Communal Medicine: A Path to Physical, Emotional, and Social Health

By Pierre Morin

Health and sickness are mystifying processes full of meaning and challenges. They are embedded in social and cultural environments that benefit some more than others and thus need us all to hone our social awareness and skills. They are also dreaming processes that require a new process-oriented intelligence and practice. Communal Medicine is about exploring the many intertwined experiences we have when we are getting sick or are facing illness. It is about understanding the lived experience of disease and the objective realities of medicine within their individual, social, cultural, dreaming, and spiritual contexts. Understanding the complex layers of a person’s and community’s health care experience will help health care providers and participants alike improve their own and their patients’/clients’ physical, emotional, and social health.

• Language: English
• Publisher: Gatekeeper Press
• Release date: Aug 3, 2023
• ISBN: 9781662909030

Book preview

CHAPTER 1

Preface

• • •

A copla is a poetic form of four verses found in many Spanish folk songs. The one above by Manuel Machado describes the vision behind most forms of creativity: to melt the heart of people in their soul and to dedicate the process to future generations. In this book I articulate ideas that abide by the same values and vision: They don’t belong to me; rather, they are yours to use, share and sing. These ideas also need further musical adaptation and transformation. They are by themselves a living organism that with your feedback, input and further development will grow and evolve.

Writing about communal and social aspects of health and medicine takes me out of my comfort zone. Most of my training and practice has been in supporting individuals manage their personal health and psychological experiences. My previous two books, Health in Sickness, Sickness in Health and Big Medicine have centered on individual health issues. In fact, I always knew that as individuals we are embedded in a social and communal field that has significant impacts on our individual experiences and our abilities to stay well. But I deferred to the taboo or shyness to look beyond the individual and broaden the sphere of inquiry to include communal aspects that I experienced in medicine and medical trainings,

Then, community and social issues are messy. As we learned from the student and feminist movements everything personal is political and everything political reverberates into all our personal lives. We cannot extricate ourselves from our communities. We are fully implicated and entangled in all social issues. All our histories and personal biases show up mercilessly. Once we open ourselves up to and engage in our communities, with our social identities and privileges we are naked and vulnerable to very exposing and confronting reactions and feedback. No wonder anybody with a sane mind and heart avoids getting involved. Of course, this is easier for someone who has some privileges to rely and fall back on and is not constantly threatened by oppressive behaviors and discriminating structures. As I continue writing you will see clearly through me, my strength and failings, my biases that stem from my upbringing in a white, middle-class family in Switzerland.

So, the questions are: How do we diagnose the social impacts and how do we include social health into our practice? What does it mean to invest in population-based health interventions? And, instead of remaining silent, how do we raise our voices to facilitate the necessary changes?

Paradoxically, while the biggest advances in health have been or would be community-based changes, we all still collude on focusing on the individual. At the end of the 19th and the beginning of the 20th century sanitation and hygiene breakthroughs helped combat bacterial infections before the advent of antibiotics. This and many other breakthroughs are community-based: Reducing alcohol related disease and death through raising alcohol taxes, the reduction of suicide deaths in the UK in the 1950s through changes in home heating sources from coal to natural gas, preventing infant mortality through maternal education and empowerment, rising health literacy through Head Start in the US.

We are social beings but our social awareness lags behind. We feel impotent because we don’t have the tools to tackle the social conditions people are grappling with. As we marginalize our own responsibility in creating our social world, the social character of our health remains obscured. And then, because we do not agree on how to solve our social problems―admittedly these are very complex issues―we fall back on focusing on the individual, also in part because some of us are materially benefiting from the status quo of our social arrangements. This is also true for many health care professionals and probably for many of us reading this book.² Because we are profiting from our social status and privileges, we are in danger of having an inherent conflict of interest and hiding behind our privileges. The result is that the focus remains on the individual body at the expense of systemic or structural issues and to the detriment of the less fortunate among us.

One main thesis of this book is that an individual’s body is only part of the causal reality of disease. We need to move beyond thinking of health as only biological and see that the conditions in which people are born, grow, work, live and age play a key role in influencing who gets sick and how they will fare with their disease. Our social arrangements are determinants of our health. We have individual vulnerabilities and predispositions and are impacted by social or systemic stressors. This relationship between the individual and the community and how it manifests in our bodies is what excites me and what I want to write about.

In this book I compiled years of experiences in medicine, community health, and Process Work practice. This backdrop of experiences informs my writing. In addition, in my writing I draw from multiple sources of knowledge and inspiration. Its foundation is intersectional and transdisciplinary. I bring to bear thoughts and conversations from evolutionary biology, anthropology, sociology, psychology, political science, theology, poetry, medicine, and epidemiology.

I would like to share my excitement and stimulate your own thinking. I will offer some inner work or mindfulness exercises to give you an opportunity to transpose some of the ideas and theories into your own practice and make them personally relevant.

In my writing I at times speak from an agreed-upon practical, rational, and factual perspective. I also integrate other levels of discourse, ones that touch upon feelings, relationships, and aspects of our experiences that are intuitive and dreamlike. Finally, I want to share my visions and values and reach you on a deeper intangible essence or spirit dimension. All these levels are relevant and important. While they at times compete and conflict with each other we need them all.

Although we might all like to believe that our experiences, feelings, and knowledge are utterly individual, each of us is in fact heir to a complex and largely invisible lineage of stories and emotions. We live through the bodies and eyes of innumerable predecessors. I would like to acknowledge my great-grandfather and my grandfather who were at the forefront of treating tuberculosis patients before the discovery of antibiotics. In the late-nineteenth and early-twentieth century they led the sanatorium of Leysin in the Swiss Alps above the Lake of Geneva. They opened the first popular facility addressing a stark health disparity of the time by giving access to the most modern treatments of the time to low-income citizens. Besides surgical procedures, these were clean, fresh mountain air and good nutrition that boosted the immune system to wall off pockets of pulmonary tuberculosis.

Wealthy citizens from all over Europe had come to Leysin for the alpine scenery and experience and rich patients were now referred to these up-and-coming sanatoria in the Swiss alps where they spent months and years until they recovered or succumbed to the disease. Thus, initially, this form of treatment was a luxury, like a deluxe health spa, which was only accessible to the most privileged. But my great-grandfather had a social instinct, and he initiated the creation of the first popular sanatorium. He advocated with county and local governments to fund the treatment facilities and give access to tuberculosis treatment to everybody who got pulmonary TB. Then, during World War I and II, many soldiers living in closed encampments became susceptible to the pandemic of contagious tuberculosis, and this infectious disease became a public health and geopolitical problem. This was one of the factors that led the Swiss federal government to create government-established health insurance and social security funds which further facilitated the access to treatment.

One of my grandfather’s medical residents, Doctor Louis Constant Vauthier, was a follower of the internationalism movement that flourished in the wake of World War I. He believed that people should unite across national, political, cultural, racial, or class boundaries to reduce conflict and war. Doctor Vauthier created a university TB sanatorium for poor sick university students and professors from all over the world. With this very diverse group of patients, Doctor Vauthier developed programs for sharing knowledge, art, and culture and building community across difference. This unique social health experiment drew the attention of many such as Mahatma Gandhi.

My personal family history illustrates that the themes I will be expanding on in this book are pre-existing. They are not new but part of my family heritage and part of our cultural legacy. The social dimension of health, the injustice of health inequities, the importance of communal and emotional healing are topics that have pervaded across time and generations.

Why am I, a white privileged man, writing about communal aspects of medicine? I think it is as much my job as anyone’s to address health inequities. Simone de Beauvoir, the French philosopher said it eloquently when speaking about the history of sexism: The whole of feminine history has been man-made. Just as in America there is no Negro problem, but rather a white problem; just as ‘anti-Semitism is not a Jewish problem: it is our problem’; so, the woman problem has always been a man’s problem.³ That is the message of this book: We are all needed to create a better world and alleviate unnecessary communal health suffering.

2 This depends greatly on our individual social identities and lived experiences.

3 Simone de Beauvoir, The Second Sex, trans. H.M. Parshley (New York: Knopf, 1952).

CHAPTER 2

Prelude: The Truth Takes Work

• • •

Not wanting to know means asking for oppression⁴ says the historian Timothy Snyder in his analysis of the medical systems in the United States. He continues to say that facts and truth don’t always align with what we feel and believe; but that without the hard work of truth finding there is no freedom. The facts we will see are horrendous, so devastating that they are almost impossible to face. The refusal to recognize that health care is a human right, and that our social and communal arrangements kill more people than any other disease is the most pressing public health plague.⁵ Health is the place where all of the social forces converge to express themselves with the greatest clarity and importance. Health is where everything comes together.⁶

Another truth is that affective polarization—a poisonous cocktail of othering, aversion and moralization⁷—is increasing and becoming more acrimonious. These communal emotions and beliefs, so fraught and misguided they might be, are realities that shape our world. We are as handicapped in stepping up to addressing the practical social and health inequities as in facilitating the subjective beliefs and feelings that originate in our lived experiences of these social circumstances.

We know, there is truth, right and wrong, there are boundaries, differences, people who are better, stronger, more capable, there are losers and winners. We are individuals with different skill sets, characters, and personal histories. Our families share different ancestries, our communities’ different cultures and values. It appears at times that we live in different worlds, different realities, and on different planets. Our world views are antagonistic, the chasms between us seem insurmountable; we want to fight for what we believe in, convince others, and win them over to join our causes and worlds.

This makes it difficult for us to listen, step into other people’s moccasins or shoes, see the world from their perspective, find common ground and ways of collaborating across differences. We struggle with building relationships and instead insist on being right, winning and making others lose. Thus, I believe, we need more empathy, emotional intelligence, and what I call communal intelligence.

Our bodies are the recipients — some may experience them as being the victims — of the social arrangements and dynamics we live in. We used to think that stomach ulcers were caused by social stress. This turned out to be wrong but chronic activation of the body’s stress response is a major cause of many diseases and of premature death.

Our personal histories, family histories, the community environments we grow up and live in have, as we know, an impact on our bodies and health. Our experiences of abuse, trauma, pain, struggle, or joy, pleasure, and support manifest themselves in our bodies and create health inequities and differences. Our body symptoms and health issues tell their story and shape us in our diversity.

We also experience acceptance and rejection for some of our differences. We know that our body shapes, genders, gender identities, sexual orientations, skin colors fit more or less with dominant culture norms. Depending on where we fit on these normative scales, we will experience in our bodies more or less pain, injuries and diseases. In addition, we subconsciously internalize these norms and add a communal and personal layer of shame, guilt, and rejection.

The body manifestations of our diversity, the lived and embodied experiences have, as I said, their own stories and they are asking to be told. When unfolded, they express aspects of our own inner diversity. In our identities, the ways we see ourselves and envision our lives, we mirror some of the dominant culture norms we have been socialized in. With our personal agendas we become one-sided and our bodies’ responses balance our primary identities and add new possibilities.

For example, I am prone to allergies, both airborne and food. I have had bouts of asthma and suffer from eosinophilic esophagitis, an allergic illness that happens in my esophagus and at times triggers severe spasms that won’t let anything go down, not even saliva. These spasms occur most often when I am eating while being emotionally distressed. My cultural and family conditioning made me conflict avoidant and remain outwardly calm, even when I am deeply upset. In contrast, my esophagus refuses to stomach or swallow anything. It shows me an alternate behavior.

Our body symptoms are the embodiments of the world and environments we live in and in some ways also a response to our internalized individual and group identities. With all their complexities and need for social change, they can bring us new insights and solutions. They are the result of social dynamics and offer new openings and doors for more awareness about inner and outer diversity. Our bodies are vessels that carry the individual and social burdens. Paradoxically they help us awaken to our own inner diversity and can bring wholeness. While we are victims of social trauma and illness our symptoms and injuries don’t have to define us. We can re-contextualize them and integrate them into our life stories and use them to learn more about our whole selves. Our symptoms and challenges are problems to be solved and they have stories or messages that are asking for consciousness.

The mind of Man is fram’d even like the breath

And harmony of music. There is a dark

Invisible workmanship that reconciles

Discordant elements, and makes them move

In one society.

The English romantic poet William Wordsworth in his poem from The Prelude has another conversation and claims another idealist truth about Nature’s harmony and her invisible conciliatory workmanship.

While we live in different worlds, have different histories, more or less power and privileges, different genders, sexual orientations, skin colors, ages, and health, we live on the same planet and universe and have a shared basic nature and need for safety to strive and love. While there are genetic differences and inborn traits, no one is born a criminal, liar, or oppressor. While we are unique and special, our neighbor is as unique and special as we are. While we deserve love, health and well-being others have the same right.

The body is where we process most of what happens to us and through which we develop maladies as well as resilience, flow, and healing. Trauma and healing express themselves through our individual and communal bodies. They are not just private experiences. The body is the vessel that locks away our stories, good and bad. Resilience and trauma are transmitted over generations through the way our genes manifest themselves in biochemical processes.⁸ As doctors, healers, and health professionals we owe it to our patients and communities to rethink medicine in terms of individual and community relationships. The purpose of this book is to explore both the wounding and healing of our individual and collective bodies.

One of the biggest issues in health and medicine today is what results from our individual and collective rank unconsciousness; the lack of understanding of how the ways our individual and systemic ranks, powers and privileges impact us and others. Rank unconsciousness is our most serious public health crisis. Rank unconsciousness that takes the shape of racism in its individual and structural manifestations and contributes to toxic social stress is a death sentence and leads to early deaths. Rank unconsciousness about access to power across gender lines and identities defines sexism and misogyny. Rank unconsciousness in wealth and resource distribution creates class hierarchies, poverty, and associated health inequities and causes lost lives. Rank unconsciousness in the balance of geopolitical power leads to destruction and war. Rank unconsciousness in the way we treat our environment results in global warming and real threat to our survival and existence.

The lesson I want us to learn is that each of us as individuals live in the context of a community of other people and the environment and that our individual and systemic relationships have an impact that can foster or destroy people’s health and lives.⁹ So that when, for example, we choose as individuals and communities to overlook power and rank differentials as public health issues and deny health care and health justice as a human right, it is a major ethical and moral issue for us as individuals and a society. On the other hand I am also making the case that our human world is less a collection of individuals and communities, with some dominating, but more an entangled and contaminated web dealing with crises together.¹⁰ I hope this book will help us focus our attention on social and structural dynamics as well as empathy and love and caring for everyone.

In the following pages I will make the case that there is a malaise of medicine that needs our attention; that the malady of medicine is rooted in the lack of understanding and acknowledgment of the structural dynamics of rank, racism, class and other oppressions; that we deserve to be liberated from the systems of oppression; and that in alignment with Timothy Snyder, to be free we need our health, and for our health we need one another. For this needed collaboration I will draw on Process-oriented Psychology or Process Work, a set of values, practices and skills that foster multi-level awareness for the benefit of individuals, groups, and communities.

4 Timothy Snyder. Our Malady: Lessons in Liberty from a Hospital Diary.