Detroit is dying and does this country give a damn?

Broken down Detroit Homes (Photos by Rudy Owens)

The River Rouge neighbhorhood is lined with broken and burned homes, like these.

As a native of Detroit, I present this first of several essays, with a profound sense of sadness. (See my photo blog for my first photo essay.)

Here's the proof if you need it--Michgian verifies I am a Native Detroiter.

Here’s the proof if you need it–Michigan verifies I am a native Detroiter.

It is hard to accept that my birthplace, this once great global city, has become a symbol for American industrial decay and capitalism’s larger ills. At one point, Detroit boasted nearly 2 million residents in the 1950s. Today is barely counts 700,000 residents. [Updated census figures, 5/5/2015.]

In its heyday of bustling industrial production, Detroit served as a global icon for American ingenuity, industrial might, and economic power. During World War II, when the larger metro area produced the country’s war weaponry to defeat the Axis powers, Detroiters proudly called their city the Arsenal of Democracy. In the 1920s and 1930, about 40 percent of all automobiles were manufactured in the Motor City and the Ford River Rouge plant was the world’s largest.

Today, Detroit is known more as the murder capital of the United States, and the arson capital. All told, 90,000 fires were reported in 2008, double New York’s number—for a city 11 times larger—according to Mark Binelli, author of Detroit City is the Place to Be. It is the epitome of racial politics. Binelli notes, 90,000 buildings are abandoned, and huge swaths of the 140-square mile urban area are now returning to nature. Beavers, coyotes, deer, packs of wild dogs, and foxes are now reported in the city.

Photo Courtesy of Detroit Dog Rescue: up to 50,000 wild dogs roam Detroit.

Photo Courtesy of Detroit Dog Rescue: up to 50,000 wild dogs roam Detroit.

I just visited Detroit, and the trip had a more profound impact on me than I was prepared for. How is it that our country could undertake two overseas wars to conquer and rebuild nations—Iraq and Afghanistan—and yet abandon a city that helped to make the country the global power it once was.

National partisan politics have played a role, with Detroit becoming a symbol of the Democratic Party’s failure, as a black city and union city, in the eyes of white and conservative detractors. Then there are NAFTA (pushed by Bill Clinton) and industry fleeing the country for cheaper manufacturing from global suppliers and gross mismanagement of the Big 3 automobile companies, two of whom were bailed out by U.S. taxpayers in 2009.

White flight eventually followed long-simmering racial tensions. There have been Detroit race riots in 1863, 1943, 1967, and 1987. Those riots were stoked by historic racism, redlining, job discrimination, and the building of freeways that helped to destroy America’s inner cities. Today, some criminal fringe actors among Detroit’s mostly black residents are burning what’s left of their own city, for at times just the hell of it.

Burned home Detroit Photo

A burned and destroyed home is a common site. This one is near Livernois and I-75.

Charlie LeDuff, author of Detroit, An American Autopsy, painted a heart-breaking tale of the city’s self-destructive conflagrations through the tales of firemen trying to combat the arsonists. “In this town, arson is off the hook,” said a firefighter to LeDuff. “Thousands of them a year bro. In Detroit, it’s so fucking poor that a fire is cheaper than a movie. A can of gas is three-fifty, and a movie is eight bucks, and there aren’t any movie theaters left in Detroit so fuck it.” (I will do a photo essay of fire-ravaged homes shortly.)

That latest malaise, on top of repeated political scandals and corruption by the city’s bureaucrats and criminal politicians, was a crushing bankruptcy filing in the face of an $18 billion debt. In December 2014, after a year an a half in limbo, a grand bargain was struck with creditors, the city, the state, and private industry that prevented the city from selling its city-owned artwork (Rembrandts, Van Goghs, and more) in the world famous Detroit Institute of Arts.

Diego Rivera Mural DIA

The Diego Rivera Mural at the Detroit Institute of Arts highlights the brutal and still glory days that once were Detroit, the Motor City.

As I wandered the glittering white palace that is the DIA, I wondered, what’s more important, this art or the blocks and blocks of emptied neighborhoods that most of this country has forgotten.

Tweet After Returning to Portland From Detroit
Coming back to Portland was hard. I posted a comment on Twitter as soon as I arrived back home how bizarre it was to be back in the whitest city in North America, Portland, after spending time in the city that America defines as African-American.

Ripping off the system, one patient at a time

This week, I attempted to do what consumers world over try to do: figure out the cost of a transaction to make an informed decision before I acted. Everyone from market shoppers in Malawi to mega-billionaires choosing to invest their capital does this. They all are promoting their self-interest and also trying to save or even make money.

I wanted to know what a doctor’s visit would cost and how much truly might be or might not be covered. If needed, I wanted to know if I had to find a better bargain, if the first option would not be an affordable activity with my plan. It might have been easier to walk across the Sahara barefoot, without water.

What I tried to do is impossible for American consumers trying to figure out the price of just about every medical procedure, doctor’s or dentist’s visit, and hospital activity.

Photo courtesy of Harvard, showing people protesting for health care access. But most of us want health pricing information too, and are prevented from getting that by providers and insurance companies.

Photo courtesy of Harvard, showing people protesting for health care access. But most of us want health pricing information too, and are prevented from getting that by providers and insurance companies.

Today, except the for very rich who do not need insurance, there is no such thing as a functioning U.S. health care market, where consumers can freely choose to pick their providers and choose lower-cost options. Insurance companies and providers do everything possible to hide prices and bully and even threaten insured consumers who are trying to make choices that occur in rational and functioning markets.

The Commonwealth Fund notes, “… the U.S. health care market is unlike any other market: patients rarely know what they’ll pay for services until they’ve received them; health care providers bill different payers different prices for the same services; and privately insured patients pay more to subsidize the shortfalls left by uninsured patients. What’s more, prices for health services vary significantly among providers, even for common procedures such as laboratory tests or mammograms, although there’s no consistent evidence showing that higher prices are linked to higher quality.”

The Commonwealth Fund argues that even some modest reforms in pricing transparency, with our broken system, could lead consumers to “receive high-quality services from lower-cost providers … This, in turn, could encourage competition among providers based on the value of care—not just on reputation and market share.”

So what does this have to do with me and my experience? Everything, actually.

Gauging consumers one by one: the thousand cuts approach:

For years, I have consistently tried to get dentists and doctors to give me a price quote before a visit. To date, I have never had any medical provider provide me prices or codes without fighting tooth and nail, and often it is with caveats that claim they are exempt from any responsibility if their pricing information is wrong, even with the diagnosis code for a routine checkup.

Here is how the health provider and health insurance fraud and rip-offs work, patient by patient, and this is how it recently happened with me.

Step one: Call the provider and have them evade sharing information.

  • “We can’t provide you a diagnosis code until you see the physician.” To which I reply, “I am trying to understand if the charge will be covered by my insurance company.” They answer, “We can’t do that because the doctor may do [fill the BS line that you prefer].”

Step two: Call the insurance company and have them not tell you if a possible charge by a provider is within their “usual and customary charges”—a term that is behind a wall of secrecy and never shared with consumers, ever.

  • “Hello, I’m trying to determine if my visit to my physician is covered and if the charges are within your accepted ranges.” They reply, “Sir, we can’t do that. We’d need to know the diagnosis codes and procedure codes before we can possibly investigate that.”
  • To which I reply, “Sir/mam, I don’t have that. Doctors’ offices never tell you that. I don’t have the codes.” Or, if I was able to get a code for a check up, “Here is the diagnosis code [fill in code], what is your accepted charge.”
  • The reply could be, “Sir, I told you we would need the diagnosis code to investigate…” Me interrupting, “Sir/mam, I just told you they won’t give me that code, and no doctor…” Them interrupting, “Sir, you are becoming agitated, stop interrupting me. I was saying we need the diagnosis….” Me interrupting, “I am not becoming agitated. I am behaving perfectly rationally. I just want to know what this will cost and how it will be covered.”
  • They reply, “Sir, I have already told you, without a diagnosis code and procedure code, we are not able to provide you…” Me interrupting again, “Sir/mom, did you just hear me when I said the office will not provide me with a diagnosis code.”

Usually such a song and dance can go on for about five or 10 minutes. In the end, the insurance reps will likely have bullied the consumer and employed their standard and tested propaganda that justifies preventing nearly all consumers from knowing if any medical procedure will truly be covered and at what level. The same works for hospitals, clinics, and other practices, who will not share their prices.

In short, they have created a system that perpetuates waste, fraud, and abuse, one patient at a time, systemwide—and it is a system that remains protected by powerful special and political interests who profit from this.

Who the hell created this mess and what it means:

We can thank our political process that encourages special interests to buy influence and bankroll candidates with campaign donations for a good chunk of this mess. We can also thank the so-called health insurance companies from protecting their market share that makes the United States the most inefficient and most expensive health care system among all developed nations.

The Commonwealth Fund in 2014 reported the U.S. trailed other developing nations in health care outcomes and costs.

The Commonwealth Fund in 2014 reported the U.S. trailed other developing nations in health care outcomes and costs.

The Commonwealth Fund also has found that the U.S. system underperforms and has worse outcomes than 10 other industrial nations, mirroring past findings. No surprises there—this fact has been reported by health and public health researchers now for years. The U.S. economy devotes an absurd 17.7 percent of GPD to health care spending, almost double that of its peers.

How the United States compares to its peers in health care spending by GPD. Source: Commonwealth Fund.

How the United States compares to its peers in health care spending by GPD. Source: Commonwealth Fund.

The Center for American Progress has described the consolidation of power by the bloated middlemen of our dysfunctional health care system as a crisis, due to consolidation and market control. The center reports the “lack of competition has led to growing insurer profits, increased costs and reduced coverage for enrollees, an epidemic of deceptive and fraudulent conduct, and rapidly escalating costs.”

Theodore Roosevelt in 1912 led one of the earliest efforts to support a national health plan in the United States, and received support from progressives at the National Progressive convention that year.

Theodore Roosevelt in 1912 led one of the earliest efforts to support a national health plan in the United States, and received support from progressives at the National Progressive convention that year.

From the early 1900s to the present, major efforts to reform the U.S. health care system to create a national health system have failed. Some of the principal profiteers that have safeguarded the status quo are the monolithic health insurance companies, like Premera Blue Cross, my provider.

Other bloated health benefits providers include Aetna, Wellpoint, UnitedHealth Group, Cigna MetLife, and Humana. All of these companies are major political players who donate generously to members of Congress and state officials.

The health insurance model is a system vigorously defended by the GOP-controlled Congress, whose members theoretically support open markets, when in fact GOP members have attempted to derail the Affordable Care Act more than 50 times as of January 2015. And that reform was ultimately about reforming the existing health insurance market, not changing the system to promote openness in pricing or improving population health that is linked to universal health care systems.

The ACA only offered modest efforts to promote transparency. The law requires hospitals to publish and annually update a list of standard charges for their services. Other provisions about requiring exchanges to show prices are at best failed and complicated efforts that do nothing to break the wall of secrecy that has fed the beast that is our health insurance market.

The most pathetic part of this is, when I as a consumer try to do something, I am labeled a problem and seen as the bad guy. But I am OK with that, because doing the right thing always will meet with resistance. I have never kissed a doctor’s feet or behind, or those of companies that profit through monopolistic practices. I do not intend to start now. It just rubs me that today when I see the doctor, and tell him to make his pricing transparent, he will roll his eyes and give that “whatever look.”

My note to the Oregonian about its amazingly bogus reporting on “immunization debates”

The resurgence and outbreak of the most contagious virus on the planet, measles, has led to a swarm of media stories that have tried to report responsibly about the pockets of perpetrators of bogus science.

Even in the face of rock-solid research, done at the population level, proving without question that there is no link between autism and autism spectrum disorder and the measles, mumps, and rubella vaccine, the naysayers continue to promote ideas that have the same validity as racial eugenics of scientific quacks and Nazi racists. There are many parties who are helping to fan the flames of ignorance that threaten innocent children who have no ability to tell parent deniers that they put infants at serious health risks when they do not have their kids immunized from extremely infectious and very preventable illnesses.

This photo, courtesy of the BBC, shows a vaccine vial for the commonly used vaccine used to prevent the spread of very contagious viral illnesses.

This photo, courtesy of the BBC, shows a vaccine vial for the commonly used vaccine used to prevent the spread of very contagious viral illnesses.

Former Playmate Jenny McCarthy and clusters of deniers on both sides of the political spectrum are partially responsible for the resurgence of measles we are seeing around the country today.

What is particularly irresponsible is when formerly balanced media outlets choose to fan the debate flames to promote their products when there is no scientific or medical basis for claiming the issue is “a debate” as opposed to a public health crisis that requires layers of interventions to ensure the best health outcomes for all of us.

Tonight, I read the Oregonian newspaper’s story seeking to solicit input from science deniers with this astounding headline: “In the debate over vaccines, where do you stand?” At the bottom of the story were numerous blog comments that were not moderated. No surprise the journalistic adventure gave Portland’s now world-famous anti-fluoride, vaccination-denier, and anti-public-health community another platform to spout nonsense. Such sloppy journalism keeps bogus science alive and well, even when quackery like eugenics is now considered bad and un-modern. (In the end, quack science is still quack science.)

The Oregonian newspaper ran this story in its online edition on Feb. 4, 2015, which helps promote skepticism that is thorough debunked as junk science.

The Oregonian newspaper ran this story in its online edition on Feb. 4, 2015, which helps promote unproven public health skepticism that is thoroughly debunked as junk science.

Reporter Kjerstin Gabrielson wrote, “What influenced your decision to immunize or not immunize your children?  Has the recent measles outbreak in the United States swayed your opinion? What concerns do you have about immunizations? What concerns do you have about the diseases vaccines are designed to prevent?”

In response to the Jenny McCarthy style journalism I found, I chose to write this note directly to the reporter. Here it is. I hope she can make amends later for her journalistic transgressions and learn a little bit more the history of communicable diseases in the Oregon, where diseases like smallpox literally helped to wipe out many Native American communities before most white settlers arrived.

Letter Sent Feb. 4, 2015, by email:

Ms. Gabrielson: What exactly were you and your editors possibly thinking framing the public heath issue of a scientifically proven health intervention (MMR vaccination) that is used globally to save lives by giving precedence to  perpetrators of junk science whose ideas have now been thoroughly disproven by peer-reviewed, country-wide, and massive population-based studies showing absolutely no proven link to autism and the MMR vaccine?

Do you even understand what a population-based study is? Do you understand statistical significance or P-values? Do you understand the perpetrator of this bogus original article has been thoroughly debunked? Do you even know the history of this state where infectious diseases literally wiped out entire Native American villages on a scale that makes Ebola look like a mild chest cold?
 
If I were to start claiming, say that European Jewry was responsible for causing World War I and helped to defeat Germany, would you print an article with a headline talking about, tell us your thoughts on the debate about Jews’ role causing WWI. Would you open up your comment blog to Nazis and skinheads who will speak with utter sincerity using widely disproven racial eugenics theory that have the exact same scientific validity as those perpetrated by former Playmate Jenny McCarthy?
 
Wow.
 
Maybe you should learn about what happened to Native Americans in Oregon barely 160 years ago, due to smallpox and malaria. Maybe that might inspire you and your paper to use your brains. Promoting profits for junk reporting at the expense of public health is rather disgraceful if you ask me.
 

One of the best little health books ever published

Few books stay with me for long. I read them and give them away. One has stayed on my bookshelf, now for 26 years. That book is Dr. Stephen Bezruchka’s The Pocket Doctor. First published in 1982 by the Mountaineers, this pocket-size reference, now being published at a bit more than 100 pages, is exactly what its title implies. It is a guide to help a traveler cope with illnesses many people in the developing world face daily. You can buy it online from many vendors, like Powell’s Books.

The Pocket Doctor Cover

Cover of the second edition, 1988 version of Dr. Stephen Bezruchka’s The Pocket Doctor (personal copy).

I credit this book for saving my bacon and mental health on several best-forgotten nights. It helped me cope with medical problems that are normal for hundreds of millions of residents globally, and for me something I did not experience back in the comfort of the United States. But I am not the only writer and traveler who praises Bezruchka and his book.

Why many trust Bezruchka’s work

Bezruchka is a Canadian-born former emergency-room doctor trained at some of the nation’s best universities (Standford, Harvard, Johns Hopkins). He has both an MD and MPH. He has worked with medical specialists in the developing world, notably Nepal for 10 years. He also has written a great guide called Trekking in Nepal, which I used back in 1989. Today he is a lecturer on global health at the University of Washington School of Public Health (UW SPH) and a nationally recognized advocate for health care reform to improve public health outcomes and to eliminate health and income inequality.

I have taken this book with me now to three continents: Asia, Africa, and South America. I just cannot say goodbye to it, even when my developing-nation jaunts seem fewer and fewer.

The advice it provides has helped me to self-diagnose all manners of common gastrointestinal disturbances, such as food poisoning (nasty and scary in a crappy place), dysentery, and common diarrhea. I also used it to help me obtain the necessary medicine for what I still believe was malaria, which I had in Kigali, Rwanda in 1997.

With this book in my hand, I felt I could handle the predicaments that afflict visitors from developed countries to less-developed areas. In my 1988 published version, 13 pages are devoted to common drugs and medicines that address typical maladies, such as the  antibiotic ciprofloxacin, to tackle infections, with information laid out in a table on a drug’s use, likely place of need (city, remote, “third world”), form, and dosage.

Basic health care advice can be fun with good writing

Bezruchka’s writing is straightforward and direct. In his chapter on drugs, he begins his recommendation with a simple message: “Remember that drugs, though valuable, are not a cure all.” He provides advice on assembling a medical kit, working with doctors at home and abroad, and dealing with major sources of health problems—namely, food and water.

Bezruchka also highlights a major global health issue that is more severe than microbial agents, trauma from vehicle accidents. “Trauma, especially that caused by motor vehicle accidents results in the majority of disability acquired in developed countries,” writes Bezruchka. “This is even more true in third world countries. Trauma causes more disabilities to travelers in foreign countries than all the exotic diseases put together.” That observation remains true to this day, as shown in global health data.

Photo courtesy of the University of Washingston School of Public Health faculty photo.

Faculty photo of Dr. Stephen Bezruchka, courtesy of the University of Washingston School of Public Health web site.

But there is much more. Rabies? Check. Animal attacks? Covered. Ticks and leeches, fever, rashes? All addressed. The two-page section, in my old and battered version, on dealing with stress in less-developed nations is a classic summary of what many first-world travellers experience.

“If the culture shock of a third-world setting with its attendant poverty and hopelessness have you in despair, take steps to improve your psyche,” writes Bezruchka. “Seek out help, another traveler, or a religious organization or individuals.”

Bezruchka even has sections on death and how to cope with returning from travels with an illness. I definitely experienced lingering issues when I came back and took this advice to heart.

Meeting Bezruchka later in life

When I first met Bezruchka in person during my studies at the UW SPH, I mentioned how much I enjoyed his book and used it frequently in Nepal. I even mentioned how enterprising Nepalis had published black-market copies of his book they were peddling on the streets in Kathmandu. As I recall, he considered that a compliment to the value of his work.

Sometimes small and perfectly executed creations are ones that have the most impact. In Bezruchka’s case, there is far too much to choose from to say what is best—from published papers to advocacy to mentorship of future health leaders. I will submit this still fine tome as work that stands the test of time and proves that small is often better.

Yes, public health blogging makes a difference

I began this blog in March 2012 to share my perspectives on public health issues and to integrate multiple disciplines and perspectives that the traditional public health field either is not doing or does not want to do–such as speaking with moral clarity on the public health threat posed by firearms in the United States.

I took this screen snapshot of my dashboard on Nov. 29, 2014.

I took this screen snapshot of my dashboard on Nov. 29, 2014.

My blog has had nearly 38,000 page views as of late November 2014. This means this web site is getting more visibility and traffic than many published papers by academic researchers. Many of their peer-reviewed articles will never be seen because they are behind a firewall run by for-profit companies that prevents publicly-financed research from reaching policy-makers, the popular media, and the public who pays for the research.

To celebrate the eventual “fall of the wall,” meaning the for-profit firewall that is stifling innovation and blocking research from having greater value to the public, I am going to highlight a few of my more popular public-health articles based on visitors and page views.

Embrace change and get cracking

I think it is time to start dismantling the firewall and to start telling public health’s story with more traditional storytelling techniques, with more creativity that bridges disciplines, and with an eye on upstream advocacy.

The articles I shared above do not follow the traditional model of public health writing or practice, and some challenge the current U.S. models as broken and even morally bankrupt, particularly regarding the historic deathly silence by public health leaders at the local and national level and at universities in the face of firearms-related violence in the United States.

So if you landed on this page and find yourself within the claustrophobic walls of academia as a student, grad student, or faculty member, and you have not been exposed by your peers or the faculty to the value of blogging, here 38 reasons why you need to get off your freaking butt right now and get to work. If you work in a public health office and your office is not actively using social media because of out touch managers and your office is not advocating with lawmakers, you need to show leadership and become the change you want to see and not wait for others to do it for you.

Yes, it is your job to challenge the current model that is underfunded and start getting your research and ideas into circulation.

Yes, it is time to think creatively and innovate and challenge the old guard whose ways are failing to make a greater impact.

My list of blogs/articles may be updated as I continue to publish more of them. I am now using this blog to discuss organizational behavior, multi-disciplinary research, and stories based on personal and professional experiences as the starting point for discussing larger issues. I hope you come back from time to time to check out my articles. Thanks.

(Note, I am publishing this blog post as both a page and post on my blog.)

Viktor Frankl and the simple secrets to living a meaningful life

Viktor Frankl Photo

This photo of Viktor Frankl was taken shortly after his liberation from the Nazis in 1945.

Renowned psychiatrist, philosopher, and writer Viktor Frankl stands as a giant among 20th century thinkers. The Austrian-born Frankl (b. 1905, d. 1997) was a psychiatrist whose life was transformed by his experiences as a Jewish prisoner who survived the Holocaust and internment at the Auschwitz death camp and three other German concentration camps.

With the exception of a sister, all of his immediate and extended family and his beloved wife were murdered by the Nazis. From the aftermath of this horrific experience, he embarked on a life’s work that provided deceptively simple but remarkably clear ideas that literally provide a framework on how all people can live meaningful lives.

Frankl survived his brutal internment, which should have killed him, by seeing a purpose in his ugly reality and by taking control of his responses to that experience with positive actions and a mental attitude that ensured his survival and also his outlook on life and his fellow man and woman. His simple ideas offer no shortcuts, and they uncomfortably place each person in control of how they choose to respond to life’s challenges, even ones as unforgiving as genocide and mass murder.

Frankl proposes all of us are motivated to seek a higher purpose, even when our circumstances are as cruel as a death camp surrounded by barbed wire and vicious men armed with machine guns. Frankl writes: “Man’s search for meaning is the primary motivation in his life not a ‘secondary rationalization’ of instinctual drives. This meaning is unique and specific in that it must and can be fulfilled by him alone… .” More than pleasure, more than material things, meaning motivates us all. It is our purpose for being.

Man’s Search for Meaning, a book that changed modern thinking

Cover Man's Search for Meaning

Viktor Frank’s seminal 1946 Holocaust memoir, Man’s Search for Meaning, has been translated into more than 20 languages, has sold more than 10 million copies, and is considered one of the most influential books among American book readers.

Frankl published those principles in his highly acclaimed and influential 1946 memoir, Man’s Search from Meaning, which today has been translated in more than 20 languages and has sold more than 10 million copies. It is considered among the most influential books in the United States, according to a Library of Congress survey.

He originally developed the framework for his sparse set of powerful ideas when he was practicing psychiatry in Vienna before the Nazi occupation and saw how he could help patients overcome their suffering by making them aware of their life’s calling. His treatise, stashed in his coat, was literally lost when he was imprisoned.

Later in his life, when he had achieved global recognition because of the widespread popularity of his bestseller, he was asked by a university student: “…so this is your meaning in life… to help others find meaning in theirs.” His reply was as clear and direct as the theory behind his therapy, “That was it, exactly. Those are the very words I had written.”

As one writer influenced by Frankl, Genrich Krasko, points out, Frankl’s ideas are more prescient today, given millions have no meaning in their lives, particularly in affluent societies: “Viktor Frankl did not consider himself a prophet. But how else but prophetic would one call Frankl’s greatest accomplishment: over 50 years ago he identified the societal sickness that already then was haunting the world, and now has become pandemic? This ‘sickness’ is the loss of meaning in people’s lives.”

Logotherapy, Frankl’s foundational theory

Frankl called his system logotherapy, derived from the Greek word “logos,” or “meaning.” It has been called existential analysis, which may over-simplify its scope. The philosophy and medical practice boils down to providing treatment through the search for meaning in one’s life. Its utterly basic but ultimately powerful foundational ideas are easily summarized:

  • Life has meaning in all circumstances, even terrible ones.
  • Our primary motivation in living is finding our meaning in life.
  • We find our meaning in what we do, what we experience, and in our actions we choose to take when faced with a situation of unchangeable suffering.

Frankl notes, “Most important is the third avenue to meaning in life: even the helpless victim of a hopeless situation facing a fate he cannot change, may rise above himself, may grow beyond himself, and by so doing change himself. He may turn a personal tragedy into triumph.” This latter point is particularly poignant, as it calls out the role that adversity can have in shaping us and our destinies and improving our character and our life’s narrative.

In short, no matter what circumstances we find ourselves, so long as we have a purpose, we can find fulfillment. What’s more, we are fulfilled by right action and by “doing,” not through short-term pleasure or narcissistic pursuits.

Frankl argues that meaning can be found in meaningful, loving relationships, in addition to finding it through purposeful work or deeds. In fact, it was the strong love of his first wife that kept him alive amid the unspeakable horrors of Auschwitz. He felt her presence in his heart and it literally let him live when others around him perished.

Frankl’s core ideas at odds with more ‘accepted’ health and mental health paradigms

Frankl’s ideas collide with behaviorist models, which show that conditioning will determine one’s responses—the proverbial Pavlovian dog or Skinnerian lab rat. By contrast, through his own experiences and those he observed treating depressed and suicidal patients before and after the war in Vienna, Frankl claims that “everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances.”

When faced with a situation, we all chose. But our power is defined by our actions. “Between stimulus and response, there is a space,” he claims. “In that space is our power to choose our response. In our response lies our growth and our freedom.”

The concept of personal choice conflicts with extensive research that clearly documents how one’s environment, race, socioeconomic status, and more—the so-called social determinants of health (SDOHs)—shape one’s life more than one’s individualistic decisions.

A model explaining the social determinants of health.

A model explaining the social determinants of health.

Viktor Frank photo 1947

This photo of Viktor Frankl was taken two years after his liberation from the Nazis, when he returned to psychiatric practice to help people through his principles called logotherapy.

For two years, while earning my MPH at the University of Washington School of Public Health from 2010 to 2012, I found myself frequently and painfully at odds with current research and literally thousands of studies that proved to me that SDOHs will impact our lives in the most profound ways.

Yet I found the field and its most ardent practitioners lacking an explanation that showed the real power people have in controlling their personal outcomes. This is something that the public health field and my faculty sharply criticized by showing the medical model, which tells persons to control their health, has largely failed to promote wider population health metrics.

While I do embrace a “policy and systems” approach, I even more strongly believe that every person has the ability to make life-changing choices, every minute of every day—from the food they put in their mouth, to devices they watch daily, to the people they associate with, to the jobs they take or do not take (however awful often), to the way they manage their personal emotions. They have choices, and often they are cruel and brutally unfair choices, which often favor the privileged.

Frankl was famous for meeting with some patients, asking them to reflect on finding meaning in their lives over their entire life span, and providing the mental treatment they needed to take control of their lives without future interventions or drugs, which predominates the American model of mental health treatment. Some of his patients only required one session, and they could resolve to deal with life’s circumstances without any further intervention.

This is a radically and in fact dangerous model that challenges how the United States is grappling with mental illness nationally, though many practitioners use Frankl in their work. One psychiatrist I tweeted with wrote me back saying, “I’m far from the only one [using Frankl]! There’s a large humanistic community in the counselling/psychotherapy world.”

Frankl’s ideas continue to be studied, refuted, debated, and argued by learned and well-intentioned academics, which I think would amuse Frankl. He was more interested in the practical work of day-to-day living and less with becoming the subject of a cult following.

As one commentator I saw in a documentary who knew Frankl noted, Frankl was not interested in fame, otherwise he would be more famous today.

Paul Wong is one of many academics who have analyzed the ideas of logotherapy and mapped them in published work.

Paul Wong is one of many academics who have analyzed the ideas of logotherapy and mapped them in published work.

Here is just one example showing how theorists explain logotheraphy; see the table by Paul Wong on life fulfillment and having an ideal life.

Why Frankl’s thinking profoundly inspired me and thousands of others

For more than three decades, I have been wrestling with the concept of personal responsibility and the influence of our environment and systems that impact our destinies. Such factors include one’s family, country, religion, income, the ecosystem, our diet, and political and economic forces, among others.

I also have been fascinated by examples of people choosing hard paths in dire circumstances as the metaphor that defines successful individuals’ life narratives. In Frankl’s death camp reality, this ultimately boiled down to choosing to be good, and helping fellow prisoners, or choosing to partake in evil, which many prisoners did as brutal prisoner guards called kapos.

No one gets a free pass in this model, and all people of all groups, can be one or the other, Frankl says. “In the concentration camps, for example, in this living laboratory and on this testing ground, we watched and witnessed some of our comrades behave like swine while others behaved like saints,” writes Frankl. “Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions.” I

had not been able to order these two lines of thinking into a coherent set of principles, as Frankl so perfectly did. When I stumbled on him quite by accident or maybe design this summer, while reading books by Robert Greene and even management guru Stephen Covey, I had that most rewarding and delicious feeling of “aha.” It was more like, “Wow, what the hell was that!”

It felt like a thunderclap. I almost reeled from the sensation. I then began to tell every single person I know about Frankl, and I learned many of my colleagues had already read him. I felt robbed not one teacher or academic, at three respected universities I attended, had covered or even mentioned Frankl, when his ideas are foundational to our understanding of the fields of psychology, public health, business, organizational behavior, religion, and the humanities in the 21st century.

Frankl deserves vastly more attention then he is given by health, mental health, and social activist thinkers. That is a shame too, because as a speaker, Frankl brimmed with enthusiasm and could convey complex ideas in the simplest ways to reach his audience. Watch his presentation at the University of Toronto–a brilliant performance.

Frankl’s ideas matter to each of us, in everyday life

Photo courtesy of PBS, showing a pensive and thoughtful Viktor Frankl (http://www.pbs.org/wgbh/questionofgod/voices/frankl.html)

Photo courtesy of PBS, showing a pensive and thoughtful Viktor Frankl. Click on the photo for a link to the web site.

One my most satisfying feelings is discovering that one’s personal life experiences and ideas on issues as big as the meaning of life also resonate profoundly with millions of others—those who have read his work. Even more gratifying is discovering that the core principles to living life amid hard choices can be grounded in principles that can help everyone, even in the most dire of personal experiences.

My own travels in the developing world stand out for me. I met countless people facing vastly more painful, difficult, challenging lives than I have faced. Yet, the wonderful people I met had nothing but smiles and treated me with genuine sincerity. I had to ask myself, why is it that so many people are clearly content when their surroundings indicate they should be experiencing utter despair and even violent rage. Why is there kindness in their hearts and peace with their reality.

Photo of Coptic Youth, Egypt by Rudy Owens

These young men, all Copts, a persecuted minority, highlight for me the depth of goodness one finds in the world, even when many have no material foundation that suggests they should be happy.

I understood at all levels what I was experiencing. But Frankl’s framework ties this rich set of personal experiences to all of us, and to larger existential ideas of what we are meant to do with our time.

For Frankl, the answer is just doing what life needs us to do. As Frankl wrote nearly 70 years ago, “Life ultimately means taking responsibility to find the right answer to its problems and to fulfill the task which it constantly sets for each individual.”

With that point, I now must ask you, the reader, What are you doing with your life, and are you doing what you are being asked to do? You cannot escape this question, and if you avoid it, you will always have the pain and emptiness of not listening to your own calling. The choice of course is your own.

The wisdom of adversity and misfortune

“But despite what you may think, good luck is more dangerous than bad luck. Bad luck teaches valuable lessons in patience, timing, and the need to be prepared for the worst; good luck deludes you into the opposite lesson, making you think your brilliance will carry you through. Your fortune will inevitably turn, and when it does you will be completely unprepared.” … Robert Greene, The 48 Laws of Power

During a recent outing to one of Seattle’s many brewpubs, I swapped stories with my good friend about hospital visits. Most people I know have had them, and a rarefied few have not. In my case, I have been hospitalized at least a half-dozen times, mostly for stitches, but also worse.

I told my friend some of my greatest learning moments came with contemplation lying in a hospital bed. There is nothing like pain one feels in the ugliness of a hospital room to focus the mind and to allow one to make sense of all the things that preceded the unforgettable trigger moments.

South African born psychiatrist and author Norman E. Rosenthal

South African born psychiatrist and author Norman E. Rosenthal

South African born psychiatrist Norman E. Rosenthal has written a book on this theme called the Gift of Adversity. Thinking back on his own Apartheid-era life, surviving a near fatal stabbing, and his professional experiences, Rosenthal argues that innovation, resilience, and understanding emerge  from our own adverse experiences and by gaining wisdom from those hard times. Writ large, economists will even refer to collective behaviors among entire generations, such as young people who came into adulthood in the Depression era, and whose lifelong buying patterns and decisions to live more austerely can be quantitatively measured.

Using examples of individuals who endured suffering yet who came out stronger, Rosenthal sees opportunity in these struggles for all of us. “Well, when adversity comes, the last word that comes to mind is gift, because it just looks like an unmitigated disaster. But, how many times have you heard a friend or somebody say, ‘You know, at the time, it seemed terrible, but in retrospect, it was for the best.’ … The first step is really to accept that the adversity has happened. … We have to somehow come to terms that it really has happened. Then, we have to analyze the situation, every adversity is different, and respond accordingly.”

My own experiences mirrored these points, almost too perfectly. Both involved small misfortunes with lifelong rewards.

Lesson No. 1: When I was 14 and not fully mature, I did something that was likely one of the dumbest acts of my life. I will not say exactly what it was, but it substantially disrupted life at my often-violent and chaotic junior high school, in University City, Mo. I was soon on my way for an expulsion as the second-to-last-day of classes was ending in June 1979.

Coming back to campus I encountered four guys who I did not know. At least three were students. The other may have been a high school student. He was older, a guy with a cast. They were tough. I was not. They were experienced in the art of violence. I had few such fighting skills. They were skillful manipulators, and I fell for small talk that drew me close. It turns out one of them had been blamed for the incident. That is the story I heard second-hand, and the group was bent on physical vengeance.

I do not remember everything that happened, but I do remember feeling a floating feeling. I was cold-cocked in the face by one of the four wearing a cast. I was bleeding profusely from a cut on my eyelid and could not see out of my left eye. I was lying on the ground not sure what had happened. I felt warm blood on my hand.

I remember the four of them mocking me and telling me if I was happy now about having the heat fall on them. It was a perfect example of the violence I had witnessed many times before at this school, often with the tense black-white racial undertones, and I am sure that tension influenced this assault too. They walked away, never having been arrested, never having been questioned by anyone, ever.

Insult piled upon injury. I had to go back to school, get kicked out by a furious principal who did not express any concern about me having just been assaulted on school grounds, and then have teachers sign my expulsion papers. One thug laughed at me in the hall and yelled, “What happened to you.” I shot back, in my un-masculine voice, “What do you think happened.” He turned cold, came close, and threatened, “Yo, want another one, mother fucker.” Luckily I walked away from that one.

I stayed at this hospital for nearly a week after I was assaulted and nearly blinded in my left eye, which proved to be a great learning moment.

I stayed at this hospital for nearly a week after I was assaulted and nearly blinded in my left eye, which proved to be a great learning moment.

My mom, a new teacher that year in the same district, took me to the emergency room in Barnes Hospital in St. Louis, where I was put into a shared room and monitored. My eye pressure was dangerously high because vessels were ruptured from blunt trauma, and I was at high risk of blindness in my left eye. The doctors prescribed having both eyes covered for more than a week to keep them from moving, lying in a bed, and having no physical activity.

I remember the slow passage of time and mostly the sounds of the ward, the voice of my few visitors, and the stories of a young man next to me going into eye surgery, not sure what would happen.

The school principal came once, talked briefly, and somehow waived my punishment as a result of being a violent crime victim. He never told me or my mom what the school or school district had done to investigate the assault. My mom told me years later she was too afraid as a new teacher to make waves with her new employer. No police officer ever took my story. The whole thing was wiped under the rug.

Lying there, in a flimsy hospital gown, feeling like needles were piercing my eyeball, I came to the realization of how precious my sight really was, and how close I had flirted with genuine disaster.

Lesson Learned: This was the clearest teaching moment ever in my life. Never, ever, do stupid things. Such acts have unforeseen consequences, particularly things that put you in a weak position with uncaring bureaucracies and with men who use violence to settle a score. If you act badly and unwisely without thinking, the sword of blunt justice will be swift, and it will be lasting. Also, without any allies or friends, one can be quickly abandoned by any organization if you are perceived as lacking advocacy skills and are vulnerable. So, do not present yourself as weak or easily exploited. Finally, and most importantly, always know exactly who you are dealing with when you confront strangers in strange circumstances. Trust your instincts, and keep your wits about you, always. Your instincts will always know who is a friend and who is a foe. Worry about bruised feelings later, from a safe distance.

It took me a whole summer to recover, and I could not engage in full physical activities for three months. I wore an eye patch half the summer. Decades later, I still have damage to the back of my eye that my most recent visit to an optometrist confirmed. He could see the damaged areas after my pupil was dilated.

Lesson No. 2: In my last month of my journalism master’s program at the University of North Carolina at Chapel Hill in July 1993, I was playing pickup soccer at the UNC-CH campus. It was supposed to be friendly, but of course men are fiercely competitive. A guy who I was marking intentionally head-butted me with the back of his head into my face. He broke my nose instantly, and it began to bleed profusely. I walked myself to the UNC-CH hospital, as it was close by.

This is how I looked shortly after my nose was broken and then reset in July 1993.

This is how I looked shortly after my nose was broken and then reset in July 1993.

I waited about three hours for a resident to attend to my situation. The plastic-surgeon-to-be had been up about 28 hours and was in a terrible mood. After shooting cocaine painkillers into my nasal cavity area, he stuck a metal rod up my nose and proceeded to move things back into place. I recall screaming like a wild animal so loudly that it clearly disrupted patients in the entire wing. The exhausted and overworked resident was furious with my uncooperativeness, as he called it. He stuck the rod back in and went back to work.

A nurse came in and saw the procedure. She simply held my hand. I stopped crying. I instantly calmed down. My level of pain subsided dramatically. The compassionate act of human touch proved more powerful than any medicine. After the resident stuffed both of my nasal passages with some sort of medical gauze, I thanked the nurse. She gave me a caring look that said, everything’s going to be OK.

That night I wrote a poem about the war in Bosnia, then raging at the time, and I put my small problem into a larger perspective of suffering felt more severely by others around the world.

Lesson Learned: Human compassion and human touch are among the most powerful healing agents in the world, often more powerful than medicine and actions of medical specialists. The mind, when it needs to, can calm down and can process a stressful situation. Set the calming effect in motion, and show mindfulness of yourself and others who may be less fortunate.

Comment: Author Rosenthal, who sees the importance of adversity, profiles the late Austrian neurologist and psychiatrist as well as a Holocaust survivor Viktor Frankl. He was the only member of his family to survive the genocide, staying in four different camps, and went on to receive acclaim for his widely read treatise called Man’s Search for Meaning, original published in German in 1946 Trotzdem Ja Zum Leben Sagen: Ein Psychologe erlebt das Konzentrationslager.

Holocaust survivor, psychiatrist, and author Viktor Frankl

Holocaust survivor, psychiatrist, and author Viktor Frankl

Frankl’s own horrific experience taught fellow psychiatrist Rosenthal critical lessons also, that one can find meaning even in the midst of terrible adversity and that no single group of people is pure good or evil. Both types of people can be found in all groups, everywhere.

“It did not really matter what we expected from life, but rather what life expected from us,” wrote Frankl. “Our answer must consist, not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual.”

In no way did anything I experience come close to the challenges Frankl and other tough and lucky individuals have endured from such crimes.

I do know that in my case, my invaluable teachers came disguised as sterile wards and rooms of hospitals, giving me opportunities to contemplate larger truths. In one case, I created my own folly but could use my intellect to evaluate my mistakes. I also benefitted from being in hospitals, where I seldom felt kindness and felt great stress and also fear. This was clearly a place to avoid at all costs. I was doubly motivated to stay healthy—mind, body, and soul.

The wisdom I gained at those small junctures far exceeded anything I received in any university setting. As Robert Greene’s opening quote aptly notes, our bad luck prepares us for misfortune and gives us the strategies to overcome the roadblocks we build for ourselves or encounter from others. Those who are blessed mostly by good luck will eventually see their luck change, and when they do, they will be overtaken by those who have adapted and learned already.

So be thankful for those learning moments. They are your teachers, and you profit immensely by employing that knowledge wisely in the future.