Individualism and Collectivism


In his January 2015 op-ed, “How Did Politics Get So Personal,” the invaluable Thomas Edsall examines many factors that have contributed to increased political polarization. In that piece, he refers to a paper, “Liberals Think More Analytically Than Conservatives,” by Thomas Talhelm, Jonathan Haidt and others. In that piece, Talhelm and his co-authors associate liberalism with individualism and, contrary to the norm, associate conservatism with collectivism.

They argue that

liberal culture is more individualistic, with looser social bonds, more emphasis on self-expression, and a priority on individual identities over group identities…

If you see the world as all individuals, then welfare recipients are individuals too, just like you. Indeed [liberals] are more likely to agree with statements about universalism — “all people are equal”; “an African life is worth as much as an American life.”.

On the other hand, conservatism

is often associated with rural areas, where people are enmeshed in tight-knit communities and are more likely to know the people they see walking on the street. Conservatism is also associated with interconnected groups, such as churches, fraternities, and the military….

Collectivism is not generalized sharing with “other people.” Collectivism is a system of tight social ties and responsibilities, but less trust and weaker ties toward strangers — a stronger in-group/out-group distinction. Conservatives care deeply about close others, but they may dislike welfare programs because those programs serve strangers or even people from out-groups.

Edsall suggests that this divide between people who are inclined toward individualism and those who tend toward collectivism has contributed to polarization.

Does that distinction make sense? If so, can that conflict be reconciled. If so, how?

Healthy Competition?

A passage in The Book of Joy, a wonderful book by the Dalai Lama and Archbishop Desmond Tutu, shifted my thinking. For some time, I’ve been arguing that because most people either dominate or submit, mutually respectful partnerships are rare. The Book of Joy offers a different perspective.

It reads:

There is a Tibetan Buddhist teaching that says what causes suffering in life is a general pattern of how we relate to others: “Envy toward the above, competitiveness toward the equal, and contempt toward the lower.”

That saying suggests that many people who see others as equals compete to establish dominance or superiority.

But does all competition cause undesirable suffering? Many leftists disparage competition and advocate cooperation as an alternative. But the situation seems more complicated than that to me. It seems some competition can be fruitful.

So I posted to Facebook, “What’s the difference between healthy and unhealthy competition?” and received four responses:

  1. If we are just as happy whether we win or lose; when we can be sincerely happy for the person who wins, then we are not really competing – we are testing ourselves against a standard that involves other people. Depending on the area, we can sometimes test ourselves against our previous level, but sometimes it is helpful to test ourselves against our peers to make sure that the standards we have set for ourselves are reasonable.
  2. Playing by the rules and knowing that winning isn’t everything, [but] too many hormones & egos get in the way!
  3. I always think of how musicians play TOGETHER rather than compete… takes a stretch to apply that to sporting competition
  4. I think it’s really quite dependent on the situation. Some behaviors that are healthy competition in some arenas are not healthy in other arenas (e.g. team sports vs individual sports, any sport vs any artistic endeavor, any artistic endeavor vs any business endeavor.) But one thing I think is true across them all: If you’re so focused on your ‘need’ to win that you’ve stopped taking the humanity of your opponent into account, then you’re probably deep into the unhealthy zone….

What do you think of those responses? What do you think about the question? Is there is a  difference between healthy and unhealthy competition? If so, what’s the difference?


Peter Coyote on the Election

Last November Peter Coyote posted on Daily Kos “Democrats Need To Clean Up their Own House.” That essay included points new to me and echoed others I’ve made in my own posts.

Of particular interest was his analysis of the impact of Federal Reserve policies on rural areas.

Coyote argued:

…In July of 1980, [Federal Reserve Chairman] Volker orchestrated a series of interest rate increases that took the federal funds target from around 10% to near 20%… [One result] was the extinction of 22 million family farmers who had faithfully followed the advice of the official institutions mandated to help them [who] had assured farmers that rising land values and additional income from increased crop yields would insulate them from debt so that it would be prudent to mortgage their land, buy expensive equipment and plant and harvest fencerow to fencerow— and they did.

[Latyr] Volker (under a Democratic President) raised interest rates by five points in a single day.  The farmers could no longer meet their new debt obligations and were scrubbed off their land as efficiently as if a glacier had scoured it down to bedrock.

After the first glacier, came others, perhaps not as large but equally destructive. For every five farms that disappeared under the auctioneer’s hammer, a local business closed.  Farming towns lost their hardware and feed stores, their FFA and scout leaders, coaches, school principals, and auto-parts stores. Deep depression and shame metastized in the farming belt growing into a deadly scourge wherein the leading cause of death on the family farm soon became suicide.

Powerful anti-government resentments began to blossom in that blighted soil…. Another crop of future Trump supporters was nurtured when Bill Clinton’s Welfare Reform legislation imposed an absolute lifetime limit of five years on government assistance to needy families…..  

The Democrats, rather than assessing the mote in their own eyes and doing a serious review of how this situation came to pass are content to criticize the easy target of Mr, Trump….Fears about Trump, while understandable, can become self-defeating and counterproductive….

Those qualities [in ourselves we prefer not to examine, our personal selfishness, greediness, anger, deluded ideas, and unethical behaviors, we project onto others, creating perfect enemies. They are perfect enemies because they are undefeatable—only phantoms existing in imagination. We are all human and not one of us is purely good or evil. Missing this point leaves us vulnerable to very destructive ignorance and relieves us of the responsibility for self-examination….

… Democrats appear to be insulated from useful truths by their bullet-proof faith in their own righteousness. If I am correct, it means that they will not take fearless inventories of the callous disregard they have inflicted on the very constituencies which denied them the office and Congressional majority they so dearly sought…. Sizeable numbers of their voters have seen through their message, directly into the Party’s true core values which have morphed since the 1940s into the pursuit, generation, facilitation and protection of wealth. …

To pursue the same habitual attempts to discredit or obliterate one’s enemies (foreign or domestic) …  is to court repeated failure…. Another path is available….

The simplest way to frame the common lessons about success that I garnered from both spiritual and secular realms is that I am my opponent. I am the one I think of as the other. I have to admit that I possess the same capacity for self-righteousness, hasty judgments, greed, ambition, envy, and delusion as those I consider my opponents. Likewise, they possess the same qualities of intelligence, ethics, probity, selflessness and empathy that I would prefer to reserve exclusively as my own. Our behaviors may differ extremely, but that is a result of worldview, beliefs, and past experience not some innate quality of goodness or evil….  All humans are like radios tuned to receive the entire spectrum of humanity.

…Not knowing our full capacity as humans makes us dangerous because our reflexive assumption of our own goodness allows us to ignore our shadows—the facets and qualities in humanity of which we prefer to remain ignorant…. If, in a dispute, I assume that all goodness, kindness, and wisdom, rest on my side of the tablet, my opponent will read those assumptions and judgments as clearly as if  I had tattooed them on my forehead.  They will judge me in the same way and defend their platitudes and the holes in their arguments as vigorously as I do mine. This is how our political system has devolved….

The most useful qualities we can contribute to public life are kindness, empathy, and the willingness to listen…. One party’s victory never insures victory for the nation unless we integrate the losers back into the population. This does not necessarily mean that either side is always correct or always wrong, but that in order to communicate we must first deeply understand what our opponents mean…..   

When we observe that self and other are simply different states of the same human entity— like water and steam–we discover that our opposing views may not be as irreconcilable as we had thought. No one in the world is pure, and there is no place to stand outside the messy everyday world to judge others reliably. Knowing that should afford us all some common ground, a place to talk and listen. We are all joined by pulse and breath. We rely on the same oxygen, sunlight, water, pollinating insects, and microbes in the soil— the identical web of life.  We all inhabit the same tiny blue pearl glowing in the vastness of space and, if we’re not careful, our shadow may ruin it for human habitation.  We have evolved technically to a level capable of destroying the planet and the world we have created.  Surely our evolution should include the ability to deepen our understanding of what it means to be human.


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.


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

Wade’s Journal – May 17, 2017

Now that I’m retired from cab driving, I’m more relaxed and look forward to a fruitful future.

My 50-year-old commitment to help organize “communities of faith, love, and action” remains intact. The language we’ve used to articulate the “faith” part has changed over time, but the spirit has not. For the first 20 years or so following that commitment, the spiritual values behind my work were implicit — until I decided to make those beliefs explicit. Since then I’ve stumbled along: researching, going to workshops, convening workshops, writing, talking, planting seeds, and looking for an open-hearted, compassionate, holistic community to join.

Now I think I’ve found one: Thrive East Bay, a community that’s led primarily — in a very non-hierarchical, “flat” fashion — by young people. As is the case with so many young people these days, the members of that community amaze me. They seem far more advanced than my peers and I were at that age. It definitely gives me hope for the future. The Thrive East Bay people I’ve gotten to know a bit personally have been impressive and highly committed to social transformation.

More than a year ago, I met the Thrive East Bay organizer, Joshua Gorman, at a workshop that he and I attended which was convened by the Center for Spiritual and Social Transformation (now the Ignite Institute). He invited the participants to an event sponsored by Generation Waking Up, a project that provides training, mentoring, and support to young people to help “bring forth a thriving, just, and sustainable world.” That event, which was open to people of all ages and whose participants were a diverse mix, was remarkably inspiring. It included poetry, music, and personal sharing from the stage as well as among the audience, who at times milled about and paired up to interact.

When Thrive East Bay began not long afterwards, I went to their first public event, which was held in a Lake Merritt apartment with about 20 people squeezed in. A similar format was employed and I again found it to be invigorating. But my working full-time interfered with sustained involvement.

After returning to one of their events last week, I’m heartened by their growth. And now that I’m free, I plan to participate fully once I return from visiting folks in Seattle and on the East Coast during the next several weeks.

The Thrive East Bay website homepage identifies the group as “a new kind of community” dedicated to “connect, grow, transform.” The About page states:

Thrive East Bay is a purpose-driven community of people committed to creating a flourishing world for all.

We are a new kind of community offering a relevant space for diverse people seeking meaning and connection in our rapidly changing world. Informed by modern science and ancient wisdom, our culture is both secular and spiritual, infused with a deep sense of purpose and interconnectedness, inspired by the arts, and focused on social change.

We welcome people of all ages and backgrounds as we engage in personal growth, shared learning, and collective action.

We host regular Sunday events, small group circles, workshops, and training courses in the Oakland, Berkeley, and wider San Francisco Bay Area.

We are inspired by the following core principles that guide our community:

  1. Thriving Lives – We support each other in overcoming personal challenges and injustice, and creating healthy lives filled with purpose, joy, and expression.

  2. Love In Action – We let love guide us toward compassion, gratitude, empathy, and community amongst diverse groups of people.

  3. Shared Learning & Practice – We seek to deepen our understanding of the world through conversation and critical inquiry, and to grow together through transformative practices and action.

  4. Systemic Change – We unite to build equitable systems where we can flourish as individuals, as communities, and as a planet.

I particularly relate to the fact that they identify “support each other” at the head of their first core principle. I also respond to the fact that in that principle they affirm “overcoming personal challenges,” which suggests a commitment to self-examination. I anticipate exploring with them whether and how they believe that effort includes “modifying harmful social conditioning,” a key concern of mine recently.

I’m also eager to participate in the “Holistic Movement Building” workshop with Kazu Haga and Sonya Shah June 26-29, which aims to

harness the power to change policies and institutions while cultivating the love it will take to transform relationships…. How do we dismantle systems of oppression without replicating those same patterns in our own relationships? How do we heal our wounds while transforming the systems that perpetuate them? How do we better cultivate the relationship between inner and outer transformation?

Kazu and I have had some rich interaction concerning those issues. I’m very encouraged to see that he, Joshua, and others are keeping the holistic-change fire alive!

“Reactance” and How to Talk

In addition to the Peter Coyote talk, another piece that has prompted me to reevaluate my thinking and my rhetoric is the June 2016 “The Anti-P.C. Vote” op-ed by Thomas Edsall and two articles Edsall referred to. He also reported that Jonathan Haidt, a professor at N.Y.U, told him “reactance” is

the feeling you get when people try to stop you from doing something you’ve been doing, and you perceive that they have no right or justification for stopping you. So you redouble your efforts and do it even more, just to show that you don’t accept their domination.

The theory was first developed in 1966 by Jack W. Brehm in “A Theory of Psychological Reactance,” in which he stated:

Psychological reactance is an aversive affective reaction in response to regulations or impositions that impinge on freedom and autonomy. This reaction is especially common when individuals feel obliged to adopt a particular opinion or engage in a specific behavior. Specifically, a perceived diminution in freedom ignites an emotional state, called psychological reactance, that elicits behaviors intended to restore this autonomy.

Haidt argued, “The accusatory and vindictive approach of many social justice activists and diversity trainers may actually have increased the desire and willingness of some white men to say and do un-PC things.”

In his reference to another article, “Psychological reactance theory” by Dr. Simon Moss, Edsall summarized that Moss found that the kind of messages that provoke a defiant or oppositional response include “imperatives, such as ‘must’ or ‘need’; absolute allegations, such as ‘cannot deny that …’ and ‘any reasonable person would agree.’ ”

More fully, Moss wrote:

Specifically, a perceived diminution in freedom…elicits behaviors intended to restore this autonomy. Reactance, for example, often encourages individuals to espouse an opinion that opposes the belief or attitude they were encouraged, or even coerced, to adopt…. Reactance was proposed to explain many common examples of resistance in society, such as the adverse effects of prohibition.

Reactance is experienced whenever a free behavior is restricted…. Specifically, individuals often show boomerang effects, in which they become more inclined to enact the very behavior that was restricted…. Finally, reactance provokes adverse attitudes towards the source of any restriction….

Research indicates that some linguistic features seem to evoke…psychological reactance. In particular, dogmatic messages were perceived as more threatening, which provoked reactance, anger, and unfavorable thoughts. The dogmatic messages include:

  • Imperatives, such as “must” or “need”
  • Absolute allegations, such as “cannot deny that…” or “This issue is extremely serious”
  • Derision towards other perspectives, such as “Any reasonable person would agree that…”
  • Threatening warnings rather than merely impartial, objective information

In contrast, messages that are less dogmatic do not provoke this sequence of reactions. These messages are more likely to include:

  • Allusions to choice, such as “You have a chance to…” or “We leave the choice to you…”
  • Qualified propositions, such as “There is some evidence that…” or “This issue is fairly serious”
  • Impartial, objective information
  • Avoidance of imperatives or derisive language

Questions are less inclined to promote reactance. These messages are not as dogmatic or dictatorial…

In the writing I’ve done since reading that article, I’ve tried to follow its recommendations. But old habits die hard!

That’s especially true when one feels a sense of urgency, and Lord knows we face many urgent issues. It’s easy to develop tunnel vision on one pressing crisis or another. But I think it’s helpful to recall Coyote’s long view and Dr. King’s faith in the moral arc of the universe — and step back to see the situation from multiple perspectives.

Yes, the Apocalypse is happening. Pick your Apocalypse; the options are many. But the ultimate Apocalypse is Death itself. All life dies. Even the universe as we know it will die (and perhaps collapse into another black hole that will explode in another big bang which will lead to new life. And let’s remember that each day more than 20,000 young children die needlessly, prematurely.

It’s hard, but we can face those realities, change what we can, accept what we cannot, and still embrace the joy that life offers — a joy that becomes deeper the more compassionate we are. With that perspective, it may be easier to avoid reactance-provoking language.

As one who has long been intrigued with the power of questions, I was struck by Moss’ report that questions are likely to be more effective. I would add, that’s especially true if they are sincere and not rhetorical questions. Regardless, I yearn for a world that, one way or the other, learns to better communicate.

What suggestions do you have for less dogmatic language — as alternatives to “must,” “need,” and other absolutes?

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.

“My Bottom Line” Revisited

Facebook just told me that five years ago today I posted, “My Bottom Line.”  On the one hand, I am disappointed that I am still seeking the kind of holistic community described in that essay. On the other hand, I am encouraged by various recent efforts to nurture such growth, including invitations that I received today from two allies with whom I have engaged in rich dialog about these matters.

The first invitation was from Kazu Haga, founder of the East Bay Peace Academy. It reads:


Holistic Movement-Building
Tuesday, June 26 – Friday, June 29; 10am-5pm
Taught by Kazu Haga and Sonya Shah

“Power without love is reckless and abusive, while love without power is sentimental and anemic.” Dr. King, Gandhi, Chavez and others envisioned a movement that harnesses the power to change policies and institutions while cultivating the love it will take to transform relationships. What does it mean to build holistic movements for justice and healing? How do we build a movement grounded in love without giving up the power and the urgency of now? How do we dismantle systems of oppression without replicating those same patterns in our own relationships? How do we heal our wounds while transforming the systems that perpetuate them? How do we better cultivate the relationship between inner and outer transformation? What do holistic movements for justice and healing look like in terms of real practice and on the ground? This workshop will engage these questions, explore past and current movements, and envision paradigms and practices to build more holistic movements grounded in both justice and healing. This four-day inquiry will interweave theory, discussion, experiential exercises, and a collaborative approach.

Cost $425. For more info, click here.


The second invitation was from Joshua Gorman. It reads:


Join Thrive East Bay for our first monthly ‘Root Down’ event this coming Sunday as we deepen in community, engage in embodied practice, and nourish ourselves with delicious food and meaningful connections.

Thrive East Bay is a community of people committed to personal and social transformation. We stand together for a world of love, justice, and belonging. Our monthly ‘Root Down’ events build upon our larger monthly gatherings by providing an opportunity to connect more deeply with inspiring people; to engage in transformative practices that we can carry into our everyday lives; and to share in the power of community in service to a world that works for all.

When: this Sunday, May 7th from 4 – 6pm (please arrive on time!)
Community potluck and connecting from 6 – 7pm

Where: PLACE for Sustainable Living
1121 64th Street
Oakland, CA 94608
(This venue is wheelchair accessible.)

Co-Hosts: Aryeh Shell & Kele Nitoto

Cost: No one will be turned away for lack of funds. There is a suggested sliding scale contribution of $10 – $20 to help us cover our costs. You are invited to contribute what you feel called and are able to.

Potluck: Sharing food together is an essential part of community. Please bring a tasty dish and/or beverage to share with others for the community potluck.

Volunteers: We are seeking volunteers to help with the set-up and break-down of this event. If you are available to arrive early or stay late, let us know at

Invite a Friend: Please feel free to invite a friend who may value attending.

We look forward to ‘rooting down’ in community!

In partnership,
the Thrive East Bay Team


As I retire from cab driving, I look forward to having much more time to explore those issues. In particular, I’m interested in finding, helping to create, and publicizing user-friendly methods that activists could use to support one another to modify their counter-productive social conditioning and become more compassionate and effective. My hope is that such methods will be widely replicated, with little or no training required by the participants.

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!



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.


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:


Holistic, consultative democratic practices


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.


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


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


Being your own advocate is vital.


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.


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!


My sentiments precisely


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.


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.


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.


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.


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


Thanks for sharing the story


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.


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


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.


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.


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.


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


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.


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


hope you are feeling better! many blessings,