Preserving the soul of medicine and physicians: A talk with David Whyte. (Reconciling the Inner Self with the Business of Health Care).

KEY CONCEPTS

* Nurturing the Soul

* Belonging in the World

* Bringing Your Soul to Work

* Following Your Personal Destiny

* The Voice and Spirit of Medicine

* The Power of the Imagination

"I HAVE NE VER H4D A money practice. But the actual calling on people, at all times and under all conditions, the coming to grips with the intimate conditions of their lives, when they were being born, when they were dying, watching them die, watching them get well when they were ill, has always absorbed me."

William Carlos Williams, MD

Q: Your book's title, The Heart Aroused Poetry and the Preservation of the Soul in Corporate America, came from a poem by William Carlos Williams, who was a country doctor and poet in Rutherford, New Jersey. Could you recite that poem?

David: My heart rouses

thinking to bring you news

of something

that concerns you

and concerns many men. Look at

what passes for the new.

You will not find it there but in

despised poems.

It is difficult

to get the news from poems

yet men (and women) die

miserably every day

for lack

of what is found there.

The parentheses are my

addition!

Q: Why does the soul of corporate America need preserving?

David: Soul is best defined in terms of belonging; without a sense of belonging, human beings can't make sense of their world or what they are doing in that world. Without participating individuals who feel as if they belong to something larger than themselves, the organization is an empty shell passed from generation to generation. It is the participative imagination that animates organizations, that makes them alive and worthwhile to work for.

I think about the soul in practical and clear terms. Soul is a measure of our belonging in the world. When there is little sense of belonging, there is very little sense of soul. We use the word soul in our vernacular speech everyday; we talk, for instance, about a building having no soul. The architecture of a building is soulless when we don't know where to put ourselves in it, when we don't know how to belong to it. We talk about things that have a great texture of belonging as being soulful. When I use that word in the workplace, I think about whether we have a sense of participation in the particular work or the organization, a sense of texture, color, intrigue, and surprise. For most human beings, that is an important question to ask and an important journey to follow.

Q: What is a good Yorkshireman like you, a poet no less, doing serving as a consultant for multi-national corporations?

David: I never would have imagined myself in this place when I went full time with my life as a poet. I am first and foremost a poet and I just happen to work in organizations because that is where I've been pulled by the gravity field of my work. But if it all disappeared, I would still be a poet, speaking and reading. I don't consider myself a consultant, although I find myself working with organizations in a consultative capacity simply because I've gained enough experience traveling around the business world to have some perspectives that seem to be valuable.

But poetry is the core of my work. I have two agendas when I go to a new organization: one is to be as useful as possible to the people who brought me in; the other is to get great poetry to as many people as possible. Poetry is incredibly useful and practical in helping us to understand the dynamics playing out in our work lives for which we often have no language, but which we live at the mercy of almost every day of our lives.

Q: Who are some of your clients and how long have you been doing this work?

David: I've worked with so many organizations over the last 13 years. The Boeing Company, AT&T, Arthur Andersen, Stanford University, Deloite and Touche, The Mayo Clinic, Harvard University, Nortell, Hewlett Packard, and so on, but I probably work in the health care field more than any other.

Q: You have a gift of reducing complex events to simple evocative metaphors. Why is this gift so important in modern day life?

David: The level of complexity is so high in corporate life. The strategic, empirical mind is helpless to place you in that moving world. It wants to stop the world in order to get on. The strategic mind is always waiting for all of the evidence to come in and it works by dividing the universe into quadrants and then assigning qualities to them. The organizational world is more like a complex living ecosystem. You have to place yourself in it as a living being--exactly the concern of good poetry and of the imagination.

The great poets, such as Keats or Coleridge, have said that we all have an inborn ability to form an image or metaphor inside ourselves that will make sense of the astonishing complexity that we may be surrounded by at any one time. This faculty of imagining can place you in the midst of very difficult, moving, fluid circumstances and give you not only answers as to what you must do, but perhaps more important in today's world, how you must be.

Much of the complexity we face may still be over the horizon, it may not have emerged yet, but using the faculty of the imagination we are able to sense the pattern and our place in it. This is what anyone does who is producing something new and worthwhile for the world. It is something that has not yet fully appeared in its final form from over our horizon and yet we are able to engage it in a real artful conversation; that is why the imaginative life is so surprising, and so pleasing to our sense of discovery. We say, "How imaginative!" when someone comes up with something new and brilliant and pioneering.

Q: You write about life in the upper world, the world of the workplace, and life in the lower world, the dark subterranean caves inhabited by the soul. Why is it important to understand this chasm?

David: There is part of you that doesn't care two cents about your career, your successes, or even the latest medical breakthrough. There is a part of each of us that has much bigger fish to fry around the great questions of living, a part of you that you will come to know when your surface personality unravels on your hospital death bed. This core identity has different priorities than our more fearful career bound perspectives. It wants to live a life it can call its own, it wants a certain kind of consummation not possible to the identity we have cultivated at the professional surface. Work in this area is not something we do, but a great pilgrimage of identity by which we discover larger and larger perspectives on our self and the world we inhabit.

Somehow at the threshold of the new millennium we have managed to create lives that are exceedingly busy but leave little time for the great questions of belonging. These questions refuse the periphery: spoken or not spoken, they lie at the center of what gives a human being a sense of meaning and belonging.

This half of human life is often hidden away and is invisible at any one time and takes a kind of apprenticeship to things that are unspoken and dark and away from the daily celebrations of everyday social existence.

Q: You say that corporations are going to have to understand that the soul is necessary to unleash their employees' creative gifts and innovation. Are executives coming around to that argument?

David: Every worthwhile organization is asking for qualities of adaptability, vitality, and creativity. And none of these qualities can be legislated, none of them can be coerced out of people. You cannot invite anyone into your office and say I want a 9 percent increase in your creativity quotient this week. The request is absurd because there is no lever inside that person that they can pull to turn on their creativity. If there was one, they surely would have pulled it years ago.

The only thing you can do is to create a conversation in the workplace that will be invitational to those great qualities of creativity that have long been associated with the soul, with a person's sense of belonging. The main task of leadership is no longer strategic management, though this will always have importance, but of creating imaginative and participative conversations that bring out the best in themselves and others.

Q: You mentioned that some of the great people, like Winston Churchill and Madame Curie, had a deep sense of soul and from that they plotted their destiny. Why is knowing your personal destiny an important part of creativity and innovation?

David: As long as we do not understand destiny as fate, then it can be a useful concept. Our destiny isn't something that we figure out, that is laid out ahead of us. It is has more of the quality of a gravitational field. It is our own particular pull into the world. We are acted upon by the rest of the world according to the nature of our own individual patterns. This frontier interaction, this conversation. is the conversation of destiny. Strong people, like Churchill or Madame Curie, had a remarkable courage that emerged from knowing when they were in this field, this conversation, and when they were simply going through the motions. They knew when they were living their own lives and not being pulled by the great tide of other people's expectations.

There comes a time in every life when we must hold onto something quite difficult, something at times we cannot even articulate. It may be that medicine is at this point right now and the main task of doctors is to extricate themselves from their buried complexity and the societal silence of their profession and stand up for the essence of their tradition.

Q: Can a poet or someone attuned to their soul make his or her way in this materialistic world?

David: Ovid said that innocence is no earthly weapon, but Blake, Keats, and Wordsworth would have disagreed. The poet historically is no simpering wallflower writing about flowers and joyful lambs, but a robust figure speaking out at crucial moments in society's evolution and often suffering the consequences of his or her speech. Good poetry is not only about courage, it is courageous speech.

If you look in the life sciences fields, the Nobel prizes are being won by people who switch disciplines, they move from microbiology to physiology, or from zoology to botany. They have all of the discipline of their training and then suddenly they are able to look at something in a completely different way. That is beginning to happen between the arts and sciences. People who have their faces right up against a problem can't see. The strategic approach to life is ultimately bankrupt; it lacks the courage of the participative imagination. The business world has intuited this already: it is looking for different voices to help it articulate a new world. We are in desperate need of good artists who can bridge both worlds.

Q: How do you condense your lyrical insights into observations that corporations can use? What can a poet teach a corporation?

David: Poetry is immensely useful. I recite poetry in order to take people into the dynamics and phenomenology of human relationships that are dominating their everyday work life. There is nothing in the inherited corporate lexicon that will come anywhere near these issues in a real way. But, poetry can speak to dozens of phenomena that are helpful to people in the workplace who feel powerless before the forces that they confront.

In poetry we can speak to issues that are dominating circumstances at work, but which people are helpless to articulate. You can recite a poem on betrayal by Marina Tsvetaeva, a great Russian woman poet, for instance. You can look at the way that people always experience some form of betrayal when they are working with others. There is nothing wrong with the experience, it is just part of the territory of relationship and work and not an excuse to say that this is a dog eat dog world and I will get in my betrayals before others get in theirs.

In a strange way, her poem says we need to create an identity that will be able to hold a sense of continually being betrayed, but being betrayed into a larger and larger sense of ourselves. We only change when we get really tired of ourselves, so every form of change is a betrayal to the previous identity that has gone before it.

Q: American physicians, particularly those in heavy managed care areas, feel the loss of their souls in the name of profit. How do they regain their souls?

David: The soul of medicine is on trial at the moment. The issues that are at stake are tremendous. It is strange that whenever there is a political brouhaha in the mainstream media about the way that medicine is going, the voice of physicians is the least heard. There is no coherent voice that is speaking up for the spirit of medicine, and the spirit of what doctors stand for. The American Medical Association has not spoken to the soul of medicine, or at least has not been heard, in recent times.

Doctors are trained in an incredibly hierarchical way. Because people's lives are at stake, there are always people who know better how to deal with those vulnerable thresholds of health. Doctors are therefore constantly deferring to someone else or to the great hierarchy of knowledge throughout the system. They slowly rise up the hierarchy, but always looking above them. Unfortunately, this process trains physicians into an entirely passive societal voice, with regard to speaking out courageously for the spirit of medicine. They will not take a stand.

Doctors have to make more spaciousness in their lives so that they can get out from under their training and their sense of being totally besieged. They must investigate and speak up for the qualities that are timeless, eternal, and absolutely human at the center of medicine. We are hearing the voice of all the vested powers and interests, but we do not yet hear the voice of doctors or the spirit of medicine speaking out in the argument.

Q: Has medicine become too much of a business?

David: It should never be just a business. Physicians should not talk about their practice in terms of it being business, though part of them has to be fiscally literate. Obviously, at times, you need business acumen, but when it takes over, then the soul of your work as a physician is in peril.

When you think about it, doctors are incredibly privileged to be in conversations with people at such astonishingly vulnerable thresholds in their existence and to be privy to what is most important to them. Surely we should never lose sight of this immense privilege through being overwhelmed by the need for fiscal success. Here, for instance, in the Pacific Northwest, around Redmond and the Microsoft area, physicians are under tremendous pressure if they attempt to keep the social status, which in their minds they have inherited as a birthright. There are so many Microsoft millionaires around that they can work all the hours God sends and they will still not be able to afford the houses they deserve in their own imaginations.

Quite often you find these doctors adding weight and stress to their practices to the point at which either the practice or, most likely, they break, and soon their spirit breaks. There has to be some kind of continual radical simplification in our approach to work in order to stay true to our calling, no matter what field we are in.

Q: How important is the health system? You come from England, which has had a National Health Service since 1948. Reverence for the health service borders on a religion, in fact, it is called the English religion. Do the people love the system because they think it has soul?

David: The health service in Britain, just as in Canada, has lots of difficulties, but it is an astonishingly cohesive glue for the whole of society. Neither country would ever swap it for the system we have in the U.S. The National Health Service gives you the sense of being part of a greater society, that you are not just part of an anthill with people climbing over one another. There is a social contract that admits to a greater bond with one another than our ability to pay up. If things go wrong, there is a safety net. Society has made a contract whereby you will be taken care of no matter what your financial background or particular circumstances; that is an immensely powerful idea. I'm not sure the conditions would ever be right in the United States for that to come to pass, because the mindset, the vested powers and the individual expectations are so different.

But something has to change. Almost no one is happy with the system we've managed to create. I think of what Oscar Wilde said of a certain person, 'He has no enemies but is intensely disliked by all his friends." It applies, unfortunately, to American health care. It is hard to find anyone who will speak up for the U.S. health system with any enthusiasm. We have almost 45 million uninsured people. No society can afford to disenfranchise so many of its members. We are surely approaching a bridge that we'll have to cross, where everyone will have to give up something, somewhere, and it is probably not too far ahead of us.

Q: You tell the story of the poet Samuel T. Coleridge who was traveling to London on November 26, 1799, and witnessed an "immense flock of starlings sweep across the sky." How does that give us insight into the new world of complexity science?

David: That is an enormous subject. The underlying philosophy is that you can only participate in living systems if you are actually living yourself. You can only prosper and be in a real kind of conversation with your environment if you attempt to be a living system yourself. Our organizations need to be more approximate to living systems, simply because the environment in which we find ourselves is like a complex ecology itself.

After the Second World War, the world economy was like a mono-culture, like a big wheat farm with the American economy, and the linear strategic approach was supremely dominant. Now we have thousands of different approaches from many sources and thousands of dynamics that are changing every day. We need a system that is adaptable, and we need to apprentice ourselves to the complexity of living environments and learn to understand them.

This is where artistry and artists and poets can be of use, because their metaphors and imagery have always looked at the way that life is both housed and danced out into the world within any system, whether it is a forest, a landscape, or a human relationship. It is those qualities that will not only save us, but will help us to create a life worth living at the center of it all. (1)

RELATED ARTICLE: About David Whyte...

David Whyte grew up among the hills and valleys of Yorkshire, England. He holds a degree in Marine Zoology and has worked as a naturalist guide in the Galapagos Islands, led anthropological and natural history expeditions in Peru, Bolivia, and Chile, and subsequently traveled India and the hinterlands of Nepal. He now lives at sea-level on Whidbey Island, Washington, working full-time as a poet, reading and lecturing throughout the United States, Canada, and Europe. In corporate settings, he uses poetry to bring an understanding of the process of change, helping clients to understand individual and organizational creativity and apply that understanding to vitalize and transform the workplace. His clients include AT&T, Kodak, Blue Cross of Maryland, The Mayo Clinic, Sisters of Mercy, and the Washington State Hospital Association. He is the author of The Heart Aroused: Poetry and the Preservation of the Soul in Corporate America (Doubleday/Currency, 1996), four volumes of poetry, an audiocassette lecture series , and an album of poetry and music. He will be a speaker at ACPE's Executive Leadership Focus in San Antonio. Texas on Friday, May 19, 2000. His general session will focus on "Courage and Conversation: Inviting the Soul to Work" Later in the day he will conduct a workshop for physician executives and their spouses on "Life, Work, and Poetic Imagination." His book is reviewed by Barbara Linney on page 59 of this issue. He can be reached by calling 360/221-1324 or via email at [e-mail]

Richard L. Reece, MD, is a health care writer and Editor-in-Chief of Physician Practice Options. He is on the board of VPmanager.com, an Internet start-up company that pro vides independent physicians with business support services. He can be reached by calling 888/457-8800 or via email at [e-mail].