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Welcome to Shrink The Government, the digital home for The James Madison Project, where we test the hypothesis that citizens, provided with an organizing format, information and tools can be trusted to reclaim their role within the political ecosystem.


Setting the Madisonian Stage for Citizen Engagement  

A series of blogs and related material setting the Madisonian stage for a six months long experiment in Citizenism, that will focus on the challenges associated with the opioid epidemic and the US healthcare system.

For the next six months, we focus on The Pain Opioid Epidemic Project starting with the Medical Case Presentation to test our hypothesis for citizen engagement.

The Medical Case of the Pain Opioid Epidemic and its Components:   We will introduce some of the elements for citizen engagement and how they are used in addressing the challenges of the opioid epidemic. 

The Narratives of the Opioid EpidemicWe review some of the narratives that have shaped the efforts to address the opioid-related challenges and shape the current conversation. 

The Path to the Current State: We systematically explore the many factors contributing to and maintaining the opioid epidemic.

The Ecosystem and the Stakeholders:  We take a deeper dive into the various stakeholders associated with the epidemic and highlight the potential for citizen action.

The Treatment PlanSalutogenesis and US 4.0: We provide a citizen-facing framework and treatment plan of sorts to address the many challenges associated with the opioid epidemic and more broadly the body politic.

Personal Statement

I am a United States citizen. Now more than ever, I realize that citizenship requires more active engagement in the political process. As a psychiatrist, I hope to contribute a unique voice to the current political conversation. 

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February 17, 2020

On September 19, 1796, nine years after members of the Constitutional Convention signed the final draft of the Constitution,  George Washington published his Farewell Address. Having served as president for the first eight years of the young nation, he was worn out by burdens of the presidency and attacks of political foes,  Washington was concerned about the safety of the Constitution and survivability of the eight-year- old United States. He believed that the stability of the Re...

February 17, 2020

Disunion in the union and the road to reunion

Thoughts on the state of the nation

Some of the most challenging and interesting professional encounters I have experienced in my decades of work as a clinical psychiatrist have involved couples in various states of disunion. The “container" of their relationship has become unstable. They experience more isolation and anger as the lack of communications threatens their family’s future. They seek out a professional judge to listen to thei...

February 16, 2020

The opioid epidemic continues to have a devastating impact on many individuals and communities throughout the United States. The statistics are overwhelming. The personal stories are heartbreaking. The financial cost staggering. The political theater riveting. The impact is experienced regardless of class, geography, gender, religious background, in other words its a unifying tragedy. 

During  the three decades I have practiced as a psychiatrist the most difficult and challenging i...

July 14, 2019

An Invitation to Citizen Action 

The Pain Opioid Epidemic Project (Pain Opioid Project Website) is an experiment in citizen engagement (Citizenism) inspired by the belief that we as citizens must engage with our fellow citizens and relevant stakeholders to achieve solutions to the challenges that face our communities and our nation. The Pain Opioid Epidemic Project (Medium) primary goal is to address the political system and the role of the citizen within it, the challenges of...

July 13, 2019


In order to demonstrate to potential for the use of the framework, an experiment, The Pain Opioid Epidemic Project will be suggested and the readers invited to take part in order to manifest an experiment in citizen engagement to address one of our current “national emergencies”.  Using the Medical Case Presentation for deliberative dialogue to address the challenges facing the United States body politic. Putting the Pain Opioid Medical Case Presentation into Practice Artic...

July 12, 2019

The opioid epidemic started at the turn of the century, continues to have a devastating impact on many individuals and communities throughout the United States. The statistics are overwhelming. The personal stories are heart-breaking.  According to the CDC, between 1999 and 2017 more than 400,000 people have died from a drug overdose, becoming a leading cause of injury and death in the United States.  In 2017, around 68% of the more than 70,200 drug overdose deaths involved an opi...

July 10, 2019


Many Americans are fearful and angry, desperately trying to understand what happened to our country when Donald Trump was elected as the 45th president of the US. Others are elated that their voice was heard and are now excited to be part of the Trump/Pence Movement to “Make America Great, Again”. Interestingly, ten years ago, upon the election of Mr. Barack Obama, many (usually not the same people) experienced the negative emotions and concerns about the future of th...

July 9, 2019

“..., I agree to this Constitution, with all its Faults, if they are such; because I think a General Government necessary for us, and there is no Form of Government but what may be a Blessing to the People if well administered; and I believe farther that this is likely to be well administered for a Course of Years, and can only end in Despotism as other Forms have done before it, when the People shall become so corrupted as to need Despotic Government, being incapable of any other...

July 8, 2019

"All new laws, though penned with the greatest technical skill, and passed on the fullest and most mature deliberation, are considered as more or less obscure and equivocal, until their meaning be liquidated and ascertained by a series of particular discussions and adjudications."

THE FEDERALIST No. 37 (James Madison)

Today’s society (US) is characterized by a set of complex problems — such as inequality, climate change, gun violence and affordable access to healthcare to list a f...

July 7, 2019

Political discourse in this country is broken. To a startling degree, dividing ideologies and sound bites have replaced rational debate. Special interests have replaced constituencies. Scandals and bickering talking heads have replaced reasonable media coverage and context. It’s clear the American public has lost its faith in its elected officials. We’ve all become cynics – about the political process, about the politicians we elect and about the outcomes we can reasonably expect...

July 6, 2019

Work in progress

Rarely in the course of human history has an idea,  and the document which grew out of it, set in motion the massive change in the experience of so many people around the globe, as did the ideas expressed in the Declaration of Independence and the political system established by the US Constitution. After deliberating through the hot Philadelphia summer of 1787, 39 of the  55 delegates representing 12 of the 13 post-revolution states (Rhode Island didn't send deleg...

July 5, 2019


As Americans, We the People continue to be troubled by an array of problems facing our nation and the failure of the political system to address them with the public's interest in mind. Trust in our governing institutions has reached historic lows as Congress’ approval ratings sinks into the single digits. A recent poll conducted by Pew found that a significant portion of the US population believe that the current function of government is the most serious problem conf...

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Shrink the Government

Psychological insight about our politics