Tsunami on the Prairie

As the adage goes, if you put a frog in a pot of boiling water, it’ll jump out. But if you put that same frog in a pot of room temperature water and gradually heat the water, the frog will stay in the pot until it’s cooked. As the current disaster in Houston plays out, the response we’ll see will be like the “frog in the boiling pot.” There’s no disputing those affected by the hurricane have major problems, but they’re acting even as you’re reading this to put things back together.

I live in Montana, a rural state. We are facing demographic issues that are the textbook definition of “the frog in the room-temperature water” (actually more warm now) and the burner is on. Minor statistical changes from year to year receive little more than a note in the back third of an article in the newspaper. But what these statistics tell us is irrefutable. Rural populations are skewing older and for the most part people are living longer. And with living longer comes more health issues, especially chronic ailments such as diabetes and heart conditions. Combine that with fact the overall population of rural America (all ages) is not increasing. In other words, there is and will be more people who will need care – and fewer people to do the caring.

If those demographic realities weren’t enough, we have the actions (or should I say lack of actions) by governmental entities in rural states. Most rural states are run by politicians hell-bent on low taxes and not spending money. Their older constituents increasingly have more needs and their representatives are more concerned with maintaining an ideology that placates the most vocal (and often extreme) members of their party. Too often these unmet needs result in despair, depression and isolation. Being old and geographically spread out is a bad combination and a prescription for mental maladies. In fact isolation is now the number one health issue in America among the elderly. And it’ll get worse if we don’t confront it head on. What rural America is seeing is an increase in demand for the exact services that are being cut and deprioritized.

Even if state and local governments aren’t going to provide adequate assistance for this increasing needy segment of the population – at least it wouldn’t it be prudent to help create the environments required to attract the young people needed to assist the elderly – regardless of their ability to pay? Not only do they provide the bulk of caregivers (along with those of diverse ethnic backgrounds), the civic amenities young people value are the exact ones that benefit an aging population, whether they support them or not. For example: farmers markets and ample produce championed by Millennials are crucial to well-being later in age: and parks and common areas provide the activities and stimuli needed to counter both physical and cognitive decline.

Unfortunately most governments in rural towns and cities don’t make attracting Millennials (and immigrants) a priority. In fact, often their actions have the opposite affect. In Billings, Montana, where I live – the city government refuses to pass a non-discrimination ordinance (NDO) to protect the rights of gay people. Gay rights are probably the number one issue for Millennials, regardless of their own sexual preference. It shows a community values inclusion. “We’re all different in some way and if the community we lives in hates one person for their difference, who’s to say tomorrow they won’t hate me for mine.”  Any city who chooses to go down this path of discrimination (regardless of the bogus rationalization) will do so at their own peril … all while their “old people” will have no one to take care of them. Not only will new young talent not want to move in … the top talent that was raised there will be lining up for tickets on the first bus out of town. What will be left is a community of hate and exclusion, with the few outliers who haven’t or can’t leave, being pushed into the shadows to scavenge any civic crumbs left by the so-called city leaders. Welcome to the slow-burn of a dystopia in the making.

What I described above is a Perfect Storm facing rural communities throughout America; thus the title of this piece, “Tsunami on the Prairie.” Not all is dire though. We can still get out of the pot before it’s too late. But our biggest obstacle is ourselves, led by those we’ve put in positions of power and influence: those we too often rely on to map our futures. Much like the road to recovery for any addict, step one is acknowledging that’s there’s a problem. Rural America, and I speak specifically to where I live, can’t afford to ignore the ominous clouds rolling in. These clouds and what they bring won’t just pass over. They’ll keep coming until there’s little left.

Abandon small town

Once we accept our demographic destiny and that fact our political malfeasance can’t continue – we can begin the battle. It’s a battle that will require all hands in the community to work together, regardless of ideology or political affiliation. It’ll require we focus on inclusion and the embrace of outliers, those different than us. We don’t know where the next Jeff Bezos, Elon Musk, Jennifer Lawrence or Chance the Rapper will come from. But chances are they’ll be the ones who were disenfranchised and looked at with indifference. These are the people who will have the ideas we need and drive to put them in play. As Albert Einstein famously said: “We can’t solve problems by using the same kind of thinking we used when we created them.” And much of the time this same thinking comes from the same people we too often rely on. To face this Perfect Storm, your community will need new ideas and new people to rise in the heat of battle.

The Norwegians have a word, dugnad – that can best be described as a type of civic and communal mindset where people get together and volunteer to fix, clean, paint or tidy things up for the betterment of their community. Dugnads are organized in neighborhoods, at summer homes, marinas, even at schools and especially places of work. It can be summed up as a time of coming together and contributing. In America one can see these dugnads as being small businesses or what I call Front Porches. This network of local merchants, their employees and their patrons are the people who want to change the status quo; people who want to pull the best from those around them and make it the future … not just look for differences. These Front Porches, while now probably just local hangouts, will be become hubs of civic engagement and volunteerism.

The Front Porch’s primary role is to identify community Solutions projects, whether they be in response to needs or opportunities. These Solutions are designed to help your community pick up the slack and mend its societal safety net as well as lead it into the future. They can range from organizing a cleanup effort, to fixing a playground, to even spearheading a high school mentoring or apprentice program. And most of all – these Solutions can be directed towards helping the elderly.

Imagine creating a program – call it: “I’m Not Alone Anymore.” This program, based out of a local business or Front Porch, would assist an elderly person with not only their physical needs but also provide emotional support by giving them an avenue back into the community. Even if just means a weekly visit for a cup of coffee … these people will no long be feel isolated … or alone.

Helpers (customers and employees) will organize through community network of Front Porches (local businesses). The first step will be to identify the elderly (Clients) needing that little extra help (physically or just emotionally). They can be found directly or through referrals. Each Client will be entered into a central database that Helpers will have access to. The database will include information such as contact information, medicines, favorite foods and activities, and anything else that can be used by the Helper to improve the lives of the Client. Also included will be contact activity data; date of last visit, schedule date of next visit and relevant information concerning these dates. The database will also provide an informed point of reference for anyone that might have to step in for the primary Helper should they not be able to visit. 

What if we designed our communities around the idea of maximizing engagement. The more engaged our residents are … the more empowered they would be. They would feel more in control of their health and their futures. Imagine if a chance to engage, whether it was physical, mental or social was just around the corner. And what if opportunities to help others realize the same were part of the fabric our daily lives. What if our physical security and well-being was not dependent on government assistance or the whims of a fickle market driven economy. What if our neighborhood was our safety net, a safety net that knew best in our time of need. And what if the streets of our community became melting pots of serendipity – places where curiosity was bred and benevolence was the norm. And what if engagement, well-being and self-efficacy was how a community measured itself, not obtuse economic activity often distorted through the one-dimensional filter of irrelevant statistics.

From this hands-on street-level altruism will come your community’s vision – a Vision Map of sorts. You and your neighbors will see directly what’s needed and what works, rather than blindly following a plan cobbled together by elected officials who may or may not be qualified vote on such a plan – let alone construct one. From devising and implementing Solutions, your community will find out who the true leaders are – not just the ego-driven politicians. You will see who is tirelessly mission-driven and able inspire those around them to be the same. You’ll see expertise and imagination come from the least likely places. You’ll build your community’s talent pool, rather than continually leaning on the same people time after time, board member after board member. Consider this map a guide of sorts for an evolved society … the society I call Community 3.0

None of this is revelationary. This is not a magic pill that will make everything and everyone in your community better. What this is is a wake up call. We’ve laid out your clothes and turned on the coffee pot. And maybe we’ve even started your car and got it warm for you. But it’s up to you to get to work and make it happen. Too often we stare at our cable news channels obsessing over the government and who we should or should have votes for. We expect the government to heal whatever ails us. You’d think we’re locked in medieval times living a serf-like existence dependent on the scraps our lords in the towers above toss out to us. Instead I offer an alternative – one of collective self-determination, altruism and a self-transcendent focus on our neighbors.

Ironically some of the most independent people in the country, people who are used to back-breaking work in the cruelest of weather have no qualms complaining the government isn’t giving them enough. I see it and hear it everyday. It’s easy to affix blame when we see others prosper in comparison to us (whatever that reason may be). And much of the blame is directed towards those on the coasts. Whether or not rural areas are short-changed is not the issue; even though statistics show it’s probably the latter. But still we have to blame someone. But for those of us who live in small or rural communities – the luxury of blame isn’t an option. Neither is circling the wagons and focusing on how far back our rural lineage goes. You’d think the more generationally deep our rural roots go – supposedly the more worthy we are of living here. It’s this thinking (if you call it that) that hastens the demise of the very communities we so ardently aim the protect. 

Our real enemy, the tsunami of demographics and governmental malfeasance rural America faces, is banking on the fact that we will continue think outsiders and the ideas they bring are the demons coming the change our idyllic lifestyle firmly rooted in the past. We must prove this storm wrong … or we will perish in our myopic naiveté.


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The Evolution of the Theory of Evolution

Darwinism and the Paradox of Altruism

During the mid 1800s Charles Darwin upended both the scientific and religious worlds by releasing his seminal theory on biological evolution. Darwinism states that all species of organisms arise and develop through the natural selection of small, inherited variations that increase the individual’s ability to compete, survive, and reproduce. Since then Darwinism has been a foundational part of our world, science and elsewhere. However social behavior, specifically altruism, has posed a bit of problem for Darwin and his universal theory.

Every altruist has their own motives, of course – some are emotional, responding to fellow humans in desperate straits, while others are more rational, thinking about the kind of society they’d like to live in and acting accordingly. Does that imply a level of self-interest? Selfless acts often attract accusations of hidden selfishness, suggesting they’re not really altruistic at all. This wasn’t the problem for Darwinism. After all, humans have culture and religion and moral codes to live by – maybe our altruism was more to do with that than biology.

It was altruistic ants that posed a particular problem for Charles Darwin. Natural selection is often described as ‘survival of the fittest’, where fitness means how successful an individual is at reproducing. If one individual has a trait that gives them a fitness advantage, they will tend to have more offspring than the others; because the advantage is likely to be passed on to their offspring, that trait will then spread through the population. A fundamental part of this idea is that individuals are competing for the resources they need to reproduce, and fitness includes anything that helps an individual reproduce more than the competition.

But as Darwin observed, ants and other social insects are not in competition. They are cooperative, to the extent that worker ants are sterile and so have literally zero fitness. They ought to be extinct, yet there they are in every generation sacrificing their own reproductive ambitions to serve the fertile queen and her drones. Darwin suggested that competition between groups of ants – queen, drones and workers together – might be driving natural selection in this case. What was good for a nest competing against other nests would then outweigh what was good for any individual ant.

Group selection, as this idea was known, was not a very good solution, though. It didn’t explain how the cooperative behaviour evolved in the first place. The first altruistic ant would have been at such a huge disadvantage compared to the rest of its group that it would never have got the chance to breed more altruistic ants. The same was true of humans – natural selection was intrinsically stacked against any altruistic individual surviving long enough to pass on their altruism. (The Story of George Price)

This left a paradox: the evolution of altruism appeared to be impossible (under Darwin’s definition) … yet clearly altruism had evolved. If this couldn’t be resolved, what would it mean for the whole idea of natural selection?

Luckily, a young man called Bill Hamilton came to the rescue with a slightly different solution in 1964. He proposed that altruism could have evolved within family groups, whether genetically or through shared environmental habits and tendencies. An individual altruist would seem to be at a disadvantage, but that was not the whole picture because other individuals who shared the same genes associated with altruism would all influence each other’s “inclusive fitness.” We see this in human families also, as parents instinctively sacrifice themselves to protect their children, the upcoming generation. To not do this is considered socially malevolent.

Evolution and the Community

Hamilton’s extrapolation of Darwinism, while seemingly radical – made complete sense. By choosing to open the door to new thoughts on evolution – we’re not necessarily kicking Charles Darwin to curb, but expanding on his work based on new levels of research and observation. Consider it letting the theory of evolution evolve. Any scientific discovery should be looked at not an end – but rather the journey down a new road to another level of enlightenment.

The same should be said for social sciences and economic philosophy. We’re still relying on the theories and assumptions of Adam Smith and Thomas Hobbes from the 19th century – with our politics following in lock-step. Why shouldn’t our thinking in this area evolve also. The societal conditions faced by the inhabitants of 1800s are nothing like that we face today in 2017. To assume the models developed then would wholly apply now is naive … if not just intellectually lazy.

“I believe that the community – in the fullest sense: a place and all its creatures – is the smallest unit of health and that to speak of the health of an isolated individual is a  contradiction in terms.” – Wendell Berry

If we espouse Hamilton’s idea that evolution can occur in family units as well as in individuals – what’s saying we can’t take it a step further and extrapolate to that of the community unit. In fact, while technically ants socialize as a family, being from the same queen, they also (if not more) act as an active part of a community.

Recognizing that your community is an evolutionary ecosystem is fundamental to its prosperity and even survival.

Evolution ecoysystem cloudIf we view our community as an evolutionary unit, then we must look for and address the components that can either contribute to its sustainability or to its demise. A community is really nothing more than the accumulation of individuals and the interactions between these individuals. Every member of your community is unique and adds to its fabric. Everyone has something to offer and everyone should be heard – no matter their age or social standing. If they are not included int he conversation – they still will be heard and it may not be in a socially accepted way (e.g. crime). Prejudice, bigotry or even indifference hurts not only them, but us as part of the overall community. All of our actions, or lack there of – have collective consequences.

“In our every deliberation, we must consider the impact of our decisions on the next seven generations.” ~ IroquoisConfederacy

We must confront the societal questions that threaten the long-term sustainability of our communities – not just the immediate issues affecting the adult population . Far too often communities concern themselves only with protecting the status quo. This may not even be intentional. Informal power cliques that continue on by monopolizing public office and solidifying their positions of influence restrict the accension of new blood and new ideas in the community. For these civic leaders, they view the pain of changing greater than the pain of staying the same. Public policies, ideals and conventions are there to be preserved – often at all costs. New ideas meant to provide opportunity to new or young residents are resisted if not outright rejected … just because: “if it ain’t broken, then don’t fix it.” Unfortunately for those not in the top echelons of the ivory towers of power – it is broken. This needed new blood will either retreat into the shadows occupying a lower rung on caste system … or move somewhere else where opportunity is more available and their assets are welcome. Neither alternative is conducive to the prosperity and sustainability of the community.

Small town decay

Enter Darwinism! Those communities that embrace ideas from other diverse sources and talent with different experiences will evolve, sustain themselves and flourish. Those that “hold on to yesterday” will whither away. These communities and their residents will suffer from isolation, and lack of economic and social opportunities as they put forth precious time and resources resisting rather than embracing. By the time the pain of staying the same becomes more than that of changing … it may well be too late for them.

However hard it may seem for community leaders, they need to be willing to loosen their grip on power and traditional structure. They need to realize that what they invest in the outliers of power and influence today will be the capital that builds the future of the their communities in the future. Without this investment – the homes, businesses and everything else they’re trying to hold on to will be yet another example of the dark side of evolution … decline and eventual extinction.

We still need structure, but that structure needs to be flexible … and directly participatory. Our current form of local representative governance is seldom more than an ego-driven career path for the few. We need a structure that is more a platform; one of inclusion and participation. This platform must be designed to identify the needs and opportunities of the local community it serves while addressing them using whatever resources are available … whether monetary or not. Think of this “resource maximization” drawing from the times of our grandparents when neighbors and community members were treated as extended family and relied on as the primary “safety net.” This was a time when no one had the luxury of sitting by idly expecting a city council (who meets once a week) to act on their best interest – assuming they even took the time or had the ability to learn what those interests were.


Biologists say trees are social beings. They can count learn and remember. They nurse sick members, warn each other of dangers by sending electrical signals across a fungal network and for reasons unknown, keep the ancient stumps of long felled companions alive for centuries by feeding them a sugar solution through roots. (Marije van Zomeren)

To find a model for organizational structure built around resource maximization and decentralized civic participation and collaboration, we need to look no further than our backyard – in nature. One of nature’s most effective means of sustainability is the Rhizome. The Rhizome is a modified subterranean stem of a plant that is usually found underground, often sending out roots and shoots from its nodes. Rhizomes develop from axillary buds and grow perpendicular to the force of gravity – retaining the ability to allow new shoots to grow upwards. If a Rhizome is separated into pieces, each piece may be able to give rise to a new plant … and a new node of above ground activity.

Credit: Debi Keyte-Hartland

A rhizome ceaselessly establishes connections between semiotic chains, organizations of power, and circumstances relative to the arts, sciences, and social struggles … the rhizome connects any point to any other point, and its traits are not necessarily linked to traits of the same nature; it brings into play very different regimes of signs, and even non-sign states … The rhizome operates by variation, expansion, conquest, capture, offshoots. A rhizome has no beginning or end; it is always in the middle, between things, interbeing, intermezzo. (A Thousand Plateaus)

This phenomena of decentralized activity in Rhizomes was best articulated in the philosophy or Gilles Deleuze and Félix Guattari in the ’60s. Rather than using the organizational structure of the root-tree system which charts along chronological lines and looks for the single origin of “things” looking towards conclusion of those “things” – a Rhizome continually establishes connections between threads of meaningful communication, organizations of power, and other influences (including arts, sciences and social struggles). The planar movement of the Rhizome resists chronology and formal organization, instead favoring a Nomadic system of growth and proliferation. In this model, influence and application spreads like the surface of a body of water, spreading towards available spaces or in the application of community – maximizing the resources available to it, regardless of the type. This is a perfect alternative to the governmental morass of dysfunction we’re currently immersed in.

Front Porches

At the foundation of this evolved, altrusitically-based society are its Front Porches – physical hubs of civic gathering and serendipitous engagement. The goal is to take the principles of resource maximization and provide the conduit to incorporate them with the naturalistic examples of the Rhizome organization articulated by Deleuze and Guattari. This result is a platform or space for community engagement and sustainability built around informal but operationally significant gatherings, otherwise know as Front Porches. While these Front Porches can form anywhere, say even in your garage, the ideal locations will be in the locally owned businesses of our communities.

Rather than myopically obsess on economic growth as almost all civic governments do, a Front Porch network will focus on destroying the silos that retard our communities’ evolution while improving its inhabitants physical, cerebral (avenues to self-actualization) and spiritual healthPeople will gravitate towards what they want to do … and in turn do what they do best. This lifestyle of self-management of interests and activities will not only benefit them, but also their community. Lives based on economic status will be replaced by those of self-actualization, self-efficacy and well-being. Civic participation and altruism will elevate them and empower them to evolve as humans – individually and collectively.

It will be the priority of these Front Porches to create environments in our communities that nurture hope by empowering avenues for us to engage with our world and express our creativity through a Solutionist mindset – letting the inherent benevolence inside us bloom. By making “helping others” our societal norm and expectation … we will supplant that of the hopeless climb up the ladder of our current economic caste system; countering the tribalism and jingoism that has reared recently shown itself to be in vogue.

Evolution through Diversity-Driven Serendipity

Rather than abide by a top-down governance model run by those embedded in the status quo (often of sustained mediocrity) – we must create platforms of serendipity where civic matchmaking happens organically through interaction uncovering commonalities between the participants. Think of a synergistic mixing bowl of opportunity; indirect, organic relationship building.

What if we designed our communities around the idea of maximizing engagement from those in the streets? The more engaged our residents are … the more empowered they would be. They would feel more in control of their health and their futures. Imagine if a chance to engage, whether it was physical, mental or social was just around the corner. What if our physical security and well-being was not dependent on government assistance or the whims of a fickle market driven economy. What if our neighborhood was our safety net, a safety net that knew best in our time of need. What if the streets of our community became melting pots of diversity-driven serendipity – places where curiosity was bred. What if engagement, well-being and self-efficacy was how a community measured itself, not obtuse economic activity too often distorted through the one-dimensional filter of irrelevant statistics. And what if getting up in the morning was a chance to nurture our hope … and engage with others to help them do the same.

Breaking Free of the Pendulum

It’s easy to just bash our present political economic situation and run the other way, ready to embrace the polar opposite. We saw this with the election of Donald Trump. Anything was better than Hillary Clinton and the establishment, however bad that might have been or not. We see it in economics with the pushback against neo-liberalism … for good reason. But does the answer lie on the other end of the pendulum and minimum basic income? Does it lie free college education for everyone, even though it’s becoming more apparent traditional college may not be the best alternative for many?

We need to be brave and think differently, not just vacillate between Smith and Hobbes or Marx. Not that those and other icons of the past don’t have positive offerings to contribute. But they don’t live today. Society changes, as does the economic conditions and requirements that forms it. And with that, so must our ways of looking at the best way to patch together a workable societal strategy for all. We need to grab from the past, morph together solutions … and try them out. Not all will work. But some parts of some of them will. And then we take those and combine them together with new ideas – all specific to our individual locales often brought to the forefront by our newly embraced outliers. Jeff Bezos from Amazon calls this Day 1Everything is always in beta – always in search of improvement. Always evolving. Never focusing on maintaining the status quo.

Bill Hamilton showed us how we need to accept alternative ways of looking at our world; even down to the most basic level – Darwin’s theory of evolution. I propose we take it further to the community. We don’t live in silos. While genetics play a vital role in ability to sustain ourselves individually and collectively … so do the interactions with those we share a physical space with. Any efforts to nurture empathetic and altruistic behavior is evolutionary beneficial.

It’s not enough to wait for a societal evolution to take place and expect other to generate the change we need. We can’t expect to sit back and reap the benefits from it after-the-fact. We need to all need to be our own local Bill Hamiltons, think differently … and usher in these evolutionary changes ourselves. We must look at our responsibility as being more than a periodic trip to the voting booth only to perpetuate yet another ineffective version of status quo.

…because we have reached a time when “the pain of staying the same has become greater than the pain of changing.”


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An Open Letter to Healthcare’s C-Suite

I didn’t think I was going write anything more about my cancer experience – at least in the near term. I’m just kind of done with it. I finished my chemo and now I have to conjure up whatever “mind over matter ninja magic” I can to keep it at bay for the foreseeable future. My next blood test is in a couple of weeks and we’ll see how things are, but I don’t anticipate anything negative. Even with a positive result – that’s no prediction of the longer-term though. I didn’t think I’d have to go back through this two years ago after the last set of infusions in 2015. But I did. So now I’m realistic. I’ll do everything in my power and that’ll have to be enough.

This year has been anything but fun. Cancer is just one part of it. Living in a world with Donald Trump, Mitch McConnell and Paul Ryan having anything to do with my well-being has me in constant state chemo-aided anger. My resistance to nonsense is at an all time low. For all my talk of self-efficacy, mine also often wains. Enough of this though. I’m still an optimist and I have to look at 2017 as just another one of those pothole ridden stretches of road to my Perfect World. It’ll get smoother.

What I do want to do is take one last stab (at least for the foreseeable future) at turning this experience into a positive for other people who may be going through something similar as I am. And selfishly so … maybe it’ll help me too.


This is my Open Letter to all those who are tasked, or have made it their profession to be part of our worlds during these precarious times of health we face.

I’ve come to realize that few people outside the “I have or have had cancer” club really have any idea of what the experience is actually like. I assumed the doctors, nurses and administrators in the exalted cancer centers of our community-dominating clinics would. I assumed once you walked past the donor walls you were given membership to some secret society where every one was in the know, empathetic and waiting to literally and figuratively take you by the hand as you waded into the deep end of this murky physical and emotional pool. Such is not the case. Having a life-threatening, debilitating disease or not … we’re all thrust into to the same malaise of issues plaguing healthcare in America. Just because hundreds of thousand of dollars and thousands of lost hours of patient productivity are siphoned through the system – we’re all relegated to the same level treatment and customer service. It’s the same experience for everyone. Obviously I’m naive to think it would have been different.

As response to my personal frustration, I have vented over the couple of years through my blog. I’m not going to rehash the content I wrote now. The links are below if you want to yourself. And it wasn’t that things went so bad, even though the chemo treatment didn’t hold the first time and within two years I was back in again for another six month regiment. And it wasn’t any one person. For the most part, the people involved in the treatment regime did what they were tasked with. They did their job. But maybe that’s the problem. My idea of what their job should be and what it is as defined by their employer, my healthcare provider, are two completely different things.

Maybe my problem is that I’m idealistic and see things how they can be, not just how they are adhering to the crippling paralysis of the status quo of diminished expectations. Maybe I’m just not tolerant of organizations who don’t make it their mission to first set the bar as high as they can for the customer. Maybe I just don’t get what health means in the context of a healthcare provider.

We live in world infected with silos. And I don’t mean silos that hold corn and wheat. The obsession with specialization and being an expert has been thrust upon us for decades now. And it shows no signs of letting up. And nowhere is this more epidemic than in the medical field. Did you notice I didn’t say health field. When specialization enters the discussion, the two are not necessarily synonymous. For example:

Many young American surgeons have a strong desire to do humanitarian work overseas. But their good intentions usually don’t match up with the skills, such as performing cesarean section deliveries and fixing broken bones, that they’ll need in poor countries. But only 0.1 percent of general surgery residents in the study had been trained to do a C-section. Yet it’s the most commonly performed surgical procedure in MSF projects.

The skills necessary for work in the developing world used to be universally taught in American surgical rotations. But training has changed to reflect increasing specialization. (NPR)

I assumed when I descended down the rabbit hole of a cancer diagnosis I would be enlisted in a collaborative effort to battle this condition. I assumed we’d have discussions about the role I would be expected to play over the next few months during treatment and afterward. I assumed we’d talk about how I could support the efforts of my doctors for my benefit. I assumed we’d have discussions on diet, exercise and mental issues as well as the physical ones. I assumed we’d talk about my life in the real world and the effect the cancer would have on those around me – those expected to provide help as well as those I’m currently providing help to.

I assumed there would be a “we.”

There is no “we.” There was no talk of my life outside the walls of the hallowed halls of the cancer center. Obviously my treatment ends at the bottom on the computer screen containing the results of my latest blood panel. Every doctor visit or infusion session began the same way: “Any pain?” My answer was pretty much the same every time: “No, but I have chemo brain, I’m tired and I have thermometer as my constant dance partner.” But since my answer didn’t reference to the pain question and wasn’t in the affirmative: it was brushed aside. It didn’t fit into the boxes on the EHR software that operates as the equivalent of a malignant shadow government in most healthcare providers. The interface design of Epic and its competitors covertly dictate our relationships with our doctors, PAs and nurses.

Well, I hope my journey of “Any pain?” questions has come to an end, at least for now. So anything that may come from any of this post will be for the benefit for those that follow me. And I’m good with that. That being said, this is my letter to those in charge of our healthcare system in this country – the ones that run the clinics with the walls filled with donor boards.

First, quit reflexively calling yourself healthcare providers. This is a title that is earned. Most of you are human body repair shops. Nothing more, nothing less. If something breaks, hopefully you’ll fix it after the fact. At least when it comes to our cars they instill the importance of changing oil and taking other preventive measures. In the six years of attending doctors appointments for either myself or my two elderly parents, not once has the questions of diet, exercise or cognitive stimulation been brought up. What’s the hell is up with that!

It’s bad enough these foundational health and well-being issues aren’t being stressed with my parents, but you’d think they would be with me being a cancer patient and facing the ravishing effects that not only the disease but also the chemotherapy has on me. Shouldn’t there be a concerted effort to attack this with all resources available – especially ones that I may be able to bring to the game. I consider myself pretty tuned into my body and mind and work hard on my self-efficacy. I firmly believe what I do will make a difference in my outcome in battling cancer. I’m not going to sit idly by and think the only component to my success is administered through an IV on the fourth floor of the Billings Clinic infusion center. But what about the other cancer patients who have only blind faith in the bag of chemicals? Will they do anything for themselves to help out their own prognosis? This disease that we’re living with is not yours – it’s ours. We have to be involved in our own future. Our parents and grandparents may have been content with turning over the prognosis of their future to you – but we’re not. This is a collaborative effort and if you as both physicians and the institutions you run aren’t prepared to accept that, relinquish some of the control … get the hell out of the business and make way for some that will. 

And another thing, don’t treat us like victims. We have lives to live that transcend our disease so don’t lump together as just survivors. Survivors are those stakeholders who have lost a loved one. We don’t have any time to relish in the fact that we are still alive. We’re too busy trying to live. And believe it or not, our lives take place outside the walls of where your paycheck comes from. 

If you want to truly deserve the name, “healthcare provider,” come to grips that health means more than what you do for us in your clinic. Get past the body repair shop mentality. If you really want to raise the bar; take a walk around your community, and not just the gated one you live in. Take a walk around the streets where those people who have entrusted their lives with you live. Do you like what you see? Do you see enough parks and places to walk? Do you see playgrounds filled with kids afterschool? Do you see a farmers market down the street from where you park your BMW; or a farmers market where a cancer patient like myself can use a prescription for fresh produce? Do you see opportunities for children and the elderly to serendipitously interact with each other … exchanging stories and dreams; of the past, present and future?

My definition of health is being able to pursue the life I want to live and having an environment that is conducive to it. If my healthcare provider wants to consider itself one in more than just name on a letterhead, it has to lead the charge in the community to make this definition a reality. Not everyone is in perfect shape, especially people who have recently gone through what I have. Help us make pursuing a good life, or at least a decent one – one that doesn’t involve massive stakeholder preparation or driving endlessly a monumental undertaking. Physical serendipity and engagement is our friend … if not our salvation. A healthcare provider most often has more community clout on several levels than any other entity. You have the stage – use it. If you’re not going to … pack up and make way for someone who will!

I’m sure a lot of you will brag about all the wonderful things you’re doing for the community. Invariably most all have to do with building stuff though. Ribbon-cutting ceremonies generate big press, big donations, names on big buildings and more names on big donor walls. And if it’s not shovels in the ground – it’s technology. A plethora of accounts on my Twitter feed are salivating over artificial intelligence and its possible effects on the healthcare field. But it seems like healthcare is a zero sum game. The more money spent on buildings being built and technology being put in play, the less on human interaction. Investing in caring for people as people is nebulous and hard to quantify going out and especially hard obliquitously coming back around.

Salutogenesis, Engagement and Self-Efficacy

Salutogenesis is a term coined by Aaron Antonovsky, a former professor of medical sociology in the United States. The term describes an approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the “salutogenic model” is concerned with the relationship between health, stress, and coping. Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum.”

In 2008 Scotland, specifically Chief Medical Officer Sir Harry Burns, adopted salutogenesis as national public health policy. Burns helped Scotland conceptualize health improvement differently, being aware that the small gains that resulted from a range of interventions can add up to produce significant overall improvements. Much of these interventions were and are aimed at empowering the populace through engagement with their own health outcomes.

Engagement creates agency and self-efficacy. Self-efficacy is defined as the extent or strength one believes in their own ability to complete tasks and reach goals. The more a person believes their actions will help their situation, the more likely they are to try. The more a person does, the more they’re likely to do. And the more they do, the more they feel what they’re doing is helping … creating a cascade of positive results and well-being. And at the center of this is engagement, whether it be personally, socially or civically.

Isolation And Our Nation’s Declining Health

A report came out last week that generated a tsunami of follow-up articles. Julianne Holt-Lunstad from Brigham Young University presented the results of two large meta-analyses on the connection between loneliness and premature mortality at the 125th Annual Convention of the American Psychological Association. 

“There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators,” Extracting data on things like social relationships, health status, pre-existing conditions and causes of mortality, the team was able to quantify a difference between socially isolated people and those with stronger relationships. Those with strong social relationships were 50 percent more likely to survive longer than those who were isolated. 

“The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity),” they write in the study.”

Being alone, often due to declining marriage rates and fewer children, is literally killing us. We don’t engage with each anymore. Not only have our communities not compensated for these changing demographics – suburban sprawl and the invasion of box stores has added to the problem. The neighborhoods America has always relied on for social support have become the exception not the norm. Rather than walk down to the local park and feed the squirrels or play chess under the oak by the playground – our isolated senior citizens watch Fox News hours on end. And not just our senior citizens, it’s anyone facing months or years of chemotherapy or similar treatment. Have we been relegated to lives of polarizing cable news ideologies or driving to Walmart?


Well-being, Hope, Role of the Healthcare Provider

“I believe that the community – in the fullest sense: a place and all its creatures – is the smallest unit of health and that to speak of the health of an isolated individual is a  contradiction in terms.” Wendell Berry

What if we designed our communities around the idea of maximizing engagement. The more engaged our residents are … the more empowered they are and feel they are more in control of their health and their futures. Imagine if a chance to engage, whether it was physical, mental or social was just around the corner. And what if opportunities to help others realize the same were part of the fabric our daily lives. And imagine if our storied healthcare providers felt their mission and their duty to be at the forefront of this effort.

What if engagement and well-being was how a community measured itself, not obtuse economic activity often distorted through the one-dimensional filter of irrelevant statistics. What if we fixated on what we “could,” rather than what we “can’t.” And what if getting up in the morning was a chance to nurture our hope … and engage with other to help them do the same. And again what if at the center of this new enlightened measurement were those allegedly in the business of keeping us healthy. Then maybe they would truly deserve the words on their letterhead.

Life doesn’t have to suck just because you have cancer, have any other hardcore disease – or are just getting old. But it sure can be if the so-called leaders or our communities, especially the ones perched in the ivory towers of storied healthcare providers, don’t step up and help us out.

We need you to lobby for our communities to be places that prioritize people and engagement – not cars and box stores. We need you take some of the money you don’t pay in taxes and invest it in community gardens, farmers markets and street fairs that showcase local art that encourage creative engagement. We need you to lead the way on healthy eating by including cooking and nutrition as an integral part of our treatment. And while you’re at it – include our stakeholders. We need you to be advocates for engagement and “getting out of the house.” Communities that encourage something as simple as allowing dogs in parks will boost their residents’ collective health and well-being.

We need you to reach out to us with transportation, especially when we live more than an hour away. I’d like to see how many CEOs go through a ten-hour chemo infusion session only to drive themselves an hour home to two elderly parents they have to help caregive. Probably not many. The life of a cancer patient is seldom one of a giving extended family waiting at the beck and call. Often it’s flipped. Cancer affects anyone and everyone … regardless of the burden of their obligations and responsibilities.

We need you to be vocal when you see politicians and government not doing what they should to improve the human condition of our communities. You should be a regular contributor in the OpEd section of the newspaper. You can’t hide behind the nonpartisan label just because you’re afraid of losing a few ideological wayward customers. Losing them is nothing compared to losing your integrity and human decency. And believe it – there is people out there like me, who can write just as well, who will call you on it … publicly.

Most of all we need you to use your stage for us – not just for the construction workers and contractors you hire to build your buildings. I always say that there are few things worse than being rewarded with a stage, a platform to make a difference – and doing nothing with it. People’s time and attention is the one thing that is scarce and money can’t buy more of it. To squander it is criminal. People not only listen to their doctors and healthcare provider – they often don’t act for their own well-being unless given the go-ahead by them. This is a responsibility you personally shoulder, whether you like it or not. If you’re not up to the job … there are other ways to pay for that BMW. Or even more so … you can trade it in for a Taurus.


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Rebutting the Hysteria: More Thoughts on “13 Reasons Why”

Last week it seemed like I was bombarded by articles on the impending doom descending upon our adolescents due to the Netflix series 13 Reasons Why. Pretty much every article cited a study done by San Diego State University Graduate School of Public Health associate research professor John W. Ayers just published in the scientific journal JAMA Internal Medicine.

Ayers and his team of researchers focused on United States internet searches between March 31, 2017 (13 Reason Why‘s release date) and April 18, 2017 (so queries wouldn’t coincide with the April 19 suicide death of former Patriots football player Aaron Hernandez). Every search phrase included the word “suicide,” omitting the word “squad” so searches for the film Suicide Squad wouldn’t contaminate the results. Then they compared those results with searches and daily trends between January 15, 2017, and March 30, 2017 to get a baseline sense of what those searches are like generally.

The findings showed that after the release of 13 Reasons Why, which follows the events surrounding a fictional teenager’s eventual suicide through a series of tapes she leaves behind, all suicide-related searches were 19 percent higher than expected.

While awareness-related phrases like “suicide hotline” and “suicide prevention” were up 12 percent and 23 percent, respectively, “how to commit suicide” increased by 26 percent, “commit suicide” by 18 percent, and “how to kill yourself” by 9 percent.

That said, it’s unclear if these specific internet searches were definitely related to the show. It also isn’t clear whether those searches actually led to suicide attempts or deaths. But Ayers noted that previous research has found a correlation between increased searches for suicide methods and actual suicides. In other words – Ayers is extrapolating his interpretation to what he thinks is causation – but can’t really show anything but what he wanted to show in the first place.

Studies like this are clickbait shrouded in an academic cloak. First correlation doesn’t prove causation. And second nothing, especially teenagers, operates in a bubble. There is no experiment group vs. control group to compare. Also, even more importantly, one would assume there would be an uptick in internet searches associated a popular teenage series (no matter the content and especially if it has weight). To think this curiosity will cause additional action where there already has been action – is far from conclusive.

In my May 12 blog piece, “13 Reasons Why” … And Why It Matters To Your Community, I made a case why I thought the series was a good thing for our communities, including both adolescents and adults. But I’m not one who thinks we need to shelter our youth from the “monsters under bed.” On the contrary, I firmly believe we should empower our teenagers to develop the skills and self-efficacy to fight back against the aforementioned monsters. For there will alway be monsters under every bed well past the teenage years. The better our children get at fighting them early on … the better off they’ll be later on in life.

What I stressed in my previous piece, and what the pieces based on Ayer’s research didn’t (anywhere) – was what is the role of the community and adults who run them. What role can those living with and around teenagers, not only parents – but mentors, neighbors and civic leaders, play in their mental health? What are these people doing to create environments that dissuade our young from getting to the point of such extreme disenfranchisement in the first place.

In “Why People Die By Suicide” (2005), Thomas Joiner, a professor of psychology at Florida State University, drew on the testimony of survivors, stacks of research and the loss of his own father to upend minds. He recognized the myriad pressures on a suicidal mind — substance abuse, genetic predisposition to mental illness, poverty — but identified three factors present in all of those most at risk: a genuine belief, however irrational, that they have become a burden to those around them; a sense of isolation; and the ability, which goes against our hard-wired instincts of self-preservation.

The question we should be asking ourselves is how should we combat this sense of isolation that breeds within our young people. Whatever the reasons why, the best way of combating destructive behavior, including suicide, is refocusing energy by providing positive outlets and alternatives. If your life has a purpose, you’re much more likely to spend your time and attention on that purpose rather than on self-annihilation. It’s hard to feel sorry for yourself and escape in a bottle of vodka if you’re too busy helping those in an even worse space than you. For example, studies have shown volunteering often helps the person doing the volunteering more than the person being helped.

Even after we’ve addressed the reasons why and created positive outlets to focus on, we still don’t live in a Perfect World though. The human psyche is vulnerable. The monsters will always be there and no matter how much we try to ignore them … they’re still going to find their way out from under the bed into our minds. Or in the words of John Milton; “turn our heaven into hell.” The question ultimately becomes … how do we deal with them when they do. Do we dive into the bottle or the medicine cabinet – or do we shake it off and put the haze of gloom behind us? How much can we, or in the case of “13 Reasons Why” our kids – take? 

Salutogenesis and Self-Efficacy

Salutogenesis is a term coined by Aaron Antonovsky, a former professor of medical sociology in the United States. The term describes a health approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the “salutogenic model” is concerned with the relationship between health, stress, and coping. Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum.”

In 2008 Scotland, specifically Chief Medical Officer Sir Harry Burns, adopted salutogenesis as national public health policy. Burns helped Scotland conceptualize health improvement differently, being aware that the small gains that resulted from a range of interventions can add up to produce significant overall improvements. Much of these interventions were and are aimed at empowering the populace through engagement with their own health outcomes.

Engagement creates agency and self-efficacy. Self-efficacy is defined as the extent or strength one believes in their own ability to complete tasks and reach goals. The more a person believes their actions will help their situation, the more likely they are to try. When fighting adversity, self-efficacy is your tool chest. It’s your ability to fight the monsters under the bed. One of the most potent defenses we have is engagement. This engagement can be with ourself, through our minds and bodies, or with those around us in our communities and neighborhoods. “Doing” is a prescription for well-being. The more a person does, the more they’re likely to do. And the more they do, the more they feel what they’re doing is helping … creating a cascade of positive results and self-efficacy.

Now as the supposed adults in this discussion (that is highly questionable at times though), isn’t our responsibility to step in and do something other than playing Chicken Little running around screaming the sky is falling. Our kids are fragile, as we are. Sheltering them is not the answer though. Empowering them and giving them access to engagement to boost self-efficacy is.

In the last couple decades we decided that the effective way to bring up our children is to strip them of opportunities to express themselves in benign ways as they wish. At the earliest age possible we relegate them to organized academic activities pounding reading instruction down their throats even in preschool rather than letting them flourish in unstructured play where they self-learn coping and socialization. It’s no wonder when they get into situations later on, outside of the constructs of the classroom, they don’t adapt well.

Even though our adolescents are exposed to the same information we adults are due to technology, we still often view them as less than people. Our teenagers are not the way we were. No matter how much we want to shelter them – we can’t. What we can do is help them acquire the tools to successfully cope and excel. And this responsibility extends well past the walls of our classrooms and even our homes. It lies open with everyone in our communities.

“I believe that the community – in the fullest sense: a place and all its creatures – is the smallest unit of health and that to speak of the health of an isolated individual is a  contradiction in terms.” Wendell Berry

The world we all live in is charging ahead at a speed no one could have envisioned. While we can pull from our experiences of the past – we can’t take them verbatim as the answer for the problems we face today. Our mission must be to use the past and mold the positive value it bequeaths us and let it evolve to a more relevant time of today and tomorrow. And central to this social inheritance is the Middle Ring of our neighborhood and community relationships.

Introducing the ‘Middle Ring”

A few years ago Marc Dunkelman wrote an excellent book on the evolution, or should I say the de-evolution of the American neighborhood, “The Vanishing Neighbor.” In his book Dunkelman introduces the concept of the Middle Ring. The Middle Ring is what Dunkelman calls our neighbourly relationships. This is in contrast to the inner-ring of family and close friends, and the ever-expanding outer-ring relationships fostered by the digital age and social media. Unfortunately the ‘middle’ is not holding, collapsing from pressures on both sides. Social media sites have brought our closest contacts closer and expanded our reach to include ‘weak ties’ that we know only through cyberspace. Compound this with the proliferation of politically and interest segregated cable and internet news outlets, we have little time or attention for anyone else, physically or philosophically. And what suffers are our neighborhood acquaintances, our communities and the memories of what they used to stand for.

There’s been much discussion in the last decade about the decay of the American community as we like to remember it, or as Hollywood portrays it. But really it’s the loss of the Middle Ring we’re seeing. We still have communities, they’re just not inhabited by ‘our neighbors.’

It’s the loss of these neighbors who were physically around that could be counted on (often without even asking) that’s creating a social divide in America. In the past, before World War II, our neighbors were our support. They were the doctors, the midwives and the handymen. They were where we could go to get food when we needed it. It’s what got America through the Great Depression.

We didn’t have to agree with them politically, socially or otherwise, but we knew them and they were still our neighbors. And we could count on them.

But with Roosevelt and the New Deal, the government became America’s support system. The help of your neighbor wasn’t as important. That worked fine, but that reliance on the township, the community, the neighborhood and in turn the nurture of our Middle Ring began to wane. It wasn’t so evident at first. But the chinks in the armour, so to say, were beginning to show, even back then.

And now it seems as if we’ve all but lost our Middle Ring. Maybe not physically. There’s still people who live next door and down the street, but we don’t know them. Maybe we’ve never even met them. We don’t know where they’ve been or where they want to go. And it kind of makes it hard to help them get there.

As a result our neighbors don’t seem to have identities – and neither do our communities. It’s hard to tell one from another. Maybe it’s due to the prevalence of homogenized big box stores like Wal-Mart and Target. Maybe its the MacDonald’s or Starbucks on every corner rather than Joe’s Diner or Martha’s Koffee Klatch. Maybe it’s the gated communities where unless you live in one … you don’t know who or what does. Maybe it’s all of it. But regardless, everywhere kind of seems the same. It’s like there’s planned communities everywhere, except they’re not intentionally planned.

It’s time to re-examine this way of life we’ve created – one that increasingly resolves around isolation not engagement. It this the world we want our children to have? Do we want their only access to the answers they need to grow up being on the other end of the screen of the iPhone? Our lack of attention to the communities we have socially and civically abandoned has given them no other option. It’s no surprise some of the most desperate see suicide as the only option.

Also last week the sentence came down on the “death by texting case.” Michelle Carter received sentence of only 15 months, while the prosecution wanted seven years. The mother of Conrad Roy, the boy who committed suicide at the encouragement of Carter is calling for new legislation to invoke mandatory sentences for future offenders in similar cases. As Bill Clinton once famously said, “you can’t legislate morality.” no politician is going to come to our rescue. Only we, the ones who live in our communities, can create them as we want to.

Since we’ve let our civic and social relationships, especially across generations, decline to the extent it has – shouldn’t we take responsibility, own up to the problem and make efforts right at home in our neighborhoods to fix them. Calls for mandatory penalties are not going to repair the social fabric of our communities, deter anti-social behavior or bring back a troubled loved one – no matter how impassioned they are. Only we, the leaders of our communities, can affect change by encouraging an embrace of empathy and compassion that jumpstarts a collaborative dialogue with our teenagers.

Whether you believe it or not, our children are more capable than we ever were at their age. We just don’t give them the avenues to express themselves to create environments around them to better fit the their social needs to handle the demands of the daily stresses they encounter in a over saturated world. And we’re sure not doing it for them.

“To learn is to accept that one’s growth—the endless process of becoming who they will be—depends on engaging the strangeness within themselves (the part that is perpetually open, unpredictable) as much as interacting with a strange world of knowledge that they can absorb but never know in its entirety on their own.” Maximillian Alveraz

The summer job at the gas station down the street or the pick up baseball game in the vacant lot are gone. We, the adults, have let them go away. We replaced them with Wal-Mart and volleyball summer camps (for our benefit more than theirs). What ever summer jobs might be left are filled by retirees too actively young or financially needing to retire. Cross-generational interaction isn’t based on physical collaboration – it’s from a spectator perspective. Distrust because of unfamiliarity extends up and down the age spectrum.

Our answers lie in inclusion and engagement across all lines. Our young people are assets if we treat them that way. Help them build their own futures rather than create barriers because we think they should act like we did (whether we even did or not). After all the world we’re living in will soon be theirs – and we will be the ones needing their help. The more successful the transition we provide … the better off we all will be.


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“Believe it or not it may not be about you!”

This is one of those “don’t forget this … and share far and wide.”

A few years back I was traveling on Amtrak from Orange County to Seattle to visit Jennifer (you’ll hear more about her down the road). Trains are great … way better than planes and cars. You get to spend hours together with people you’ve never met and probably will never see again. All you have is that single experience.

At the beginning of the trip, I met and sat next to a young man who happened to be a Buddhist. Now he didn’t look like the stereotypical Buddhist; no shaved head, no robe … just kinda look like I looked twenty-five years ago (except probably better looking). For miles we talked, ate and talked some more.

Note: Coincidentally, I did meet two “typically looking Buddhists” the next morning a few hundred miles up the road after being left a train station; That’s different story for different day.


One of topics of our conversation was his girlfriend – who lived with him on a Buddhist compound outside of San Diego. Over the last couple of months their relationship had declined. She would come home from work in a surely mood and stayed that way through the night. “What was wrong and what had he done to cause her malaise.”

“What can I do to make you happy,” was the pretty much how every evening began.

At wits end, my new Buddhist friend went to his monk for advise.

This is it:

“How can you be so arrogant and self-absorbed that you think everything in her life revolves around you and is caused by you.”

The next time you beat yourself up over something having to do with somebody else, try empathizing – look at the world from their perspective.

Believe it or not – it may not be about you.


If you like this … please Tweet it and follow me on Twitter @clayforsberg


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Staying Strong

Monday morning I got up early and prepared myself for I thought would be my last three-day session of chemo treatments for my lymphoma (Using the word “my” in reference to having cancer seemed odd writing it, but I suppose if I take ownership over it – it won’t own me) . Unfortunately I got bumped. My platelet count was too low and my ordeal is now pushed to next week. In the whole scheme of things this is no big deal – but it’s just another one those straws putting pressure on the proverbial camel’s back. It’s not just the all day infusion sessions: It’s the preparation, mentally and physically that’s a big part of it. Now I’ll have do it all again at the end of this week. Hopefully my blood levels are up so I can get on with this.

Later after I got back home, I checked my email and came across an article in my Fast Company feed, “Why Telling John McCain to Beat Cancer Feeds Into a Dangerous GOP Narrative.” All things considered, this piece peaked my interest.

Now for those living under or in a rock and oblivious to current happenings in the world, John McCain was diagnosed with a fast-metastasizing cancer of the brain, Glioblastoma to be specific. The outpouring of support was no surprise. And the tone of the support was really no surprise either considering who John McCain is and his personal history. No one is feeling sorry for him. Just the opposite. People are assuming he will fight this with the same tenacity he did as a POW in Vietnam.

Jean Hannah Edelstein, the author of the Fast Company piece had an odd take on the situation. In this brief, maybe 500 word article, she didn’t really talk about John McCain or cancer that much. Instead Edelstein chose to attack the Republican party and their healthcare policies. She also threw Barak Obama under the bus for good measure.

Now I want to pile on the toxic dumpster fire that is the Republican party as much as anyone. But I don’t really see why John McCain’s cancer is the place and time to do it. This isn’t a partisan issue. Access to treatment maybe – but reaction to it … not at all.  To make it that – is to further feed the fire that has created the toxic political and civic environment we all now inhabit. If anything, McCain, who for the most part is not a polarizing figure, may be one of the rare politicians who could generate a common sense of compassion and human decency. That being said, his vote repeal Obamacare yesterday did little to endear him or his situation to me. One would think he would have acquired a new sense of empathy for those less fortunate financially in situations similar to him. But apparently not.

Regardless, that doesn’t change Edelstein’s reaction to the outpouring of support for McCain – which occurred before the vote. She used the situation as yet another opportunity to further the political divide. Rather than encourage people diagnosed with cancer to fight the disease and build their self-efficacy, she thinks we should show them sympathy. To encourage them to fight the disease implies if they give way to it, they didn’t fight hard enough and the outcome is their fault. I suppose I get where she’s coming from. I’m not against a show of sympathy. While not my preferred reaction – it works for some people. But I have real hard time with the view that one’s own efforts have nothing to do with the outcome when it entails a disease. When does self-responsibility and personal power affecting change come into play in Edelstein’s mind? Does it ever … for anything? Or are we just innocent victims of a predetermined fate – possibly only affected by the efforts of someone in a white lab coat and a fifteen minute visit.

For example she picked a bone with Paul Ryan, who I’m no fan of, and his views of self-responsibility.

Paul Ryan spearheaded the concept of personal responsibility in the context of health care in 2009, when he wrote in his Patient’s Choice Act that a “large percentage of heart disease, stroke, and type 2 diabetes, as well as many cancers, could be prevented if Americans would stop smoking, start eating better, and start exercising.” Health policy should be built, he argued then (and now) to reward people who look after their health—to disincentivize illness, as if people are eager to pursue bad health.

While Ryan’s Ayn Rand extremism is exactly that, extreme … there are things we can take from it. Should we embrace Ryan’s view of “pulling ones self up by the bootstraps” wholeheartedly – probably not. But should we buy into Edelstein’s succumb to destiny and fate – probably not either.

Her views are affected by the death of her father, a non-smoker, of lung-cancer at age 69 (as the article outlines). For good reason, it’s obvious this has had a major impact on her life, specifically her views on healthcare. Her bio even says she’s writing a book on cancer and genetics. In addition, she’s a writer for the Guardian – which has become a go-to anti-GOP media outlet (no judgement intended, but it’s impossible to ignore its left-leaning direction).

Disclaimer: I used to read the Guardian, but can’t anymore. In my opinion, their political views have infested virtually everything they publish – whether the content should be taken as political or not. I suppose they believe they are doing a service. That may be – but they can do it without me. I believe Edelstein’s article in Fast Company follows along with this philosophy.

She takes the opportunity to rally us for a “healthcare for all” policy of government. While a noble cause (and philosophically I agree with – and I have enormous skin in the game) – its implementation is a completely different story. I’ll leave discussions of a single-payer government-run system for a different day and different couple thousand words. Let me just leave it with anyone who has had experience with American Veterans Choice program wouldn’t wish that experience on anyone, friend or foe.

To assume that we turn over everything to the government and expect them to sprinkle fairy dust on every problem we have and make it better, is naive at best and most realistically – pragmatically irresponsible. The government isn’t going to fix healthcare or much anything else – regardless of what party and color clown suit they’re wearing. The governmental apparatus is mired in operational malaise and void of innovative talent. Unfortunately, what our founding fathers created is no match for the complexity of today’s world and the narcissistic political behavior that has manifested in Washington D.C. under the guise of representative democracy.

My journey with cancer over the last two and half years has heightened my obsession with self-efficacy. I have no other option. I have to believe what I do and what I think makes a difference. I’ve never been one to believe in fate – and I sure as hell I’m not going to start now. My way of dealing with this is believing that self-efficacy is my partner in this battle. The stronger it is … the stronger I’ll be and better my prognosis. I’ve even created an engagement platform to help me in my journeyOf course I have my medical treatments which I anticipate will work, but I don’t have any control over that. What I do have control over the is my attitude during this journey (both during treatment and afterwards) – to help ensure I don’t have to go through this for a third time (or more).

I can be positive and take care of myself; and most of all try to lend support to others by being part of the solution to issues in their lives. I believe looking outwards is a big part of internal healing. We are a function of so much more than just ourselves. We are products and parts (today and in the future) of those around us – in our communities. I’ve taken this stance and made it a cornerstone of my Community 3.0 project, right there next to Rhizomes and Front Porches

That is what I can do … and will continue to do going forward.

My very good friend Bob always tells me to stay strong. It shows he cares. But more than that, it shows he thinks enough of me to believe that my strength and self-efficacy will in some way lead me to a positive outcome. This makes me try harder. And that’s a good thing. How Jean Hannah Edelstein can justify taking that away from me is malignant in itself. I go through my own battle, and yes Jean that is what it is (and I wouldn’t doubt your father considered it the same), with the same passion and drive I’ve put forth towards anything else I’ve done in my life. Only in this case, the stakes are higher. Whoever wants to jump on board and give a little push … I’m all in.

Battling cancer is so much more than just the end-game. It’s the journey. It’s the side-affects and the treatment. It’s the physical turmoil. And it’s emotional rollercoaster. It’s Chemo Brain and the struggle keeping concentration. And it’s not enough to take care of and worry about myself – it’s the affect my situation is having on those around me? And if I succumb to it, what effect will that have on those closest to me? Will they never be able to let it go – always looking for an answer, dedicating their lives or worse obsessing over of it until it consumes them too? Or will they turn it around and pull strength from it – much like a vicarious spirit of the Phoenix. Personally I want to lead by example, and as Bob says … Stay Strong!

May this post be a message to those close to me, and those close to others with cancer who are battling, often in ways you have no idea of. We don’t need sympathy. We don’t want you to feel sorry for us. We want to know our battle will transcend us as you take the baton our of strength and self-efficacy and carry it forward to use in your own lives – adding to your own personal emotional and mental toolboxes. Make our battle worth more than just the efforts of us alone. Use it fight to fight your own battles too.

You can follow me on Twitter at @clayforsberg.


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Rebuilding Alexandria

About twenty years ago, my daughter Alex and I were living in Marin County above San Francisco. During this time I became addicted to reading. I don’t know if I was trying to make up for lost time or what; but a pile of five books (all in various stages of completion) became a permanent fixture on my dining room table. At least once week, and more often more than that, I made the trek to my local independent bookstore in Corte Madera down the road to see if there were any new current event titles I could add to my menu of cerebral digestion. Normally a book stayed a couple of weeks until I was done with it – only to make way for another to take its place. There was one book however that stuck around a lot longer. The 100: A Ranking of the Most Influential Persons in History by Michael Hart written in 1992.

Hart’s book was fascinating to me. Since I was in grade school, I’ve been a history buff – even reading the entire encyclopedia sitting on the living room floor when sub-zero temperatures and three-foot snow banks put a damper on outdoor activities (obviously it was a pre-video game era). What intrigued me about “The 100” was that Hart didn’t pass value judgement on whether the influence the person had was good or bad – just that the person had influence. Jesus and Sir Issac Newton figured prominently, but Hitler and Genghis Khan were also ranked. He also went into copious detail on why he ranked them where he did. A lot of the reasons weren’t obvious, but once brought to light – made complete sense. George Washington for example, was ranked in the top 40 not because he was the first president of the United States, but rather because he chose to voluntarily relinquish his office after only two terms, setting a precedent that would remain intact until Franklin Roosevelt 150 years later.

Being immersed in the printing industry as a headhunter, I loved the fact that Johann Gutenberg and his printing press made the Top Ten. But the one person that took me by surprise was the one Hart ranked as Number 10 overall. That was Euclid. I didn’t know who Euclid was – even with my encyclopedias and three-foot snow banks.

Euclid and Alexandria

Now for those of you who are as uninformed as I was, Euclid is known almost solely for writing the math text, Elements.

Euclid (fl. 300 BCE) was a Greek mathematician, often referred to as the “father of geometry”. He was active in Alexandria during the reign of Ptolemy I (323–283 BCE). His Elements is one of the most influential works in the history of mathematics, serving as the main textbook for teaching mathematics (especially geometry) from the time of its publication until the late 19th or early 20th century.

But the most interesting part about Euclid was that Elements wasn’t really that much of an original text. He didn’t make any groundbreaking revelations like Newton or Copernicus. He pretty much just took the works of other scholars, many of which lived and worked in Alexandria, and synthesized into one book a comprehensive guide to geometry. In summary – Euclid was a curator; and a prolific enough of a curator that Michael Hart had him ranked Number 10 in the list of the most influential persons of history. Holding a curator in such high regard, especially at that time in history where personal contact was really the main way to spread knowledge – brings up an interesting point. Euclid was a product of his geography and those who resident in his civic proximity. Euclid embodied the very essence the of Alexandria, Egypt … the diverse cross-pollinated intellectual melting pot of the world. Rather than beset by religious and societal division, it was a bastion of inclusion and open thought. Thinkers worldwide traveled from afar to participate in the collectivism.

In January of 1989, my wife Mitra and I found out she was pregnant. I vividly remember the discussion of names. Before we knew the baby’s gender, we picked both a boy’s and girl’s name. We didn’t necessarily agree on the boy’s name (which I don’t even remember). The girl’s name was a different story. The decision on Alexandria came quick as our first pick, even though our reasons were different. Mitra liked the name itself (as did I). But I really liked what it stood for. It’s hard to set the bar much higher for your child than being named after arguably the most prolific center of learning in the history of the world. If some of that rubbed off on her … all the better.

On October 11, 1989 in Burbank, California – Alexandria Noelle Forsberg was born.

Two years ago, as part of my series on community-based societal evolution, I wrote “Silos.” “Silos” outlines the need for communities to rise above their provincial jingoism in order for them to truly pursue sustainable policies. Cross-pollination; whether its gender, sexual-preference, ethnic, racial, age-based or especially geographic – must be fundamentally encoded in a community’s civic DNA. All to often however, especially where I live, the opposite is often preferred. How far back your Montana roots go back somehow makes you a better person – not more geographically myopic which is actually the case.

Community and the Value of Diversity

Everyday the environment we live in changes. These changes are a response to external stimuli. Darwin’s theory of evolution states that the flourishing and ultimately the survival of a species (or any other anthropological entity) is based on its ability to adapt to stimuli. Diversity is an advantage if not a necessity. Lack of diversity makes itself open to disease (literally and figuratively).

My daughter Alexandria breeds exotic snakes, specifically Rainbow Boas. She goes to extreme lengths to make sure the gene pool of her breeding stock is as diverse as possible. It may be a lot easier and less expensive to acquire stock domestically – but due to inbreeding (often unintentional) by less diligent breeders, genetically based pathologies often occur. To counter this, Alex has imported snakes outside the genetic pool from Finland and Great Britain. It’s much more difficult and more expensive – but it’s her only option with the bar she’s set for herself and her projects.

Your community really isn’t a lot different from Alex’s Rainbow Boa community (aside from the preponderance of scales). Any community is the product of its residents. Social inbreeding creates weak species and weak communities; vulnerable to adversaries, internally and externally. Inbred societies rely on decision-making and responses founded in a narrow historical perspective – severely limiting its response to challenges and opportunities.

The fact is that if you want to build teams or organizations capable of innovating, you need diversity. Diversity enhances creativity. It encourages the search for novel information and perspectives, leading to better decision-making and problem solving. Diversity can lead to unfettered discoveries and breakthrough innovations. Even simply being exposed to diversity can change the way you think. This is not just wishful thinking: it is the conclusion I draw from decades of research from organizational scientists, psychologists, sociologists, economists and demographers. Scientific America

A community is the collective sum of the value of its individual inhabitants multiplied by the community’s ability to synergize these individual parts (by curating organized and random encounters). Every encounter or engagement has an opportunity to be a synergistic one. Empathetic cross-pollinated engagements are the key. The city of Alexandria during the time of Euclid was a perfect example of this. Even though there were organized discussions and forums, just walking down the street could lead to a serendipitous encounter that might result in a groundbreaking discovery.

Every member of your community is unique and adds to its fabric. Everyone has something to offer and everyone should be heard – no matter their age or social standing.  It’s up to us to find it and help them see it. The more expressively diverse a community is, the more resilient it is and more potential it has to invoke change – both inside and outside its walls. Our focus must actively be on inclusion, not retreat into personal protectionism and paranoia of those different from us. We must resist the temptation of the comfort of “sameness.” Nothing happens in our comfort zones. If we don’t venture into the land of wonder … we’ll never see, let alone realize the possibilities life avails to us.

Designing for Serendipity, Synergy and Collaboration

Cross-pollination doesn’t happen easily though. People of different fabric may inhabit the same locale, but that doesn’t mean their views and ideas will synthesize and your community will be built on Alexandria-type collaborations. You have to reach out and try to understand these people not like you. You first need to empathize with them. The most effective way to do that is through shared actions – specifically shared community-beneficial actions. For example, building a school playground with your neighbors of different ideologies can bridge chasms that would otherwise be uncrossable. It’s amazing what work for the common good can do. This is what happens in disaster relief efforts. I doesn’t matter if you’re a Republican or a Democratic, everyone bands together to help rebuild the town they all live in. We just have to not rely on disasters to bring us together. Community commonalities are everywhere. We just have work to create opportunities for everyone to share in them.

From these opportunities and resultant actions will come serendipitous relationships; relationships that create synergies that move your community ahead in ways no one envisioned. That being said, we have to design environments; physical, social and personal so that these opportunities, actions and relationships become baked into our society. In business applications we strive for economies of scale. These efficiencies are mainly mapped on vertically axis or are niche based. Building for serendipity takes community economies of scale and expands their opportunity on the horizontal axis across defined multiple niches and focuses. This solution thinking stemming from diverse thought breaks through conventional siloed vertical constraints.

Imagine if your community had a Department of Horizontal Integration, where its primary role is to break apart the silos of the status quo power structures and connect dots from the pieces. This department wouldn’t need to be housed in the government. In fact it would be best if it wasn’t – for obvious hierarchical reasons. It could rely on your community’s true assets; its people and where they congregate, the Front Porches of the small business network.

Rather than abide by a top-down governance model run by those embedded in the status quo of mediocrity – we must create a platform of serendipity where matchmaking happens organically through interaction uncovering commonalities between the participants. Think of a synergistic mixing bowl of opportunity; obliquitous, indirect, organic relationship building.

Now imagine organizing set gatherings where this serendipity is on the menu. While there’s no guarantee your group will change the world – increasing that chance through proximity of diverse thought and motivation sure increases its chance. And what if the overarching goal of your gatherings was to improve the human condition in your community. How this is accomplished would be determined by those in the room not by a top-down bureaucracy mired in inefficiency and out-dated procedures. Everyone is here for the same reason and they are here because they WANT to be … not have to be because of an overriding need to fuel ego and status. 

For arguments sake let’s call your gathering, Serendipity. Serendipity could be a petri dish for how to solve civic and social problems directly rather than through government. It would be the platform for inclusion and experimental benevolence. The bar would be set so that no area of community need would be untouched. If something needed to be fixed, or something needed to be done – there would be no questions and no siloed jurisdictional squabbles … it would just happen.

In 1986, John Gage, then of Sun Microsytems, organized NetDay in California. NetDay was historic grassroots effort in the classic American barn-raising tradition. Using volunteer labor, their goal was to install all the basic wiring needed to make five classrooms and a library or a computer lab in every school Internet-ready. If the same work was financed by taxpayers, it would cost more than $1,000 per classroom. Volunteers from businesses, education, and the community acquired all of the equipment and installed and tested it at each school site. As a result 20,000 volunteers helped to wire 20 percent of California schools to the Internet. In addition, by bringing together these diverse elements, NetDay established a framework for lasting partnerships among business, government, educational institutions, and local communities provide ongoing support for the schools to this day.

What if we designed our communities around the idea of maximizing engagement from those in the streets? The more engaged our residents are … the more empowered they would be. They would feel more in control of their health and their futures. Imagine if a chance to engage, whether it was physical, mental or social was just around the corner. What if our physical security and well-being was not dependent on government assistance or the whims of a fickle market driven economy.

What if our neighborhood was our safety net, a safety net that knew best in our time of need. What if the streets of our community became melting pots of diversity-driven serendipity – places where curiosity was bred. What if engagement, well-being and self-efficacy was how a community measured itself, not obtuse economic activity often distorted through the one-dimensional filter of irrelevant statistics. And what if getting up in the morning was a chance to nurture our hope … and engage with others to help them do the same.

Building Your Own Alexandria

It’s obvious the human species must evolve. The ascent of Donald Trump to the forefront of our attention has presented us with some hard facts. We all have to take look in the mirror and ask ourselves how we got here. We will have to change our thinking – or maybe just start thinking. Instead of relying on past expectations, and cultural assumptions and metrics as our guides — we have to envision what could be … not just what always has been and try to bring it back to life.

But vision is only part of the journey. We have to look past how things in past have been done. No longer should government and traditional institutions be looked at as the first line defense … rather should be looked at only as a last resort. Our reaction should be to assemble our friends and neighbors at our local Front Porch, organize and do what has to be done — developing self-efficacy, individually and collectively along the way. And we best accomplish that by inclusion and reaching out to those around us who normally we may feel uncomfortable doing so. These outliers of our social circles may be the exact people who ensure the our very survival.

We can make the change we need — but it won’t be by thinking the way we’ve always thought and doing what we’ve always done — the way it’s always been done.

If you’re interested in moving on from the status quo that will inevitably take anyone and anything down with it … please check out Community 3.0, my vision of an evolved society where self-efficacy and well-being is priority. Or even better email me, at clayforsberg@gmail.com and we can set up time to have a conversation.


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