A Madisonian Journey to Reclaim My Role as a Citizen
On August 2nd, 2009 I had a transformative experience, a (civic) religious experience of sorts that continues to energize me a decade later. On that hot Sunday, responding to a flyer randomly picked up while enjoying breakfast at a local deli, I decided to participate at a town hall meeting at the US Constitution Center in Philadelphia, about the healthcare legislation that was to become ACA AKA “Obamacare”. I had come to hear than Secretary of HHS Kathleen Sebelius and the late Senator Arlen Specter conduct a conversation with “the people” about the legislation. Little did I expect what was to follow. At the town hall, against the background of Independence Hall in Philadelphia, I experienced the passion of citizens enraged by a government that they believed will limit their liberties and freedoms, to take what is rightly theirs and give it to “others”. At the town hall, against the background of Independence Hall, I experienced the passion of citizens enraged by the fear the government will limit their freedoms or enslave them in socialist chains. The anger and passion were striking. The rage at the speakers that afternoon spread across the country that summer and in the past decade has generalized, with rage, hatred, and hyperpolarization becoming the political currency of choice for many political actors. The passion and rage of citizens are not unique to our time. The current poisoned political environment highlights the shortcomings of the political system’s architecture constructed by the founding fathers and ratified by “the people” in 1789. The DNA for our body politics that was established to contain the dangers that passions pause for the republican government. Or so I thought at the time.
While I didn’t agree with their conclusions, the anger and passion displayed by many of the participants at the Town Hall meeting were striking. That rage continues to energize American political life. The rejection of redistribution and concern about having fewer benefits was a major driver. For others the focus on expanding insurance at a time when few were held accountable for the 2008 disastrous financial crisis was unacceptable. But as then President Obama said to then House Speaker Eric Cantor, “Elections have consequences”.
For the next few years, I watched as the nation became more polarized. With each legal challenge of the legislation, milestone in the implementation, and federal election, the passions driving a segment of the population infused our body politic with divisiveness and our governing institutions with increasing pathology and dysfunction. Concurrently, digital technology evolved with social media platforms assuming greater importance in “wiring” the body politic. Following the ACA legislation, and the battle around its passage and implementation, has provided me an opportunity to test and magnify my citizen evolution/transformation.
A central part of the journey was re-discovering James Madison and converting “to republican constitutionalism” as my civic religion. James Madison’s contribution to our evolving nation was unparalleled for creating the structure that allowed the US to persist for over 230 years. I clearly remember my initial response upon reading Federalist 10. In this paper, considered one of the most important in political history, James Madison seeks to convince the skeptics, why the constitution as constructed in Philadelphia should be ratified by the citizens of the states. For the past 6 years, I explored Madison’s political philosophy, his analytic skills, and his personal qualities as he confronted the political dysfunction of his time. I have contemplated how his efforts can guide us through our own political challenges. I have grown to appreciate Madison’s dedication and contribution to the ideals of the Enlightenment, as well as the skills he employed to construct the architectonic document containing the DNA of our nation’s political institutions. James Madison was not a physician, but he adeptly used a medical framework to shed light on the pathology of republican governments by providing both diagnosis and treatment plans to address the “mortal danger” of their ills.
At this political moment, when it appears that citizens all over the country are filled with rage and division and the feeling their government and other political institutions aren’t serving them anymore when many are questioning the benefits of the democratic form of government when congress appears to be hopelessly mired in partisan gridlock, I feel optimistic. The exploration of the process and becoming familiar with James Madison, “the father of the Constitution”, has provided a framework to become a more engaged citizen. Mr. Madison has guided me helped me regain my quest to be an informed and actively engaged citizen. His writing, activities and dedication to improving the lives of his fellow citizens have inspired me to embrace Supreme Court justice Louis Brandeis’s assertion that the “The most important political office is that of the private citizen.” Most importantly, my quest to become “an informed” citizen has been great “treatment” for the frustration I experience as a citizen with our current political environment and its detrimental impact on most Americans.
James Madison was not a physician however he was using medical metaphor to provide a diagnosis of the governments that had existed at the time and to provide a treatment plan to address their pathology. His use of the disease metaphor, which included a description of the pathology and symptoms of the post-revolutionary war government structured by the Articles of Confederation, was instrumental in the creation of the constitutional architecture of the American republic as a treatment plan.
As a physician, I found Madison’s use of the disease metaphor particularly intriguing. In particular, what inspired me was Madison’s ability to communicate through the Federalist papers his reasoning for the constitution. Similar to the activity of a physician treating a person suffering from a disease, Madison used aspects of the Medical Case Presentation to achieve his goal for “individual freedoms”. He described the “symptoms” (vices) of the political system of his time; study the history of political institutions, offer an assessment of the problem and provide differential diagnosis, engages in compromise, created a treatment plan, and then monitored and adjust the treatment plan to changing data and environment.
“By a faction” he writes, “I understand a number of citizens, whether amounting to a majority or a minority of the whole, who are united and actuated by some common impulse of passion, or of interest, adverse to the rights of other citizens, or to the permanent and aggregate interests of the community.”
He identifies the symptoms of the government defined by the Articles of Confederation:
“Complaints are everywhere heard from our most considerate and virtuous citizens, equally the friends of public and private faith, and of public and personal liberty, that our governments are too unstable, that the public good is disregarded in the conflicts of rival parties, and that measures are too often decided, not according to the rules of justice and the rights of the minor party, but by the superior force of an interested and overbearing majority. “
The causes for the dysfunction, Madison diagnosed,
“must be chiefly, if not wholly, [the] effects of the unsteadiness and injustice with which a factious spirit has tainted our public administrations.”
For this malady, he identified two treatment options:
“There are two methods of curing the mischiefs of faction: the one, by removing its causes; the other, by controlling its effects”.
Madison then set forth two ways to remove the causes of faction -- rejecting both, for one meant destroying liberty and the other changing human nature -- and two ways to control the effects. His political schema involved the latter, extending the size of the territory and refining, enlarging the public views through the republican principle of representation and active participation.
Had Madison been familiar with the current understanding of human physiology, anatomy and pathology would he have been able to make our constitutional representative democracy more resilient? would he utilize a more systemic approach to address problems facing the body politic? Would he have a greater trust for citizens as they interact in the political ecosystem? I believe he would do all of the above.
I am proceeding with a conceptual framework and an action plan to provide a citizen-oriented action plan to health the pathology of our body politic.
Citizenism is the recognition and exploration of the role of the citizen within the political ecosystem. Citizenism aims to enhance our democracy, to reclaim the citizen as a central stakeholder in the political ecosystem and strive for deliberative dialogue as understood by the founding fathers, where the people are the ultimate sovereigns. It builds on the founder’s view of the active citizen continuously participating in their government, locally and nationally. It studies the nature of the citizen rights, responsibilities and the influences that make the modern citizen. Citizenism borrows from other fields and disciplines, including human behavior, medical science, social science, political science and is Informed by network science, complexity, and translational democracy. Citizenism is positioned to respond to a troubling array of problems facing our nation’s political system.
Citizenism is not limited to a theoretical realm but rather it, offers a citizen user’s manual of sorts, a toolbox, for reclaiming the centrality of the citizen from subjects, consumer, taxpayer, voter, elector and related roles that have defined Americans. To operationalize citizenism, we provide structure and tools. A citizen’s owners manual to collaboratively address challenges in our political system. Using principles of adult education, we utilize case presentations to explore and highlight constitutional principles and their impact on our body politic. Our first case addresses the Opioid Epidemic. The interconnected and complex challenges of pain and its optimal treatment/management, opioid use disorders and its fatal consequences, and the “failed” War on Drugs provide an excellent framework to test a citizen-centric approach to address problems facing our nation.
The Pain Opioid Epidemic Project (Opioid Project) is an experiment in citizen engagement 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's primary goal is to address the political system and the role of the citizen within it, the challenges of the system will be taken as a given and the presentation will focus on the actual aspects and problems associated with the pain opioid epidemic. In addition to the symptoms associated with opioid use and pain management, the Opioid Project focuses on the underlying “symptoms of the diseases of the US political system”. These symptoms are epiphenomena for a more virulent if not “mortal disease” of the US body politic. The environment that maintains the veracity of the symptom is the political/ economic reality (Democracy-Capitalism) can lead to despair/ alienation, marginalization, hopelessness, helplessness. It sets a spotlight on the cause and offers a “treatment” citizen-oriented approach to underlying challenges in the US body politic.
More directly the Opioid Project tests the hypotheses that citizens, provided with an organizing format*, information and tools can be trusted to and should be involved in solving complex social problems. The Opioid Project is informed by the recognition that despite efforts on the international, national, state and local levels and billions of dollars spent, the opioid epidemic continues to worsen. It is not for lack of motivation, data, resources, best practice that there has been little impact on the epidemic. A more complex set of biological factors, economic and political barriers and interest groups exist and must be overcome to effectively change the course of this epidemic. The challenge of pain and related opioid use requires a well-formulated, coordinated effort that addresses the complexity of the pain-opioid ecosystem*, the social determinants contributing to it, and the interconnection of the multiple stakeholders (government (Federal, State, Local), the medical system, nonprofits, as well as private industry, academic institutions, and social agencies).
The US constitution, the DNA for the federal government, has been remarkable in providing a fairly stable framework to weather the past 225 years and achieve remarkable success in creating a government that has seen peaceful national elections and succession of political power. During this time the United States has become a global superpower and the standard of living of our citizens has been unprecedented. However, the current political environment highlights the shortcomings of the political system that has emerged in the twenty-first century. The political process, defined by the constitution, has been corrupted to the point that it is an existential threat to the US. Culture wars, congressional paralysis if not obstructionism, a polarized electorate, global challenges, the surveillance state, concern regard growing national debt, growing inequality, money’s impact on the political election have all contributed to growing distrust of the federal government. Reclaiming the centrality of the citizen in the political ecosystem as envisioned by James Madison is more important now than ever to heal our body politic. Citizen focused treatment plans for the Opioid Epidemic may provide a framework to address the pathology of the body politic.