By Michelle Bernabe, RN
The podcast currently has 10 episodes available.
The Sackler family - a name that resonates through the chilling caverns of the opioid crisis, their legacy a symbol of the suffering that has descended upon countless lives. But in this bleak tableau, they inadvertently unveiled a critical paradigm we'd previously overlooked in healthcare: the role of pain as the fifth vital sign.
Now, let's reclaim this revelation. Instead of quantifying the fifth vital sign as physical pain, let's assess something that the Sacklers seemed to have tragically mislaid: a moral compass. Welcome to an era where 'vital signs' take on a deeper, more profound significance. In this world, your encounter with healthcare takes on an entirely new dimension.
Imagine, for a moment, stepping into the hushed tranquility of a clinical space. The routine melody of health checks ensues. Blood pressure - check. Pulse - check. Oxygen saturation, respiratory rate - check, check. But then, a shift in the cadence, an unexpected note. An exploration into your moral health.
Embark on this thought experiment with me. Questions, not of physical wellness but of ethical vitality, begin to unfurl: "Do your daily actions echo the rhythm of your core values? Does your family life breed tranquility or unleash tempests? Do your social interactions ignite fulfillment or spark disquiet? Does the ethos of your workplace align with your moral compass or veer off course? In your interactions with nature, do you feel an exultant connection, indifference, or a pang of guilt? Are the decisions of your government, the laws and policies that orchestrate your life, harmonious with your beliefs or do they strike a dissonant chord?"
This is not a rhetorical exercise; you're prompted to chart these facets on a scale from one to ten. Each number, a reflection of your moral equilibrium within the grand tapestry of life. Your moral health, thus, revealed not as an abstract notion, but as a tangible, measurable entity, ripe for introspection and growth.
Could the way we make moral decisions, how we interpret and act upon what we perceive as right and wrong, be intrinsically linked to our health? This thought might appear to be hanging by a thread at first, but give it a chance, let it steep in your mind for a moment.
The concept of 'moral injury' might help tie these seemingly disparate domains together. To break it down, moral injury is the damage done to our conscience, our moral compass, when we commit, witness, or fail to prevent acts that transgress our deeply held moral beliefs. Now think about the unease, the restlessness that lingers when we go against our core values. We might try to numb it, drown it under indulgences - food, leisure, shopping, alcohol, or drugs. But in the quiet moments, it seeps out, a gnawing discomfort that refuses to be silenced.
This isn't merely a philosophical musing. What if this moral discomfort, this nagging 'injury,' plays a significant role in our overall mental and physical health?
A Lawyer's Struggle with Morality and Addiction
With this backdrop, allow me to introduce you to Greg. A wonderful human I met while working at an ultra-high-net-worth rehab in New York City. He isn't just a man grappling with the complexity of life, but a soul wounded by the profound betrayal of his moral beliefs by a system he trusted. His personal tragedy paints a vivid picture of how societal corruption, and individual choices, infiltrate our being, deeply influencing our emotional, mental, and physical health.
In the tranquility of the upmarket rehab, Greg and I found ourselves nestled on plush armchairs, splitting a tub of Ooey Gooey Butter Cake ice cream as the Statue of Liberty twinkled outside the panoramic windows. The ambiance of the room echoed a quiet yet luxurious solitude.
"Greg," I said gently, "Would you feel comfortable sharing with me the point in your life where you felt alcohol started to take a greater hold over your life?"
His spoon stilled mid-air, and for a moment, he was somewhere far away. Then, shaking his head as if to dislodge the troubling thoughts, he replied, "I suppose it started when I was a fresh-faced lawyer under Roy Cohn."
"Cohn? The infamous Roy Cohn?" I couldn't conceal my surprise. Greg merely nodded, the ghost of a smile playing on his lips.
"Indeed, the notorious Roy Cohn. Words like ‘snake,’ ‘scoundrel’ and ‘a new strain of son of a b***h’ barely do him justice. Law school, even the best one, doesn't prepare you for working with someone of that caliber," Greg said, pausing to draw a long, slow breath. "I was so young then, brimming with hope and dreams," he recalled, his gaze fixed on a past only he could see. "Ideals of justice and fairness, these were what fueled me. I remember the countless hours spent in the dead of night on each case, firmly believing that every word I penned, every argument I presented, could bring about a change."
"Okay, so what went wrong? Weren’t you able to effect that change?" I asked, trying to trace the turning point in his narrative.
"It’s bizarre," Greg replied with a humorless chuckle. "The scales of justice tipped at the most unexpected times. I'd party at Cohn's behest, show up to court unprepared with a hangover, and win. But when I'd stay in, bury myself in my work until the early morning hours, preparing diligently for the case ahead... that's when I'd lose. It was like a twisted joke that I couldn't comprehend."
One night, fuelled by alcohol and frustration, Greg confronted Cohn. "I asked him, 'How can this be? Why am I winning when I shouldn’t, and losing when I’ve given it my all?'"
"And what did he say?" I prompted.
"He laughed," Greg's voice faltered, shaking off years of silenced torment. The room seemed to contract around us, the chill of his past filling the space, making the butter cake ice cream taste bitter. "It was a laugh I won't forget... Cold. Hollow. As though he was amused by my naivety. He leaned back, staring at me through half-lidded eyes. 'Greg,' he said, 'you've got it all wrong. It's never been about the well-crafted arguments or the compelling evidence. ' He had paused then, that smirk still playing on his lips, and I remember the dread that had started to build in my stomach. "
'It's about who has the wealth to buy the judge, to... tip the scales.' His words hung in the air, a veil of corruption revealing itself. 'It's all about who's got the judge snugly fitted into their pockets. You could lay out the best argument of your life and if it wasn’t us who bought the judge it wouldn’t matter.' He had stated it like a simple fact, an unspoken rule of the game that everyone knew but me."
The weight of those words hung heavy in the air. The devastating blow to Greg's faith in the legal system, his vales crushed by the raw, corrupted reality, began the downward spiral.
"I couldn’t cope," he confessed, his voice just a whisper, "My entire worldview was shattered. My whole identity was just wiped away. Where was the justice I had been working for? Where was the difference I was supposed to make in this world?"
"I can only imagine how devastating that must have been," I responded, allowing the weight of his revelation to sink in.
"Yes," he said, a tear tracing the line of his cheek, "The system I had trusted was corrupt. My hope was broken, and I felt so lost. I didn’t know how to make room for this reality in my body so I decided not to feel it and just to drink. It's not a justification, just the harsh truth." His words tumbled out, raw and unfiltered. He was a man well into his golden years, yet there he was, laid bare, tears pooling in his tired eyes.
In that shared silence, I truly saw Greg. Not as a broken man but as a wounded spirit, his journey tainted by a deceitful system that betrayed his core principles. His disillusionment wasn't just a personal tragedy, but a stark reflection of how societal corruption can seep into our very marrow, eroding our physical, mental, and emotional health.
Yet, through the veil of his vulnerability, I saw a stubborn flicker of resilience. It was buried deep, numbed over by years of self-medication, but it was undeniably there. The road to recovery was not just about detoxing his body, but about rehabilitating his faith in humanity, in justice. It would be a strenuous journey, riddled with confrontation of his painful past, but as long as he was honest in his pursuit, there was room for redemption. His journey underscored a profound truth - for healing to occur, it isn't enough to treat the body. We must address the moral injuries that our souls carry.
Unfolding the Concept of Moral Health: Individual and Collective Impact
So, what exactly are we referring to with this concept of 'Moral Health'? Allow me to elucidate: it's not about enforcing a universally accepted moral code or advocating for an elusive state of moral perfection. Instead, it's about acknowledging the significant influence our personal morals, community values, and the ethics of the systems we are part of exert on our physical and mental health. My experience in nursing has laid bare the intricate interplay between morality and health, and the devastating consequences when the moral compass goes astray.
Our moral compass acts as a guide, leading us through life's labyrinth. When that compass is disrupted—when we, or our organizations or communities, lose our direction—it adversely affects our health. As people in positions of influence, our actions can ripple out, impacting the wellbeing of those around us. Conversely, when we live in harmony with our moral principles, our bodies and minds respond positively, fostering healing at a profound, holistic level.
In healthcare, our primary focus often rests on physical and mental health, but the necessity to consider our patients' moral health is increasingly apparent. This might involve facilitating discussions about ethics, understanding their moral dilemmas, or even providing guidance to help them align their actions with their deeply held values—discussions as critical as those about blood pressure and heart rate.
While I'm not suggesting we start prescribing morality, I am advocating for a recognition of its significant role in our overall health. As a nurse dedicated to healing, I believe it's essential to consider all facets of our patients' wellbeing, and that includes moral health.
As we begin to attune our moral health, we'll inevitably start to see transformations within ourselves and in our relationships. When we're grounded in our moral principles and align our actions with our values, we foster a sense of integrity and coherence that radiates outward. This alignment could significantly alter the dynamics of our relationships, making them more authentic, nurturing, and interconnected, with undeniable effects on our physical health.
Moreover, these transformations and ripples of moral alignment could resonate throughout our communities, organizations, and governments. As each one of us engages with our moral health, we collectively foster healthier, more morally responsive systems—systems where honesty is commonplace, compassion is the norm, and these values serve as the bedrock of our shared existence.
So, as we delve deeper into the exploration of moral health, let's remember: it's not solely about individual transformation. It's about fostering healthier relationships, building morally aligned communities, and above all, recognizing our shared humanity in the process.
Thank you, dear friends. But remember, don't just take my word for it; seek silence, listen to yourself.
Michelle & Moral Health
Reflect. Write. Transform: Narrative Medicine
Take a closer look at the artwork below and allow the feelings it evokes to wash over you. What memories and stories does it bring to mind?
Take three minutes to reflect and jot down your narrative. Whether you choose to express your thoughts in a journal or share them in the comments, the critical thing is that you take the time to consider the art and what it signifies to you.
Reflect on a time when you sought refuge in excess—be it alcohol, food, or even exercise—as a means to escape the emotional impact of a moral decision made either by you or someone close to you.
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Greetings directly from the heart of the 2023 American Psychiatry Association Conference! I'm presently enveloped in a profoundly illuminating talk on a topic close to my heart - "Making Good Trouble in Psychiatry". In the course of this compelling session, the healthcare contributions of the Black Panther Party (BPP) have taken center stage, and I'm eager to share these revelations with you.
The mention of the "Black Panther Party" usually conjures vivid images of bold socio-political activism. However, their contribution to the healthcare domain often remains under-appreciated and is a fact that can take many by surprise. History buffs and avid readers may be aware of the BPP's wide-ranging impact, including its pioneering social programs, such as one of the country's largest free breakfast programs. Yet, few are familiar with their establishment of free acupuncture clinics and their ground-breaking initiative on Sickle Cell disease, the first of its kind in the U.S.
Their holistic approach to healthcare, manifested in an extensive network of community clinics, provides an insightful case study of personal, community, and systemic transformation. When you really get to know the Black Panther Party model of healthcare, it’s not far off from ideas that have attracted millions in funding from the likes of 8VC, Sidewalk Labs (Alphabet), Thrive Capital, Maverick Ventures, Town Hall Ventures, EmblemHealth, and more.
Free High-Quality Whole-Person Clinics
One of the most enduring contributions of the Black Panther Party to the realm of healthcare was undeniably the creation of the People’s Free Medical Clinics. These 13 free clinics were spread across the United States during the late 60s and 70s, a time when marginalized communities faced significant barriers to healthcare access.
Offering a diverse array of essential medical services, from hypertension, diabetes, and lead poisoning screening to advanced diagnostic services, these clinics weren't merely notable for their medical provision. Their groundbreaking aspect lay in the fact that these services were available at no cost.
Lowering Costs: Healthcare Access Sans the Price Tag
The BPP's decision to provide free healthcare services in America was a revolutionary move, serving to dismantle the socio-economic barriers that stood between impoverished communities and healthcare. This effort was a clear pushback against entrenched health disparities, casting healthcare as an inalienable human right rather than a luxury afforded by financial means.
Better Outcomes: From Reactive to Preventive Care
These free clinics went beyond providing reactive care to illness. They pioneered preventive health measures, offering health education to promote healthier lifestyle choices and early detection of diseases. This focus on prevention was transformative because it represented a shift from simply treating illnesses to fostering wellness and equipping communities with the knowledge and tools to take charge of their health.
Better Experience: Putting the Community in Health
The BPP's strategic positioning of the People’s Free Medical Clinics within the communities they served was no accident. By placing clinics within these communities, they ensured that the particular health needs and concerns of the communities were directly addressed.
Furthermore, these clinics were staffed by members from the communities they served. This fostered job opportunities while cultivating trust and mutual understanding between patients and healthcare providers.
By offering localized, free, and comprehensive care, the Black Panther Party's healthcare initiatives played a significant role in reducing barriers to health services for marginalized communities. The footprint they left behind continues to inform the operations of contemporary community health centers. Their legacy remains a potent reminder of the possibilities for health equity when healthcare is universally acknowledged as a fundamental right.
Focus on Mental Health: Breaking The Stigma
The Black Panther Party's revolutionary stance on mental health represents a pivotal component of their healthcare legacy. In an era when mental health was shrouded in stigma and misunderstanding, the BPP boldly prioritized it, breaking cultural and social barriers.
Confronting Cultural Stigma
Mental health, particularly within the African American community, was a largely taboo subject during the time the BPP was more active. Many people viewed mental health issues as personal failures or moral weaknesses rather than legitimate health problems. The BPP, however, recognized the criticality of mental health and its inseparable link to physical health, echoing what we now understand as the biopsychosocial model of health.
In the face of widespread stigma, the BPP's open discussions about mental health issues, their advocacy for mental health resources, and their establishment of mental health programs within their clinics were groundbreaking. By doing so, they began to dismantle the cultural barriers that have long hindered mental health awareness and care within their communities.
Social Determinants Are Health
Moreover, the BPP recognized that mental health could not be isolated from the broader socio-economic realities people faced. They understood that social determinants, such as poverty, racism, and violence, had a profound impact on mental and physical well-being.
This awareness led the BPP to approach mental health from a broader societal perspective, advocating for systemic changes that could alleviate the social pressures impacting mental health. Their stance highlighted the importance of addressing these societal factors as part of comprehensive mental health care, a concept that is only now gaining traction in mainstream psychiatry.
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Revolutionizing Mental Health: Acupuncture in the Black Panther Party's Integrative Approach
The Black Panther Party's dedication to holistic care shone brightly in their innovative utilization of the National Acupuncture Detoxification Association (NADA) Protocol. This ear-based acupuncture treatment, conceived in the 1970s and still used today, was initially intended to help manage symptoms of anxiety, trauma, and addiction. But the BPP perceived its potential beyond its immediate therapeutic scope and embraced it as a key component of their forward-thinking mental healthcare strategy.
Holistic and Patient-Centered Care to Build Trust
The prevailing mental health methodology of the time was heavily reliant on pharmacological treatments. Unfortunately, the black community found themselves being routinely overprescribed antipsychotics — a situation that persists to this day. While psychiatric medications are undeniably crucial in managing mental health disorders, their application without thoughtful consideration can breed mistrust due to unnecessary potential side effects and risks.
The NADA protocol, in contrast, presented a non-pharmacological pathway, offering a supplementary or alternative treatment method. By integrating this protocol into their practice, the BPP demonstrated their openness to diverse, integrative treatment approaches. This move not only helped foster a more personalized, comprehensive, and balanced patient care model but also was key in nurturing trust with their patients. This effort significantly enhanced trust within their community and subsequently paved the way for the exploration and acceptance of further treatment possibilities as necessary. This integrative model of care reflected the BPP’s commitment to treating the whole person—not just a set of symptoms—and their broader philosophy of promoting community health and empowerment.
Challenging the Narrow Status Quo
Perhaps most significantly, the Black Panther Party's integration of the NADA protocol challenged the psychiatric status quo. It signaled their willingness to depart from conventional wisdom when such departures could potentially yield better outcomes for their community. Their courage in embracing this new approach to treatment underscored their larger mission: challenging systemic inequities and advocating for comprehensive, accessible, and empathetic care for all.
The NADA protocol was one piece of a larger puzzle in the BPP's healthcare mission. Yet, it exemplifies the forward-thinking and integrative approach that made their healthcare initiatives so impactful and their legacy so enduring.
Advocacy and Activism: Healthcare as a Human Right
The BPP's healthcare initiatives were underpinned by their staunch belief that healthcare is a human right, not a privilege. Their healthcare activism extended beyond their clinics. They lobbied for health policy changes, challenged medical discrimination, and exposed unethical medical experiments conducted on Black communities.
Looking back at the legacy of the BPP from the vantage point of the APA conference, it's clear that their approach to health was far ahead of its time. Their innovative and inclusive healthcare initiatives still carry valuable lessons for our contemporary struggle to achieve health equity.
As we strive to "make good trouble" in psychiatry and beyond, let's remember the pioneering efforts of the Black Panther Party in reimagining community health. Their legacy is a testament to the transformative potential of community-led initiatives in improving health outcomes.
Let's carry their spirit forward in our quest to ensure that everyone, regardless of their socioeconomic status or racial background, has access to quality, integrative, local, and trust-building healthcare.
Michelle & Moral Health
Reflect. Write. Transform: Narrative Medicine Meets AI
Prepare to embark on a contemplative journey as we explore the world of Narrative Medicine and AI-generated art. Take a closer look at the artwork below and allow the feelings it evokes to wash over you. What memories and stories does it bring to mind?
Take three minutes to reflect and jot down your narrative. Whether you choose to express your thoughts in a journal or share them in the comments, the critical thing is that you take the time to consider the art and what it signifies to you.
Consider your first impressions of the Black Panther Party. Now reflect on how the narratives and stories often shared about them have been influenced by who has the power to tell their story. How has learning about their substantial role in healthcare reshaped your understanding of their place in history?
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Dear Moral Health Readers,
As a nurse, I've come to understand that comprehensive health—encompassing both physical and mental well-being—requires us to consider the broader picture. We must truly zoom out. If you've been following Moral Health’s work, you might be under the impression that it's solely about individual change—transform yourself to transform the world. Here, I'd like to add a layer of complexity to that narrative. The best things in life are often paradoxes. Our health isn't merely about us as individuals; it's equally about the complex network of external factors that shape our well-being. Everything is interconnected. And we, good scientists of life, know that. Today, we're going to delve into the symbiosis between healing and the world around us, drawing from the insights of adrienne maree brown. We'll also discuss what this means for us in terms of doing the right thing for our health.
In a compelling metaphor, adrienne maree brown gives us a great way to think about this - she compares healing to a river. She says, "Sturdy like something in motion that is also changing and that requires the balance of the world. The river can dry up if there’s not the balance of the world." This imagery not only highlights the delicate equilibrium between our individual healing processes and the collective harmony of the world we inhabit, but also underscores the need for active engagement in the pursuit of not only taking ourselves to the doctor but also the world.
"Sturdy like something in motion that is also changing and that requires the balance of the world. The river can dry up if there’s not the balance of the world."
Our health is influenced by a complex web of factors, from societal challenges and environmental stressors to interpersonal relationships and power imbalances in the world of business. Take, for example, the Bayer-Monsanto merger, which points to a troubling connection between environmental toxins and the very medicines designed to treat the illnesses they cause. In a world where businesses profit from both the problem and the solution, the cycle of harm continues. So, where does the opportunity to heal lie?
Deep-rooted issues, such as harmful power dynamics, systemic discrimination, and climate change, significantly impact our well-being. Harmful power dynamics in relationships, schools or workplaces can lead to various mental health conditions, including depression, isolation, anxiety, and post-traumatic stress disorder (PTSD), according to the American Psychological Association. Systemic discrimination, as per a study by Williams and Mohammed (2013), has been linked to a range of health outcomes, including heart disease and mental health disorders like depression and anxiety, due to the chronic stress of enduring regularity of discrimination. Lastly, climate change, according to the World Health Organization, is predicted to cause approximately 250,000 extra deaths annually between 2030 and 2050 due to factors like heat stress and malnutrition. And these are merely the most overt examples.
It's time we cast a critical eye on the system we're immersed in. We must pose some challenging questions - can our communities truly find healing while ensnared in a matrix of systems that perpetually foster injustice and imbalance? Is it pragmatic to believe that the path to genuine health lies solely in the hands of our primary care doctors and therapists? This is a pertinent question, especially when some of our relationships and business practices seem to prioritize profit and harm, knowingly or not. This misalignment incites more disharmony externally and internally rather than cultivating equity, healing, and balance.
However, let's not mistake this as a dismissal of the role of healthcare professionals. On the contrary, their expertise is indispensable. But the point I wish to highlight here is that health extends beyond the clinical realm. It is also fundamentally a social issue, embedded in the complex interplay of environmental, economic, and sociopolitical factors.
This perspective invites us to reconceptualize health and healing as something more holistic and systemic, rather than purely individualistic. It challenges us to confront the systems that perpetuate harm and discord, and to consider how we can shift our ways of being towards nurturing equity, healing, and balance. Can we imagine a world where our collective well-being is as much a measure of societal success as economic growth? By aligning our health with our values, we can work towards this ideal and cultivate a society where true health is not just a possibility, but a reality for all.
As adrienne maree brown insightfully points out, "Sometimes the best way I can be with my community, or with someone who’s on a healing journey, or with my own healing journey is to actually return my attention to the larger balance of the circumstances that we’re in." We must challenge ourselves with this question: are we concentrating on too narrow a problem set within healthcare? Are we simply treating the symptoms of health and mental health issues, while ignoring the systemic factors contributing to them? Could it be possible that we're searching for answers in the wrong test? Are we inadvertently aiding an environment that's drying up the river of healing by not adequately addressing systemic human and planetary injustices and imbalances? It's not merely about survival in this current system—it's about reshaping it, redefining it, and reorienting it towards the health and healing we all fundamentally deserve.
"Sometimes the best way I can be with my community, or with someone who’s on a healing journey, or with my own healing journey is to actually return my attention to the larger balance of the circumstances that we’re in."
If you are an organization or individual genuinely dedicated to promoting well-being and impact-driven solutions, or if you are a health organization, I encourage you to thoughtfully navigate the complex landscape of interconnected healing. In pursuit of truly transformative solutions, consider incorporating these key elements:
* Curiosity and Connection Mindset: Invest the necessary time to educate yourself and others about the far-reaching implications of health and mental health. Recognize the truth that individual health does not exist in a vacuum but is intricately interwoven with societal, environmental, and economic systems. We must comprehend that our actions today have a direct bearing on the health of future generations, and that our health is a reflection of the health of our communities and our planet.
* Active Engagement in Works of Justice: We cannot afford to remain passive or indifferent to the profound impact our existing systems have on us. It transcends being merely a societal concern - it's a health crisis that permeates through each of us. We must actively partake in the pursuit of justice, recognizing that our collective health and healing hinge on dismantling systems that are not grounded in human dignity, equity, and compassion.
* Address Harmful Power Dynamics: Power dynamics can be uprooted through fostering a culture where grassroots thoughts are amplified, ensuring voices from all walks of life are heard and valued. This approach pivots towards a wisdom exchange that is bidirectional, disrupting the traditional top-down flow of knowledge. It's a move towards a more empathetic and respectful culture that honors all points of views and holistically nurtures mental health and well-being. It's a future where no voice is insignificant, no idea is too small, and every human being has the power to inspire change.
* Enviromental Consciousness: Understanding the health impacts of the environment is crucial. Exposure to toxins, polluted air, and extreme weather, exacerbated by climate change, can lead to a variety of conditions including inflammation, cancers, respiratory and cardiovascular diseases, as well as mental health stressors, among others. Advocating for health-protective environmental policies and supporting sustainable solution organizations is imperative. Individual actions to reduce one's carbon footprint, like using renewable energy and waste reduction, can significantly minimize personal health risks. Such eco-friendly habits not only preserve the planet but also enhance physical and mental health, illustrating the vital symbiosis between environmental consciousness and health.
* Self-Reflection and Mindful Action: Engaging in self-reflection and mindful action indeed fosters personal insight and accountability, vital for both individual health and the well-being of our interconnected world. This introspective journey illuminates our innate interconnectedness with the world, underlining how our actions inadvertently influence the broader ecosystem. Uncovering this interplay can awaken a deep sense of responsibility to not cause harm, to ourselves or the world. It's a profound realization that when we are truly connected to ourselves and cognizant of our place within the global community, causing harm seems incongruous with our nature. Instead, we naturally gravitate towards actions that promote health and harmony. This shift is more than personal growth; it's a ripple effect that can transform societal norms and inspire collective healing. The power of self-reflection and mindful action, therefore, extends beyond individual health, sparking a chain reaction of positive change in our intertwined world.
The river of healing might appear to be drying up in certain places, but as long as we continue to support each other, hold ourselves accountable, and truly understand the interconnectedness of our experiences, we can replenish it with the life-affirming waters of empathy, understanding, and growth.
Thank you, dear friends. But remember, don't just take my word for it; seek silence, hear yourself.
With warmth and hope, Moral Health
Reflect. Write. Transform: Narrative Medicine Meets AI
Prepare to embark on a contemplative journey as we explore the world of Narrative Medicine and AI-generated art. Take a closer look at the artwork below and allow the feelings it evokes to wash over you. What memories and stories does it bring to mind?
Take three minutes to reflect and jot down your narrative. Whether you choose to express your thoughts in a journal or share them in the comments, the critical thing is that you take the time to consider the art and what it signifies to you.
Prompt: Recall a time when you felt a deep connection to the world around you, whether it was admiring the beauty of nature or feeling a sense of community with those around you.
Thanks for reading Moral Health! Subscribe for free to receive new posts and support my work.
As I eagerly first stepped into the bowels of the New York City Hospital, a disquieting dissonance washed over me. This city, so known for its ceaseless dance of lights and unabashed extravagance, seemed a world away from the hospital's dimly lit corridors and the stifling air of abandonment that pervaded its halls. How could a place so vital to the health of a city so vibrant be so disheartening and forlorn?
The staff, visibly strained from overwork and underappreciation, teetered on the edge of breaking. The equipment surrounding us seemed like relics of a bygone era, desperately in need of modernization. And to make matters worse, there were never enough supplies to meet the demand. The scene unfolding before me was a tragic comedy, where laughter served as a coping mechanism to grapple with the harsh realities.
My debut as a psychiatric emergency room nurse catapulted me into a world of intensity and chaos—a place where each decision held the power to sway the delicate balance of life and death. Virginia, one of my enigmatic mentors, seemed to saunter through the hospital's chaos with a grace that commanded respect and admiration. There was something in the way she navigated the storm, a poise and determination, that set her apart.
Virginia and I were as different as night and day. I was a hopeful novice, green and eager, while she was a seasoned realist on the cusp of retirement, her hair streaked with gray and her face lined with wisdom. Our contrasting dispositions often led to clashes, but her candid demeanor helped me develop a deeper understanding of life. Virginia's sharp wit and unrelenting honesty were an enthralling mix, and though her words could sting, I found myself drawn to her unvarnished truth.
One day, she led me out of the depressing confines of the hospital and into the gritty embrace of the city streets. It felt as if I'd stepped right into the heart of a raw, unfiltered New York City film.
Leaning against the cold brick of the emergency entrance, Virginia stood as a pillar of unwavering strength, her face etched with the fierce determination that I would come to know as her signature.
With a casual air, Virginia pulled a cigarette from her pocket and lit it. She drew in a deep breath, and as she exhaled, tendrils of smoke swirled in the crisp air. I glanced around nervously, half-expecting a stern supervisor to materialize and chastise us, but Virginia seemed unconcerned with potential consequences. She was a vision of unyielding defiance, radiating an indomitable sense of self-assurance.
"What about the hospital's no-smoking policy?" I ventured cautiously.
Virginia rolled her eyes, releasing a plume of smoke. "Oh, honey, breaking the rules is what makes life worth living," she said with a dark chuckle. "Besides, we all gotta die of something, right?" Watching her smoke with such audacity, I grasped that Virginia represented more than just a mentor to me. She embodied the grit and tenacity needed to not only endure but thrive in a harsh and unforgiving system. I couldn't help but wonder if I had what it took to survive.
Gathering my courage, I asked Virginia for her honest opinion of me. She flashed a wry smile and took a puff of her cigarette before responding, "You, my dear, are a clay pigeon - just waiting to be shot." Her words served as a sobering warning, but at the time, I was too young and inexperienced to fully grasp my vulnerabilities within such a massively misaligned system. So I laughed it off instead.
In the first month of shadowing Virginia in the psychiatric emergency room, I was plunged into adventure and turmoil, a bizarre fever dream that seemed to defy reality. To compound the already bewildering bedlam, Virginia – a steadfast conservative with a penchant for debate – took delight in goading me, as if it were a sport.
One incident, in particular, remains etched in my memory. With a devilish grin, Virginia shared how she used to release patients from the psych ER directly to Zuccotti Park, during the Occupy Wall Street encampment, guiding them toward free resources such as food, water, and socks.
Astonished, I asked, "Are you suggesting that you would encourage people who were recently discharged from a psychiatric emergency room to join a protest camp?" Virginia nonchalantly shrugged. "What better place for them to find support and community? These individuals are already feeling ostracized and disempowered. At least there, they can be part of something bigger."
I was taken aback. The notion of releasing vulnerable patients struggling with mental illness into the pandemonium of a protest camp struck me as reckless at best, perilous at worst. "You are absolutely insa—”. I caught myself and rephrased. “Doing that was completely inappropriate and dangerous," I exclaimed.
A spark of mischief in her eye, Virginia countered, "Dangerous, you say? You know what's truly dangerous? The status quo. How many times have we seen patients with mental illness being released from the hospital with zero follow-up care? How many times have we seen them return to the hospital because they didn't receive the support they needed in the community? The belief that we can persist in our ways and expect different results. That, my dear, is the epitome of a dangerous insanity."
She leaned in, her voice animated. "At least my discharge plan involved clothing, food, and a sense of community. What does your plan offer these vulnerable souls? A relentless cycle of forced hospitalization in locked facilities, stripping them of their autonomy and freedom?"
Her words struck me like a gut punch, catapulting me into a maelstrom of clashing emotions. I wrestled with both the inner turmoil born from admiring Virginia's unwavering conviction and iconoclasm while feeling a gnawing upset about her unorthodox and inappropriate methods. As the dissonance grew, I began to recognize that her audacious decision to send patients to the Occupy Wall Street encampment – though deeply disconcerting – painted a vivid picture of the systemic inadequacy we were facing. The fact that such a radical alternative could be considered by a compassionate and veteran nurse only served to emphasize the pressing need for change in a system that consistently fails those it is meant to protect.
How could it be that I had just earned my degree from a prestigious New York university, only to find myself blindsided by the intricate complexities of a hospital just a stone's throw away? One of the nation's finest, no less. The chaos and turmoil that had swallowed me whole upon entering the psychiatric emergency room, the bewildering fever dream that had initially left me reeling, now appeared as a glaring reflection of the broken system I had unwittingly become a part of – a system I would be compelled to navigate and decipher, whether I was ready for it or not.
Reflect. Write. Transform: Narrative Medicine Meets AI
Prepare to embark on a contemplative journey as we explore the world of Narrative Medicine and AI-generated art. Take a closer look at the artwork below and allow the feelings it evokes to wash over you. What memories and thoughts does it bring to mind?
Take three minutes to reflect and jot down your narrative. Whether you choose to express your thoughts in a journal or share them in the comments, the critical thing is that you take the time to consider the art and what it signifies to you.
Prompt: Describe a time when you encountered an unexpected teacher in your life. What was the circumstance and how did this person impact your learning or personal growth?
I always love to read your reflections below!
Thanks for stopping by, friends.
Whether you are a reader or a writer, don’t forget our Moral Health disclaimer!
Thanks for reading Moral Health! Subscribe for free to receive new posts and support my work.
Greetings, friends! Welcome back to Moral Health, a substack dedicated to inspiring reflection, fostering transformative insights, and uniting a community of individuals who are passionate about personal growth and moral progress. Together, we'll explore the intriguing realms of reparative memoirs, narrative medicine, and moral leadership, all while spotlighting the fascinating and often wild world of healthcare.
In today's post, we provide a housekeeping update by revisiting the core principles that govern this Substack, along with presenting a necessary disclaimer!
Foundations Rewind: Setting Intentions, Embracing Accountability, and Healing Together
Let's begin by revisiting the core principles that we’ve built thus far:
The Smoke Signal: Building a Community of Growth - We openly share our values and aspirations in order to attract kindred spirits, creating a tight-knit, supportive community of remarkable individuals eager to grow together.
Beyond Cancel Culture: Accountability Embraced - We foster an environment that transcends cancel culture by valuing accountability, embracing a reparative mindset that encourages growth, understanding, and compassion for one another.
Healing and Evolving Together: A Journey of Equals - As we embark on this journey, we recognize that each of us is here to heal and evolve, learning and growing with each step we take.
Narrative Medicine and Reparative Memoirs: Illuminating Characters, Stories, and Catalysts for Personal Growth
As we move forward with Narrative Medicine, we will introduce reparative memoirs that illuminate a vibrant array of characters and stories from both my own and others' experiences. These memoirs will serve as catalysts for personal reflection and growth, interpersonal repair, and systems change, helping us contemplate and process the complexities and challenges present in the realm of healthcare (and beyond!).
The Disclaimer: A Restorative Twist on the Usual Memoir Disclaimer
At Moral Health, we take a unique approach to writing that blends personal experiences, and restorative justice principles. Occasionally we will use narrative stories as a means to promote reflection and foster change. Throughout this narrative medicine journey, we'll share a series of "moments" that represent composite scenarios of people, challenges, and situations encountered within the healthcare system. To protect privacy and promote restoration, all names and identifying characteristics have been altered, and some events and dialogues have been condensed or recreated.
Our goal is to use these composite scenarios to spark reflection and discussion around systemic issues within healthcare, with the aim of driving restorative and transformative change. It's important to understand that while these moments may feel familiar, they do not depict any specific individuals. Rather, they represent composites of people and experiences that we can all learn and grow from.
The opinions expressed by the authors in this Substack represent their own personal reflections.
Kindly note that these thoughts are solely attributed to the authors listed with each post and do not reflect the positions of their employers or colleagues.
Embarking on the Transformative Journey Together
Now that we’ve gotten our housekeeping out of the way, I'm thrilled to embark on this journey with you as we explore the reparative memoir genre and our unique approach to narrative medicine and moral leadership. We'll confront uncomfortable truths, meet intriguing and, at times, uncomfortable characters, and challenge ourselves to become better individuals and community members.
So, let's dive in together and begin our transformational journey. Thank you for being an essential part of the Moral Health community. We couldn’t do it without you.
In solidarity,
Michelle and Moral Health
Reflect. Write. Transform: Narrative Medicine Meets AI
Prepare to embark on a contemplative journey as we explore the world of Narrative Medicine and AI-generated art. Take a closer look at the artwork below and allow the feelings it evokes to wash over you. What memories and thoughts does it bring to mind?
Take three minutes to reflect and jot down your narrative. Whether you choose to express your thoughts in a journal or share them in the comments, the critical thing is that you take the time to consider the art and what it signifies to you.
Prompt: Write a story about a time when you faced a conflict between achieving personal success and making a positive impact.
Thanks for reading Moral Health! Subscribe for free to receive new posts and support my work.
Hello Moral Health friends!
As we continue our journey toward building the foundational components for Moral Health, calling in community, and adopting a restorative mindset, we now turn our focus toward ourselves.
Our next community cornerstone honors the wisdom of the late Grace Lee Boggs, a trailblazing activist and philosopher. Her mantra, "Transform yourself, transform the world," challenges us to examine our personal lives, jobs, and relationships as the frontlines for cultivating new systems.
As we strive to improve healthcare, it's important to consider whether positive change can occur without individuals within the system committing to personal growth, healing, and introspection. While change is inevitable, it's crucial to ask if it can be directed towards progress without inward focus. This is where the concept of Moral Health becomes crucial as a catalyst for driving substantive change.
Healing and Evolving Together: A Journey of Equals
One thing that should be made clear from the outset is that everyone at Moral Health, myself included, is joining you on this journey as equals, not from a position of moral superiority. We're all in this together, learning and growing with each step we take. In the spirit of "the healthy don't need a doctor," despite healthcare being full of them, we acknowledge that we are all here to heal and evolve. Boundless humility, unwavering accountability, and insatiable curiosity define the essence of our shared pursuit.
Embracing the Unfolding Healthcare Revolution: Could Facing Your Demons Unlock the Future of Healthcare?
A recent PwC survey of 2,000 CEOs revealed that 40% believe their companies will cease to exist within a decade, and nearly 60% feel they should invest more time in transformation. Healthcare, as an integral component of this landscape, confronts a seismic shift that presents a multitude of challenges.
To successfully navigate this transformation, we—healthcare professionals, patients, and administrators—must be adaptable, innovative, and courageous. Dave Chase, a healthcare visionary, recently underscored the necessity for resilience and resourcefulness amidst the "Innovator's Dilemma." We are called upon to embrace new ways of thinking and develop groundbreaking solutions to the challenges we face.
Building on Dave's insights, could it be that we have missed a vital element in our quest to revolutionize healthcare? What if an additional component to transformation lies in prioritizing our personal healing? By bravely confronting and resolving our inner traumas, biases, and struggles, we become clearer and more creative effortlessly. I contend that leaders and business builders who take an integrated mind-body approach with themselves can be more effective in establishing an adaptable healthcare system that values and respects the worth and dignity of every individual. This is because they have learned to do the work on themselves first, enabling them to build systems that reflect their inner empathy, authenticity, and compassion for the people they serve. Although this trauma-informed leadership approach is often overlooked, I am convinced that it can play a critical role in addressing the many challenges facing healthcare today.
When people carry unresolved pain, they not only inflict harm on others but also contribute to perpetuating dysfunctional systems.
The healthcare industry, worth trillions of dollars, is a lucrative space that rewards even the most unskilled and unfeeling among us. However, if we truly yearn to go beyond profiting off the pain of others and create a healthcare system that is truly transformative, then we must make self-healing a top priority. Neglecting to acknowledge and address our own wounds and traumas will only serve to uphold an unjust and dysfunctional system.
Are we willing to acknowledge the role our own personal growth and healing can play in creating a more equitable and just healthcare system? Can we dare to question how our own transformation can be the catalyst for uprooting a colossal "too big to fail" system?
The key lies in understanding that broken individuals create and maintain broken systems. This cycle persists as the pain of one is unconsciously transmitted to others, and the broken system itself only serves to reinforce this suffering. To truly break free from this pattern and foster genuine healthcare transformation, we need to muster the courage to confront our own brokenness and harms and address them, healing one at a time.
Having fun with chaos theory.
Chaos theory highlights the "butterfly effect," implying that even the smallest actions can yield significant and far-reaching impacts in complex systems. Recognizing that all individuals carry some form of trauma, and that no one possesses a perfect set of circumstances, those who have not embarked on the journey of healing inadvertently make small daily choices and decisions that perpetuate this cycle of dysfunction on others and within the system. On the other hand, I believe that by pursuing a path of self-healing and growth, we can contribute to rectifying these systems. Just as the subtle flutter of a butterfly's wings can set off a chain of events culminating in a distant tornado, our personal healing journeys are crucial in reshaping healthcare.
A collective shift in how we manage our personal well-being is essential if we aspire to create systems that genuinely care for others. The process of healing begins with simple measures: learning to acknowledge and sit with our emotions, nurturing self-compassion, taking accountability for our actions, and embracing and offering forgiveness. As we achieve inner balance, we disengage from harmful patterns, establish boundaries with individuals and systems that evade accountability, and move towards people and systems that conscientiously strive to be sources of authentic healing. Through our individual healing and growth, we transform into healthier people, eager to construct and participate in healthier systems. Our personal development catalyzes a ripple effect, inspiring others to embark on their own healing journeys. This marks the tipping point for a profound evolution in healthcare.
Let us carry with us the wisdom of Grace Lee Boggs and remember that true transformation starts within ourselves and radiates outwards to the world. By turning inward with grace and determination, we can co-create a future where every individual has the opportunity to be healthy and free.
In solidarity,
Michelle and Moral Health
Reflect. Write. Transform: Narrative Medicine Meets AI
Prepare to embark on a contemplative journey as we explore the world of Narrative Medicine and AI-generated art. Take a closer look at the artwork below and allow the feelings it evokes to wash over you. What memories and thoughts does it bring to mind?
Select a prompt and take three minutes to reflect and jot down your narrative. Whether you choose to express your thoughts in a journal or share them in the comments, the critical thing is that you take the time to consider the art and what it signifies to you.
AI Art #1
Prompt #1: Describe a moment when you realized that healing is not a linear process and how that understanding has impacted your journey.
AI Art #2
Prompt #2: Share a personal story about how your unhealed wounds or biases led to a difficult interaction with someone else, and how you overcame the situation through self-reflection, awareness, and personal growth.
Prompt #3
Prompt #3: Share a personal story of a time when you discovered the need to prioritize your personal healing journey and began to explore and embrace the different parts of yourself that you may have previously ignored or suppressed.
Thanks for stopping by! As you reflect and write, consider sharing your thoughts with a loved one, or a colleague, or posting them below.
Here are three ways to get involved with Moral Health:
* Read and engage with our content by subscribing to our substack.
* Reflect and grow with our narrative medicine prompts, either in your personal journal or by sharing in the comments section below.
* Submit your story or artwork to be featured on the substack and inspire others and be part of shaping a better healthcare future for all.
The Moral Health Rules of Engagement: A Reparative Approach
Welcome back to the world of Moral Health! Before we begin our transformative journey, which will push us to confront the messiness of moral leadership, the challenges of repairing harm, and the beauty of building more equitable systems, let's establish some ground rules. Here, we don't shy away from the difficult conversations - we dive headfirst into the depths of what it means to be a moral leader and engage in restorative practices. This is a space where everyone is welcome to experiment fearlessly, emerge stronger, and create real, lasting change.
But before we get to some of our norms some exciting news - since our last chat, we've birthed a new and innovative genre called Reparative Memoir. This revolutionary approach blends narrative medicine, restorative justice, reparative reading, and actionable steps for transforming individuals and systems, starting with ourselves.
In the coming weeks, we will explore this groundbreaking genre further and share case studies and thought leadership on moral health. Join us for an engaging and transformative journey. But before we begin, we invite you to explore our first norm.
To make the most out of this journey, we request you embrace a reparative mindset. You may be wondering what that means. Let us explain.
The Power of a Reparative Mindset: Building Bridges in a Divided World
Paranoia, paranoia, everybody's coming to get me. It's a common feeling that many of us experience, especially in today's polarized world. We're quick to judge, quick to criticize, and quick to cancel. But what if we took a different approach? At Moral Health, that's exactly what we strive to do, and it all starts with the reparative mindset.
The reparative mindset, inspired by the refreshing work of Eve Kosofsky Sedgwick, is a way of approaching the world that seeks to build bridges instead of walls. It calls for us to pause, reflect, and recognize our own biases and defenses, and to make a deliberate effort to understand the viewpoint of those who hold different opinions.
Embracing a reparative mindset can be challenging because it requires pausing, becoming aware of one's own biases and defenses, and intentionally seeking out opportunities to build bridges with those who hold different beliefs or perspectives. It's critical to note that there is a competing mindset that can make this endeavor even more difficult - the paranoid mindset.
The paranoid mindset focuses on finding faults and issues without acknowledging any positives. This approach leads to snap judgments, accusations, and attacks on others without any attempt to understand their perspective. Let's look at an example of an unexpectedly hot-button LinkedIn comment I made last week. To write restoratively, I will not use any of the actual responses, but I will enlist AI to help reimagine what came next.
A key community norm at Moral Health is to make space for different voices and opinions, even if they don't align with our own. It's essential that we learn to listen and understand, even when we don't agree. We don't have to see eye-to-eye on everything, but we must learn to be comfortable in relationships with people who are not like us and still treat them with respect and dignity.
Let’s first look at a paranoid response:
While a paranoid response may offer a momentary sense of satisfaction, it does not actually achieve much apart from the dopamine hit of having a real “zinger”. Paranoid responses tend to be reactive rather than proactive and often focus on assigning blame rather than finding solutions. A paranoid response can often lead to further division and mistrust, making it more difficult to achieve the desired outcome. Therefore, it's essential to approach problems with a clear and rational mindset, focusing on constructive actions that lead to positive change.
On the other hand, the beauty of the reparative mindset is that it allows for disagreement while fostering empathy and understanding. It creates a positive and inclusive environment where all voices are heard and respected, no matter their background or beliefs. When we approach interactions with this mindset, we open ourselves up to transformative change and growth, both individually and as a community.
Now a reparative response:
At Moral Health, we firmly believe that the reparative mindset is essential to create a robust and supportive community that can challenge entrenched systems in healthcare and beyond. So much so it’s our first community norm, and while it may not be easy, it's certainly worth it. By embracing this mindset, we can break down the walls that separate us and work towards a more connected society, where we build bridges instead of burning them.
If you ever feel the paranoia creeping in, pause and reflect on how you can better understand and connect with others. How can you break down barriers and foster meaningful connections? It's important to remember that transformation and healing are possible for both individuals and systems, and it all starts with adopting a reparative approach to how you interact with others. Join us at Moral Health in embracing a mindset of healing and understanding, and let's work together to forge new paths in this divided world.
How to Use Chat Bots to Reimagine Disagreements
Here's an idea: next time you find yourself passionately disagreeing with someone, try engaging with Chat GPT or any other chatbot. Take action by typing in your response and then prompt the chat with a request like "keep my opinion but make it more restorative" or "rewrite this using Eve Kosofsky Sedgwick's reparative framework."
By exploring the resulting output, you can gain fresh insights and potentially discover new ways to approach disagreements in a more constructive and collaborative manner. And don't forget to have fun with it!
Give it a try and let me know how it goes - whether it leads to a breakthrough or a laugh, every experience is valuable.
Reflect. Write. Transform: Narrative Medicine Meets AI
Prepare to embark on a contemplative journey as we explore the world of Narrative Medicine and (mostly) AI-generated art. Take a closer look at the artwork below and allow the feelings it evokes to wash over you. What memories and thoughts does it bring to mind?
Select a prompt and take three minutes to reflect and jot down your narrative. Whether you choose to express your thoughts in a journal or share them in the comments, the critical thing is that you take the time to consider the art and what it signifies to you.
AI Art #1
Prompt #1: Describe a time when you experienced a broken relationship, and reflect on what you learned from the experience.
AI Art #2
Prompt #2: Reflect on a time when you approached a situation with a negative, paranoid mindset and the impact it had on your experience.
90s Music Video #3
Prompt #3: Listen to Flagpole Sitta and reflect on a time you had to change who you are to fit in with a particular group or community.
Thanks for stopping by! As you reflect and write, consider sharing your thoughts with a loved one, or a colleague, or posting them below.
Here are three ways to get involved with Moral Health:
* Read and engage with our content by subscribing to our substack.
* Reflect and grow with our narrative medicine prompts, either in your personal journal or by sharing in the comments section below.
* Submit your story or artwork to be featured on the substack and inspire others and be part of shaping a better healthcare future for all.
With love,
Michelle & Moral Health
Thanks for reading Moral Health! Subscribe for free to receive new posts and support my work.
Moral health is the understanding of the systems and structures that shape our world and actively working to create a more just and equitable society. As Martin Luther King Jr. famously stated, "the arc of the moral universe is long, but it bends toward justice." However, with a staggering 4 trillion dollars the temptation to bend away from morality in healthcare can be strong. It is our duty to ensure that the arc of the moral health universe remains steadfast, guided by values and principles, not just by the pursuit of ego and wealth.
In healthcare, it's a heartbreaking reality that the system is rigged against those who it is built to serve. The ones who are already struggling with their health, the ones who are fighting for their lives, are often being robbed. This is not just for patients, but for the dedicated and hardworking health workforce as well. The system is failing them too. We must recognize how broken it all is. Are we taking time to pause and really reflect on what is actually going on in healthcare beyond just attempting to fix it? If we don’t create room for critical reflection, we aren’t going to be capable of building solutions strong enough to transform the system.
As an NYC nurse for over a decade, I've witnessed heartbreak, pain, and helplessness every day. It's taken an immense toll on me and left me feeling overwhelmed, unsure of how to process the traumatic events I've encountered. As a patient, I've struggled to deal with my own emotional turmoil during my illness, feeling lost and helpless. And as a caregiver, I've been torn between being polite and being an advocate for my loved ones, navigating the healthcare system's labyrinth with no clear answers. The reality is, the healthcare system is a mess and it breaks my heart.
The mission of Moral Health is to gather people who see the importance of storytelling and introspection in advancing healthcare systems. We won't shy away from the challenges in the industry, even if it means facing very uncomfortable truths and spilling very hot tea.
As a nurse, I have witnessed healthcare leaders champion change, but too often prioritize their own ambitions over the greater good. It's clear that many leaders lack the reflective tools necessary for making responsible and transformative decisions. How can you make a connected decision if you are not even connected with yourself? In my experience, there’s an inverse correlation. That's why I believe that by prioritizing self-awareness and storytelling, we can tap into our creativity and humanity, and build the cognitive capacity needed to bring moral health to healthcare.
This Substack is a smoke signal for individuals who seek to bring about change in the healthcare industry. This community provides a space for individuals who are dedicated to improving the healthcare system through a diverse range of approaches, such as deep listening, constructive conflict, restorative practices, contemplation, and balancing innovation and tradition. This community is for those who are truly invested in the healthcare industry and are determined to create change not only within institutions but also within themselves.
By joining this community, we strive to create a more equitable and just healthcare system and world. Here, we will have conversations about healthcare in various perspectives, both critical and personal, spiritual and humorous. We will explore the interplay between healthcare, individuals, and society. We will delve into healthcare from all the views available to me as a queer nurse in Brooklyn - a perspective that may diverge a wee bit from what you are accustomed to hearing. And hopefully, this change in who holds the healthcare mic will be a positive one. The more voices singing healthcare karaoke, the more fun it will be. I promise.
As stakeholders in the healthcare system, our voices hold a great deal of influence and can play a crucial role in driving positive change. One way to tap into this power is by utilizing the principles of narrative medicine, which recognizes the transformative power of storytelling. By taking the time to examine the narratives that play out every day in healthcare, we can gain a deeper and more personal understanding of the impact healthcare has on us, as well as the impact we have on it.
By pausing to deeply listen or write your story, you have the opportunity to not only process and make meaning of your experiences, but also to impact the lives of others. Engaging with narratives has the power to inspire, comfort, and provide hope to those who may be trying to move through similar experiences. It can also contribute to the creation of a culture and systems that prioritize empathy, compassion, and ethical decision-making in healthcare. Going inward to change external systems is an act of bravery and vulnerability that has the potential to make a lasting impact. So why not take this chance to use narratives to strengthen your capacity for good and healing? The arc of the moral universe is long for us all.
Here are three ways to get involved with Moral Health:
* Read and engage with our content by subscribing to our substack.
* Reflect and grow with our narrative medicine prompts, either in your personal journal or by sharing in the comments section below.
* Submit your story or artwork to be featured on the substack and inspire others and be part of shaping a better healthcare future for all.
So, whether you stumbled upon this substack through a random search or by word of mouth, you've somehow found my smoke signal. Stay awhile, we need one another.
— Michelle
AI + Narrative Medicine Exercises: Free Your Mind
Take a seven minutes to reflect and use these AI-generated images and prompts to journal or share your thoughts in the comments below - feel free to stray from the prompts if they are not helpful.
Image #1
Prompt #1: Write about the complexities of balancing the stress of a demanding life situation with the need for self-care, ritual, or healing.
Image #2
Prompt #2: Reflect on the implications of prioritizing personal financial gain over the basic needs and health of others.
Image #3
Prompt #3: How do images and stories in the media shape our ideas about different groups in healthcare?
I’d love to read your reflections below!
Thanks for stopping by, friends.
Thanks for reading Moral Health! Subscribe for free to receive new posts and support my work.
[I wrote this poem on my last day as a full-time nurse in a psychiatric emergency room in new york city.]
"You Kind Of Had To Be There"
—
It was a big love. It was late-night stories and early-morning banter kind of love. The kind of love that is a divine disruption to your reality. The kind of love that keeps you up till 730am. The kind of love that has you endlessly asking open-ended questions. The kind of love that is constantly confronting you with how lucky you are. The kind of love you want to tell everyone you meet about but you kind of had to be there for.
It was the heart-filled comfort of Filipino cooking, it was begging for more of that Jamaican jerk chicken. It was midnight snacking on red jellos, kosher puddings, and Mott apple juices. It was a menu of late-night cocktails that were exclusively drawn up in syringes.
It was impassioned conversations about consent or lack thereof. It was learning that touch isn’t always healing. It was the inappropriate choice of laughter because you couldn’t bear to keep crying. It was the quiet sanctuary of a bathroom floor. It was a fierce independence that turned into a sloppy codependency (with the panic button).
It was the explosive aggression of the Broadway star after a night of smoking K2, the homicidal woman about to have a baby, the biological man pregnant with lizard twins, the secret alcoholism of the American Ballerina, the strength of the single father to call 911 on himself, the billionaire who threw his "always recognized but rarely seen" Amex Black Card at my head, the late night tv star that assured me I was a f*****g c**t, the supermodel who didn't remember who she was, the endearing and gentle lives behind shocking NY Post cover stories, the honeymooner whose manic episode caused the plane to emergency land, the Ivy League student desperately hiding his first schizophrenic break, the elementary school teacher who stopped taking her Abilify, the sassy teenager who communicated only in hashtags, the refugee with trauma so severe he sat catatonic and mute, the financial tycoon who survived his second suicide attempt, the active duty military personnel who didn't trust herself with her own gun, the con artist faking it all to get away from his parole officer, the known murderer whose chilling words shook my legs indefinitely, the wannabe ISIS member who was too disorganized to get in touch with ISIS.
It was being a brand new nurse and having a twenty-something addicted to heroin gently teach you the best way to stick a needle in a vein. It was being 26 and not knowing what to say to the inconsolable subway conductor who just killed the person who jumped in front of his train.
It was fighting to stay present to each experience after the eleventh hour and fighting to not take home each experience after the twelfth.
It was being outraged with the status quo, it was knowing the status quo is the best we have. It was the terrible reality of seeing a patient come back again and again, it was the quiet comfort in knowing they're still alive. It was seeing people terrified of themselves, it was learning to see myself in them. It was nakedness, exposure, vulnerability, and failure. It was inclusivity, mercy, forgiveness, and surrender. It was a psychiatric emergency room in New York City. It was, at times, the furthest I've ever felt from myself. It was, at times, the closest I've ever felt to God.
No one said love would be easy and you definitely were not. Maybe that's why I liked you so much. Like the best of lovers, you transformed my every cell forever changing the shape I will take in this world. I will step forward softer and stronger for having stood beside you in your most broken places. I am grateful for each experience, violently dark and playfully light, that we shared. Although our time together is ending, our love is not. And perhaps, that's my favorite thing about big love.
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This poem is for B. In 2019, I was honored to read it to members of NYC City Council.
The sun dipped low, painting the sky in fading light. It was your turn, a ritual of sorts, to pick our next song. You typed into YouTube, "Ben Howard — Old Pine." Like so many nights, in that tired, sterile hospital room, we laughed and sang, our voices in perfect discord. Then, your gaze filled me with deep sadness, like the flick of a light. "Everything okay, B?" I asked.
"Michelle, I dream of ordinary things—I want a job, you know, and someone to love." Your glance caught the trucks arriving each evening at the hospital morgue. "I think I'd be a great boyfriend. I'm strong and kind, isn't that what people want?" Your sorrow shifted to an optimistic smile.
Those bright green eyes saw more than any young person should.
"Take your medicine, okay? I don't want you back here again and again. You're nineteen. Your whole life is ahead. That job, someone special—you'll find them."
"Michelle, I feel so lonely out there. The voices are the only friends I have. When I take this medication, I lose them. Without them, I truly have nothing."
B, you taught me so much about the field I was a professional in. Making me question the label we slapped on you and the chemicals we forced in you. A tortured mind full of such brilliance. Sunday night, you got off those train tracks. And walked yourself to the emergency room.
B, you lived your life so perfectly.
Days later, the sky darkens, and an unexpected storm wakes me. "Hello?" "I'm sorry, can you repeat that?" I struggle with her words. She tells me you returned to the hospital, as was often the case. But... this time… tears overwhelm me. Confusion... nausea...
"Michelle, B is dead." Her tone is detached, clinical, "He was pulled off the subway tracks and he walked himself to the emergency room. The team decided he didn't meet the admission criteria. They sent him away. An hour later, he was brought back, severed in two."
Severed in two? I can’t... I can’t feel my body.
"Michelle, after all these years, his mother finally came to the hospital." Silence. "His... his mom..." Her voice breaks. "His mom was inconsolable, screaming, pounding on the plexiglass, '¡Tu lo mataste! ¡Mataste a mi hijo!'"
I hang up the phone. My hands shake, my thoughts circling in a relentless loop, whispering the same two words: I'm sorry.
I’m sorry that in the year 2017, we lacked a system to nourish a life as vibrant as yours. I’m sorry we believed we knew what was best for you. I’m sorry we failed to understand you. I’m sorry that after you stepped away from those subway tracks on Sunday night, we decided you didn’t need help. I’m sorry there was no space for you. I’m sorry that despite your vulnerability and courage, the hospital only made room for your cold and dismembered body. B, I am so sorry.
that, like so many others before you,the only thing in this worldwith enough grace and strengthto hold and supportyour brown bodyyour radiant mindyour curious eyeswere those heavy wooden panelsand those sharp iron subway rails.
I’m so damned sorry
you didn’t die fighting your illnessyou died fighting ours.
B, you lived your life so perfectly.
Dare I say, God is in the Rails/ Michelle Bernabe, RN/ June 1, 2017
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