Dear Members,

In these COVID-19 days, it’s as difficult as ever to make sense of the world.

Are the pandemic, the global surge of protests against racial injustice, and the crisis of faith in many (if not all) of our established institutions inter-related in some way?

What message do we, the practitioners of the art and science of medicine, have for our fellow human beings in this time of great reflection and contemplation?

Will our understanding of the concepts of health, healing, and wellbeing help light our way as we move forward, down such uncertain and perilous paths into the future?

Will the institutions that we’ve built in the name of health serve as centers of wisdom, reassurance, and guidance in such a time of great turbulence and confusion?

Will we clearly see and be able to articulate the ways in which our healthcare system itself is cracking beneath the weight of its own unsustainability, in synchrony with the inherent instability of so many of the other institutions, industries, and infrastructures which form the foundational pillars of our society?

Perhaps it is precisely the notion of health that is being called into question.

The only viable path forward for our communities, our society, and our civilization is to clarify what health actually is, and learn how to cultivate and nurture a state of health within all of the various aspects of life.

To be healthy is to thrive, flourish, and exist in a state of adaptive, anti-fragile wellbeing.  The words health and healing are related to the concepts of being “whole” as well as to being “holy”.  This implies the importance of integrating various forms of fragmentation and separation, as well as reconnecting to the sacred.

Whether we are able to collectively understand these integrations and connections or not may be the defining question of our time, and may in fact be an existential one.

 

 

I am a family practice doctor working on community-based resilience and health in Boulder, CO.  I have a background in many areas of the American healthcare system.  Originally starting down the path of becoming a transplant surgeon, I later changed course to train in primary care.  Since earning my MD in 1999, I’ve worked for two decades as a board-certified family doc, and many of those years included being an ER physician.  I’ve staffed hospitals, nursing homes, college health centers, and many outpatient clinics.  I’ve also been privileged to live in 8 different countries in Europe and the Middle East.

So this patchworked background has unlocked within me a passion for the broader conversation around health, systemic healthcare, and the concept of healing writ large.

I am continually awestruck by the astonishing power of our western allopathic model to fix people who are broken in a certain way which cannot be denied.  The modern medical miracle is a real thing, and many have benefited from the vast toolbox of drugs and surgery with remarkable success and relief of suffering.  From antibiotics to biologics, from immunotherapies to gene therapies, from liver transplants to total hip replacements.

And yet, it is a toolbox designed for Pandora. Something is terribly wrong.

The system is so complicated that it’s not easy to figure out what is and isn’t actually working.  One important orienting step is to look at ALL of the various simultaneous pandemics of our time, not just Covid-19, as they clearly point to areas in which our current healthcare system is inadequate:

In addition to having lost 200,000 lives to coronavirus in the US at the time of this writing, we are in the midst of a pandemic of chronic disease including cancer, cardiovascular disease, and neurodegenerative disease—all of which are being driven by obesity.  We are also facing a pandemic of addiction in which every 7 minutes someone dies of opiate overdose in the US (not counting any other drugs of abuse or alcohol).  Additionally, a pandemic of autoimmunity and allergies continues to escalate in incidence, along with other environmental illnesses caused by pollutants and endocrine disrupting toxins.  We are also suffering from a pandemic that some have described as a “crisis of meaning” with an alarming increase in rates of suicide, depression, and anxiety.  Meanwhile all of these pandemics are coinciding with the first documented successive two-year decline in life expectancy since World War I.

These multi-dimensional health crises are unfolding amidst a healthcare system so staggeringly expensive that it already eclipses the entire federal budget in terms of cost.  In 2019 the budget of the federal treasury totaled $3.4 Trillion, whereas healthcare spending exceeded $3.7 Trillion, and those expenditures only continue to grow.  By no later than 2027, healthcare spending is projected to exceed $6 Trillion, and by 2030, the annual cost of care for seniors over age 65 alone is projected to reach $3 Trillion.  The math doesn’t add up, especially as we face the prospect of plummeting tax revenues due to the record numbers of business closures and skyrocketing unemployment due to Covid-19.

And much like our systems of education, criminal justice, agriculture, energy production, the media, and infinite-growth based economics in general, etc., even a 5-year time horizon appears unsustainable for these and many other basic institutions without some kind of major overhaul.

To complicate matters, we are at an inflection point of profound uncertainty regarding the impending impact of three concurrent exponential technologies:

AI (Infotech)

Automation (Robotech)

Synthetic Biology (Biotech)

Each of them has the power to completely transform life as we know it very quickly, and yet there is little evidence that we are well-prepared for the various potential outcomes.

We are also facing the unpredictable threats of climate change-induced destabilization of food production and distribution, human migration patterns, and the lives of the billions of people living in coastal communities.  And many experts warn about our national and international vulnerabilities to cyber-attacks, power grid failures, and threats to our clean water supplies.  Such threats continue to mount through the destruction of ecosystems leading to the decimation of forests, coral reefs, fish populations, pollinators, etc., to the degree that we are witnessing the rapidly accelerating extinctions of entire species, which some have calculated to be 10,000x higher than the natural rate.

Related to this decimation is the toxification of our air, water, and soil which is now so pervasive that the pesticide called glyphosate (the active chemical in RoundUp), the use of which has been growing logarithmically since 1990, is now present in human breast milk, in honey, and even in the rain.  And most large ocean fish contain toxic levels of mercury, 10 million tons of which we dump into our rivers and oceans each year.  Newborn babies have detectable levels of 200 chemicals which have been found consistently (almost universally) on day one their life.

Lastly, we are no longer able to ignore or mollify the core wound of our nation, implicit within its founding history.  The profound collective trauma inflicted by our legacy of slavery and ongoing evidence of racism—as well as the genocide and deracination of the indigenous people of North America—continues to haunt us with increasingly painful reminders that this wound has not healed.  Far from it.

Any of these challenges individually, would be considered herculean in times of great harmony and collective solidarity.  Unfortunately they are all converging simultaneously, and we happen to be living in the most polarized society of the modern era, by most indicators.  Our very systems of communication and media are intentionally algorithmically designed to foment outrage, indignation, and vilification of others.

It’s fair to say we have a healthcare crisis in our country and we’re clearly struggling to figure out exactly what’s going on with the system and how best to fix it.  But the answers to both of those questions—both what is wrong and what should or could be done about it—arise from and are interwoven with the deeper challenges that we face as humans on a global scale, on a species level, and as a planetary civilization.

 

 

 

And yet there is hope.  There is potential that by finding systemic solutions to the healthcare crisis, with all of its complex interwoven challenges, we may in fact discover essential insights for addressing the other concurrent crises in the rest of the foundational pillars of our society.  And although most of our institutions will require coordinated and simultaneous re-envisioning, the alignment of our healthcare system towards a new north star could become a catalytic event which aids the others toward effective transformation.

 

But what can be done?

What should we do?

How can we heal on all of these levels?

Where do we start?

Where is the new north star?

 

Here we propose the concept of Salutogenic Eudaimonics as a potential north star.  This thesis rests on the notion that a deeper understanding of health, healing, and human wellbeing and the alignment of our institutions toward their support is the essential first step toward co-creating a future worth building and through which we will gain the necessary insights to address the other systemic issues.  This is the path toward a future in which we are resilient and antifragile and can become worthy ancestors of our children’s children.

The message we all need to hear this this: We already have everything we need to build the most beautiful world which our hearts know is possible (to use Charles Eisenstein’s phrase).  The next move is simply to see it.  To see it with refreshed eyes that can constellate the stars that are already shining brightly, and bring them together into a more coherent and interconnected framework or network— a frame/net that, like most good ideas, doesn’t just come from ordinary thought at all, but from a much deeper place—a realm of openness and willingness to receive.  To receive and breathe in.  To accept insight and inspiration with gratitude, recognizing that it doesn’t just come from the conventional place of cognation or mentation that we use to analyze a math problem.  It incorporates multiple forms of intelligence: concentration, contemplation, and meditation.  It comes from:

 

A place where siloed information does not exist.
A place where the future can be remembered.
A place that can only be entered by saying:  “I don’t know, but we know.”

 

There is a new world view that is gaining the momentum of inevitability.  It is fundamentally non-utopian, non-naïve, and non-pollyannaish.  It radiates both sincerity as well as levity, with both science and spirit. It goes by many names and has various cultura foci and nuances.  Some call it “2nd Tier,” or “Integral,” or “Metamodern,” or “Post-Progressive,” or “Game B”.  Others speak of the coming “age of the Eagle and the Condor.”

This emerging world view develops its source code by clearly seeing the dark sides of the three dominant existing structures as mere variations on an “Us -vs- Them” ethos that must be transcended, while also acknowledging the deep-seeded value of each of those current perspectives.  It looks backwards with gratitude and forgiveness, and looks ahead with openness and hope.  It simultaneously embodies both grief and praise.

This perspective has not yet reached a tipping point in our culture, but it is gaining traction.  It sees both the dignity as well as the disaster of the current mainstream views: conservative, modern, and postmodern.

The conservative (pre-modern) view contains a dark side which retains its ethnocentric heritage.  It proclaims, “my country, right or wrong!”, and “you’re either with us or against us!”.  It leans toward xenophobia, homophobia, sexism, and racism, and not only carries a nationalistic tendency of “Us -vs- Them” but also an extractive, dominating mindset of “Us -vs- Nature.”

The neo-con (modern) view moves beyond targeting specific populations of “Others” (an enormously positive evolutionary leap), but its dark side drifts toward a contracted “Me against The World” stance of hyper individualism, narcissism, and corporate materialism.  Its poster child is Gordon Gecko from the 1980’s movie Wall Street whose motto was “Greed is good.”  Margaret Thatcher also articulated this perspective during a speech in 1987 when she famously stated that “there is no such thing as society, only individuals and families.”

The progressive (postmodern) view attempts to embrace everyone’s “truth” as being equally valid, but quickly backfires upon itself when it vigorously “cancels” those who disagree with their values, especially conservative and modernist individuals, and particularly if they’re white males.  Its dark side holds deep resentment and aversion towards most of the Western, Euro-American socio-cultural enterprise, even its many redeeming attributes. It is often expressed as “Us -vs- the Unwoke.”

All three of these conventional existing “Us vs Them” world views are embattled and locked in bitter and immovable conflict on the political stage, yet each has extremely valuable contributions for our culture.  It is paramount to honor, include, and incorporate their many positive and useful components.  But this trifecta of opposition has brought us to an impasse, and we cannot address our contemporary challenges with their frameworks, structures, and perspectives.  All three are stuck in a war mindset which can only propagate further conflict.

The new cultural dynamics which are emerging arise from the stark recognition which is resonant with the principles of salutogenic eudaimonics. In fact, it is the most salutogenic eudaimonic epiphany of all:

 

There is no Them. There is only Us.

 

 

 

On a microscopic level, when we declare war on pathogenic microbes with broad spectrum antibiotics, we often unwittingly damage our own gut flora with potentially devastating consequences to our biology.  An astounding 90% of all of the DNA in our body is not human.  The vast repository of evolutionary intelligence within our “selves” is in fact neither homo sapiens, mammalian, nor even eukaryotic. It is our microbiome.

On the most fundamental level, we are not separate from the most primordial life forms which first appeared over 3 billion years ago. And they are inseparable from us. These organisms have co-evolved and co-exist interdependently with “us.”

Even as individuals, we are superorganisms.  And while germ theory and the era of antibiotics led to the development of a vast armamentarium of life-saving pharmacotherapies for acute infections, we are now realizing the serious downside of antibiotic resistance and potential unintended consequences of antibiotic overuse in humans as well as in animals.  Similarly, our declared war on insects has decimated our pollinators, causing harm to our ecosystem.  When we declare war on weeds, we poison our soil and water, and damage our bodies.

And on a macro level, when we fail to see that we are in fact a global society that is fundamentally interconnected — wired together with a shared internet-based neural network, we may miss seeing the wisest way forward amidst the mounting dangers of various geopolitical flashpoints.

Ours is the struggle to see the water that we are swimming in, to see our frames, and our own social conditioning.  It is the struggle to recognize our inherent hard-wired ethnocentrism, narcissism, and revenge-seeking (which lead to separation and disconnection), and acknowledge the trauma-perpetuating characteristics of these universal human tendencies.  It is the struggle to reach the escape velocity of the ego’s orbit, both as individuals as well as groups.  To move beyond that vestigial aspect of our being which still dominates our lives, but which is incompatible with happiness and wellbeing and is exclusively oriented toward rapidly cataloguing all of the ways that every moment of our existence is inadequate, unsatisfactory, or wrong.

Fortunately, we have various maps, guideposts, and heuristics by which to reset our compass.

Some of the key tenets of this newly coalescing world view include:

      1. The biomimicry of natural patterns for regenerative sustainability and resilience
      2. An increasing ability of letting go of the need to be right
      3. A willingness and desire for open source information
      4. A deep interest in downstream consequences of our actions and innovations
      5. A lack of conflict between honoring the innate worth and dignity of every human being, while recognizing the inherent hierarchy of values, ideas, systems, methods, and processes
      6. An increasing sense of comfort with paradox, duality, multi-perspectivism, and multidisciplinary approaches
      7. Locally-based, decentralized networks—where-ever possible
      8. “Collaborate not Commiserate” and “Collective Intelligence not Groupthink”
      9. A world-centric circle of deep care and curiosity
      10. A Focus on adult development and conscious evolution of the self first, and society second
A move toward these core principles effortlessly recognizes the value of diversity—which is simultaneously both a celebration of uniqueness and a radical awareness of oneness.

We live in a time between worlds, or it seems that way for many of us. What this means is that, while it is difficult to put one’s finger on it, there is a nonlinear shift that seems to be underway which is neither gradual, linear, nor merely a progression of business as usual, but rather a net zero profit reconsideration of the very basis of our usual business.

It very much feels like the story, the narrative, the agreed upon social contract within our culture no longer fits, or in some ways no longer feels relevant, and needs to be updated in some kind of basic or fundamental way.  A phase-shift is needed and indeed seems to already be underway.

 

 

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