people as a future-oriented abstraction that’s hard for them to relate to. Leading with that language can leave people mystified, or drive them away. So it can often be more effective to connect around concrete concerns, build momentum, and grow community — and talk about “transformation” later.
  6. That’s how I take Coyote’s reference to a “secret” practice. We need not be “in your face.”  We need not be self-congratulatory about being a change agent. We can just be compassionate. We need not always talk about why we’re doing it. We can just do it.

More Dialog on “Patient As Doctor”

I wanted to let you know how I chose to use your essay, “Patient As Doctor,” in my class. Some background: …I teach a Professional Foundations of Nursing course to 96 junior nursing students (so they are early in their nursing education and have a varied range of patient care experience). In this course they learn about nursing history, ethics, laws relevant to nursing, the image of nursing, the US health care system and leadership.

In class yesterday, students divided up into 16 groups of 6 students and followed this format:

In your assigned group, designate the following roles:

1 writer
1 timekeeper
1 presenter

Read the essay below and answer the following questions. Be prepared to share at least one of your group’s responses with the class.

Patient As Doctor

1. How does this patient’s account make you feel?

2. In your opinion, does the US health care system disempower patients?

3. If so, what examples have you seen?

4. What can nurses do to promote patient empowerment within the US health care system?

After their group work, each group had one presenter come up to the front of the room and answer the questions listed above. Students had some powerful responses.

Students felt saddened, uncomfortable, surprised, not surprised and ashamed by your account. They believed that the health care system does disempower patients and some of their examples included: doing to the patient before asking or obtaining consent, not explaining rationale/educating, not providing the patient with options or choices, not encouraging the patient to ask questions, rushing through patient care, and not using an interpreter. They felt that some subgroups are even more likely to be paternalized/disempowered, including the elderly, the disabled, those who do not speak English, and the mentally ill. They provided several inspiring examples of how nurses can promote patient empowerment, giving me hope for the future of nursing and the advocacy of nursing as a counterbalance to the predominant medical model of care.

Just wanted to share and extend my appreciation of your willingness to let me use your writing in my teaching. I think that is was a very powerful exercise for the students!

Best,

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Interesting and valuable feedback.  I’d like to add one more comment in response to this one that someone submitted:

Your article makes a number of good points about our paternalistic system. Whether it is medicine, law enforcement or the media we are treated as if we can NOT make informed decisions on our own.

Again, it’s also about personal responsibility.  We are treated the way we allow people to treat us.  We have to step up to the plate and choose:  accept what we’re told, question what we’re told and then decide, or reject what we’re told.  Even these choices are our decision, so to say we’re treated as if we can NOT make informed decisions is a cop-out.  The system won’t change just because we blame it.  We have to change the way we respond to it.

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My response:

I agree that we need to affirm and nurture personal responsibility. But why should the patient always have to fight to be heard? Why don’t the professionals initiate dialog? Patients are often already stressed out. Fighting or pushing adds to the stress.

I do not believe that I blamed the professionals. As I see it, individual patients are a component of the System. Blame is shared.

It’s not either/or. We need not blame the individual either. But often others treat us the way they choose to treat us — not because we allow them to do so.

In my case, I did resist quite a bit. But when you’ve got a 103-degree fever and are wiped out by multiple drugs, it’s hard to speak up consistently.

Responses to “Patient As Doctor”

The many, varied responses to my report on my recent hospitalization, “Patient As Doctor,” including numerous shares and likes on Facebook, were very helpful. Those comments that resonated with my critique of the health care system as a reflection of the larger society reassured me I am not alone. And the empathy and sympathy that were expressed was healing.

At the same time, however, I appreciated those who offered a different perspective. Generalizations are dangerous. Reality is a mixed bag. It does seem, for example, that Kaiser Permanente, “an integrated managed care consortium,” generally offers better care than is provided by “fee-for-service” institutions that generate greater income by providing more, often unnecessary, services, as is the case at my hospital. And no doubt many people receive good care at that hospital as well.

All of which raises questions about strategic language. If one is not careful, overblown rhetoric can alienate one from one’s audience, making it more difficult to build pressure for positive change. Words matter. What should we seek? Evolution? Revolution? Fundamental reform? Transformation? Creative change? It gets complicated, but those are questions I’ll continue to explore.

In the meantime, here are the responses to my piece, which I posted on multiple platforms:

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Holistic, consultative democratic practices

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So sorry about your experience. What you describe is why I don’t interact with the medical establishment. They are not a health care system but a medical industry. I object to all the debate around “health care” because that is a misnomer for the medical insurance business which is driven by the profit motive not any kind of caring much less for health. Our society is so deeply devoted to the principle of money over everything that those involved in it cannot see it. I hope you get well soon.

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Thank you for posting this. Ridiculous what happens in a hospital

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I’m sorry that happened and it’s so true. Needs to change.

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Being your own advocate is vital.

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There are now patient experience departments at every hospital. Send this letter to the CEO and cc the Patient Experience Team at the organization. The organization is measured on these things now for reimbursement as well as accreditation. The CEO will act on this…if not…don’t ever go back to that particular hospital unless you have too.

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I’m sorry for your ordeal, Wade. What happened to informed consent? I have had a similar bout of illness lately. I agree that our so-called health care system is moreso a medical industrial complex that sometimes is needed and sometimes helps. At Kaiser, which is lacking in many other ways, I have always been informed and asked for consent re interventions. Where did your experiences take place? Worthy of an official grievance!

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My sentiments precisely

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I go into my doctor’s office with a list of questions. I’m lucky to be pretty healthy but the last medical issue I had, I had a specialist thank me for being a proactive patient. She said too many patients don’t ask questions.

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Wade, I’m glad to hear you are feeling better, but what an ordeal. One person with bad communication I can understand, but an entire system? I agree that your description should go to the hospital admin. I had pneumonia about 4 years ago, and I found not being able to breathe well a very disconcerting sensation, to say the least. In diagnosing it, they kept asking me, “Do you feel exhausted?” And I kept saying “No, I just feel like there’s not enough oxygen in the room and opening a window wouldn’t help.” It wasn’t until later when the antibiotic started to work and I *could* breathe better that I felt exhausted. I realized that adrenaline from a very primal panic about not breathing was keeping me from feeling exhausted.

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I couldn’t agree more with your statement: “…we need to apply holistic principles to every institution, not just health care. If we did, we would “transform the System.” But the world descends into ever more tribalism, materialism, and militarism.” Wade!

‘Holistic’ to me means ‘integrated’. But the reality is that we live in a world where segregation, isolation and antagonism are the rule. “Divide and conquer” rather than “Unite and evolve”, that is why ‘the System’ is broken.

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I’m really sorry to hear about this ordeal, Wade. I do agree with the other person who said that Kaiser is a lot better in this regard. I also had pneumonia about ten years ago, and although the active infection went away quickly, I was drained of energy for several months afterwards. I sure hope you don’t have to deal with that.

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Wade Hudson continue to be proactive about your health; Be well!

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Thanks for sharing the story

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With you on all accounts! Glad you made it through. Very glad you are using the learning experience to help us and the hospital. Yes, empowerment and education are needed throughout society. Liberating structures as the scaffolding for reconstruction.

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i am glad you’re doing better despite the poor treatment. Thankfully, my experience with heart surgery and recovery has been significantly more positive.

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Regarding what you wrote about your experience in the hospital and the general comments about health care and practitioners.  It’s really easy to blame the system — broken or otherwise.  But what came to mind for me was where do we as patients/users of the system take responsibility?  Do we ask direct questions about why we need a particular treatment or medication, what is it supposed to do, what are the side effects, etc.  I do this all the time, and

as a result haven’t had any problems with the doctors I see — including my adventures in the E/R.    Our parents’ generation accepted doctors as gods….”they know what’s best, don’t rock the boat” etc.  At least that was my mother’s philosophy. If we pay attention to our bodies they tell us what they need if we only listen.  Medical professionals are there to help because they MAY have more specific medical knowledge about what’s going on, but we can’t assume their solutions are the only ones.  I’ve had medications reduced and even eliminated because I said that’s what I wanted, and so far I’ve survived quite well.  And we have to ask and question. I think that’s what the intern meant when he said we are our own best doctors.

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Your article makes a number of good points about our paternalistic system. Whether it is medicine, law enforcement or the media we are treated as if we can NOT make informed decisions on our own.

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I am glad you are feeling better. Thank you for your articulate analysis. One of my adult daughters has had significant health issues for most of her life and we have had this conversation often as a family. We have come to the conclusion that there is an eerie similarity between the health system and the criminal justice system regarding disempowerment, “professionalism,” disorientation and vulnerability. I’m glad you included the hopeful comments by the medical student and your primary care doctor.

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Hope you are feeling better. Pneumonia is serious and deadly.

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I’m sorry you had to go through this — sounds like you were on your own during your hospital stay? Your “treatment” / mistreatment by medical professionals is something I’ve also experienced; not as a consumer but as a caregiver / advocate for people in Cambodia’s even more wretched and class-based medical system, and then for my dad dealing with shockingly similar attitudes in Virginia. I learned in Cambodia that in order to survive the medical system, every patient must have an advocate. So it seemed natural to take on the role for my father (even though the doctors and social workers thought I was a hostile pain-in-the ass). I’m glad I persevered; on at least one occasion, if I’d left my dad in the hands of the ‘professionals’ one night and gone home instead, my dad would have died much sooner than he needed or wanted to…. Your primary care doctor sounds like a goddess-send. I believe she’s the one who wrote about the healing qualities of gardening / farming, especially through contact with soil? This is a topic I’ve been exploring recently through workshops in horticultural therapy.

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Thank you, Wade. I wish that everyone who has such an experience would flood the media (social and otherwise), the hospital admins, the medical schools, the newspapers and beyond, so that patients would take it into their hands and REFUSE to be infantilized. In many ways we are a country of rebels, but when it comes to doctors and medicine we are amazingly compliant. And, I realize how hard it is for anyone to challenge a system when one is in the midst of illness or emergency.

Thank you for your part of testifying and waking people up. We are trying to do this about advanced directives for emergencies and end of life. What you are addressing affects many more people. Citizen driven research has been making strides. Seems like it could be even easier to move citizen-driven medical practices.  

I’m glad you have such a forward thinking primary care person. If that person is in SF, I’d love to know who it is for referral status

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hope you are feeling better! many blessings,

Tax Reform: What’s Fair?

How much should various income groups pay in federal taxes? How much federal revenue would be generated by higher rates on the wealthy?

Forget “nominal” rates. What matters are “effective” tax rates — what people actually pay.

According to the CBO, in 2013, the last year for which detailed data is available, the average before-tax annual income of the top 1% was $1.5 million. With their 34% federal effective tax rate, their after-tax income was $1.0 million.

Those in the 96-99 percentiles averaged $327,000 in pre-tax income. Their rate was 26%. So their after-tax income was $240,000.

The 91-95 percentiles averaged $200,000. With an effective tax rate of 23%, their average after-tax income was $155,000.

For the sake of argument, consider the impact of a graduated tax scheme that resulted in those income groups paying 60%, 45%, and 40% respectively.

That would leave them with after-tax incomes of $628,000, $180,000, and $120,000 — substantial to say the least.

With their same incomes, the increase in federal revenue would total one trillion dollars.

That would be enough to hire 32 million full-time workers at $15 per hour.

Just saying.

What tax rates would you consider fair? Bear in mind the total local, state, and federal tax burdens as reported in the graphic.

Lenin, Bannon, and Trump’s Movement

The bit of information from Steve Bannon’s recent interview with the Times that most interested me has received little attention. Bannon was one of the few advisers who “urged on Mr. Spicer’s confrontational, emotional statement to a shocked West Wing briefing room on Saturday.” That report suggests to me that the controversies about crowd size and voter fraud were manufactured in a calculated manner, not the result of Trump’s impulses.

Trump and Bannon,Trump’s chief strategist, operate on the same white nationalist, authoritarian wavelength. Like Lenin, whom he admires, Bannon takes the long view. He doesn’t care that they only have 33% approval now. That’s more than enough “vanguard.” So he focuses on solidifying the loyalty of those true believers by getting them to trust their “alternative facts,” as I discussed in “Trump Constructs Reality?

As they see it, when the chaos they foment with trade wars, undermining the new world order, and provoking violent demonstrations which will result in more repression, they and their vanguard will be well positioned to build on their 33% and take charge.

Their ad hominem attacks and their scapegoating “enemies” contributes to that devolution.

If we respond in kind, we’re taking their bait and adding hate to the heat. Rather than psychoanalyzing Trump, applying psychiatric labels to him, and otherwise demonizing him, we’d spend our time more fruitfully being proactive, focusing on the issues, and organizing compassionate communities.

 

No Shortcuts

Jane McAlevey, longterm labor organizer and author of No Shortcuts: Organizing for Power in the New Gilded Age, was the guest today on Your Call Radio. Following are my notes from what she had to day.

Need to shift away from deep organizing to shallow mobilizing

The Women’s Marches were incredible, especially small rural towns

How do we translate it?

The Right’s key is to sow division with fear

Trump won because the Democratic Party has failed most working class people in this country, black, brown, and white.

Now is an outsider moment.

To keep the momentum, we must have a longer-term attention span, do power analysis and strategic thinking.

Think globally, act locally.

Must figure out: 1) how to take over locally; 3) elect local leaders

Go to town council meeting, take over neighborhood or union, then town council

Figure out how to actually win

We need a Tea Party-like structure within the Democratic Party

It will take time and patience

Must build real, high-participation organizations and sustain that structural power, which we aren’t doing.

We’re out-strategized by the Right

Not everything is sexy, like taking control of your local Democratic Party

The work is messy and hard

Build power locally and amalgamate it higher up

We can build big, win, and keep it democratic and progressive

Focus on how do I become a precinct leader? Congressional Districts are too big to start with

The Right started at the local level

Take on yes or no campaigns

How do you build a class movement that is intersectional?

We must tackle and overcome race and gender because we have to in order to win

We don’t wake up wondering how to talk about identity

When you do a union campaign you’re not picking who you relate to

It’s structure based, not self-selecting

Most of the people we need aren’t coming to our meetings

You must overcome the complexities of various identities

No Shortcuts

Jane McAlevey, longterm labor organizer and author of No Shortcuts: Organizing for Power in the New Gilded Age, was the guest today on Your Call Radio. Following are my notes from what she had to day.

Need to shift away from deep organizing to shallow mobilizing

The Women’s Marches were incredible, especially small rural towns

How do we translate it?

The Right’s key is to sow division with fear

Trump won because the Democratic Party has failed most working class people in this country, black, brown, and white.

Now is an outsider moment.

To keep the momentum, we must have a longer-term attention span, do power analysis and strategic thinking.

Think globally, act locally.

Must figure out: 1) how to take over locally; 3) elect local leaders

Go to town council meeting, take over neighborhood or union, then town council

Figure out how to actually win

We need a Tea Party-like structure within the Democratic Party

It will take time and patience

Must build real, high-participation organizations and sustain that structural power, which we aren’t doing.

We’re out-strategized by the Right

Not everything is sexy, like taking control of your local Democratic Party

The work is messy and hard

Build power locally and amalgamate it higher up

We can build big, win, and keep it democratic and progressive

Focus on how do I become a precinct leader? Congressional Districts are too big to start with

The Right started at the local level

Take on yes or no campaigns

How do you build a class movement that is intersectional?

We must tackle and overcome race and gender because we have to in order to win

We don’t wake up wondering how to talk about identity

When you do a union campaign you’re not picking who you relate to

It’s structure based, not self-selecting

Most of the people we need aren’t coming to our meetings

You must overcome the complexities of various identities