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A Treatment Plan for Our Poisoned Political Climate 

The rage and division among people of divergent groups, and dissatisfaction with government is not unique to today’s U.S. citizens. It has happened before, and studying what was done at those times can help us now. 

One such time was Shay’s Rebellion in Massachusetts in 1786/1787, when Revolutionary war veteran Daniel Shays led 4,000 rebels in a march on the U.S. Armory near Springfield where he attempted to seize weapons and reform the country’s first governing document, the Articles of Confederation. That rebellion served as a catalyst for the calling of the U.S. Constitutional Convention and the shaping of the new government under the laws of the Constitution.     

The Constitution is now 233 years old, and its founders, especially James Madison, who in his youth was the chief framer of its wording, understood it would need revisions as time went on to ensure that America remains a land we could all say was meant for life, liberty and the pursuit of happiness for “We the People.” And that meant all the people.

Now, our political environment is poisoned, and today’s rage and passion is not that different from what has  gone before as the outcry of citizens spreads throughout the country. Night after night reports of protests and warlike attacks between citizens and groups fill the news. What we must do now is quell the fears and distrust and work together  on problems to prevent this chaos and rebellion from becoming worse.. 

I became acutely aware of the anger over the state of our political system in 2009 while attending a Town Hall Meeting. As a psychiatrist, I had responded to a flyer to participate in a talk about what was later to become known as Obamacare. I expected to hear Secretary of HHS Kathleen Sebelius and the late Senator Arlen Spector conduct a conversation with the local citizens about their needs and methods needed to achieve them, but instead, I experienced the passion of my neighbors, enraged by a government they believed was limiting their liberties and freedoms. “They’re taking our rights and giving them to others,” people said. While I didn’t agree with their reasoning and many of their conclusions, I was struck by their anger and passion.

That is when my deep study of today’s politics and comparisons with the problems our founders had took root. As I read and continued to study, The Citizenism Project, based on James Madison was born. Taking a deep dive into the remarkable contribution of Madison and the other founders in creating the framework for the Constitution has captivated me and served as an antidote to the frustration and other negative emotions I experience when reacting to our political scene. I have grown to appreciate Madison’s dedication and contribution to the ideals that most Americans share. I also became  as to the fact of his slave ownership.  His political philosophy, analysis, skills, and  personal qualities as he confronted the dysfunction of his time can guide us at this moment of our own political existence. 

As I have become more and more familiar with Madison’s thinking and extraordinary acts, I have come to truly appreciate the resilience of our Constitution. At this political moment, as we celebrate the signing of the document 233 years ago, I wonder what the father of it would make of our current Congress, Presidency, courts, media and the people.

More importantly, how can we resurrect the framers’ values in this polarized climate? 

What would Madison do now to correct the dysfunction of the political organism he helped bring to life? Would he research the threats to the nation, develop and participate in its reshaping, as he did when contributing to the ratification of the Constitution with his Federalist Papers, helping the passage of the Bill of Rights and helping draft President George Washington’s farewell address? 

His passion and skills let him work with other visionaries of his time while battling with Patrick Henry, whose political philosophy was much like today’s Tea Party and many supporters of president Trump; with its limitations on religious freedoms. Of vital importance to Madison was the idea of a strong central government to protect citizens while limiting its powers over the individual.

In the spring of 1784, Madison watched Henry from the floor of the General assembly as Henry rose and proposed to force every taxpayer to dedicate a portion of his taxes to a Christian organization. While Madison had once been a supporter of Henry as a governor, Madison’s insistence on the separation of church and state was a wedge between them after that. 

In 1786, 35-year-old Madison, supported by Washington, called the Annapolis Convention to adjust the Articles of Confederation ;the failing political framework that organized the thirteen states. Although the 1786 convention was poorly attended by representatives of the states, Madison and Alexander Hamilton were able to call for a Constitutional Convention to take place in Philadelphia, starting May 14 of the following year. 

Madison prepared himself to be the most informed and perhaps most knowledgeable delegate to that convention. All winter and spring of 1787, he kept himself busy analyzing the histories of past republics and diagnosing the defects of the current American republic. Having served in the Virginia legislature and Confederation Congress in the 1780s he had witnessed first-hand the inter-related failings of each under the Articles of Confederation. Congress had been ineffectual in responding to the discriminatory trade policies of Britain and the closing of the Mississippi River to American traffic by Spain. It also lacked the means to comply with its revenue needs, even in the face of armed insurrections, like Shays Rebellion.

The states, each of which had retained its complete sovereignty under the Articles of Confederation, for their part proved unreliable because the state legislators were irresponsible and did not commit themselves to the good of the whole, but to their own state only.

Madison’s “Vices of the Political System,” was both a summary of his findings and a prescription for the ills he diagnosed. 

As a citizen and a psychiatrist, learning of Madison’s focus on individual psychology and fundamental need to control the violence of factions which he believed were a mortal disease, resonated strongly with me. Anyone following the country’s political landscape today cannot escape the truthfulness of these observations about human nature. He said,

“So strong is this propensity of mankind to fall into mutual animosities, that where no substantial occasion presents itself, the most frivolous and fanciful distinctions have been sufficient to kindle their unfriendly passions and excite their most violent conflicts.”

It was important to Madison that citizens be helped to contain rage, and turn passion to helpfulness, to form a “more perfect union, establish justice, ensure domestic tranquility, provide for the common good and prosperity, and to ordain and establish this Constitution of the United States of America.”

These concerns are as relevant today as they were then, and Madison’s method of diagnosing the problems by looking at history and then seeking solutions is the best way to proceed together as a unified people. 

Madison’s way of approaching America’s problems was as a result of his many roles in government as well as his personal philosophy. Nicknamed “The Father of the U.S. Constitution,” he originally backed George Washington, but in 1791 along with Thomas Jefferson, he abandoned the Federalist Party and founded the Democratic-Republican Party of the United States. Born in Virginia, he graduated from the College of New Jersey (now known as Princeton), served in the Virginia State Legislature, went on to serve as a U.S. Congressman, and fought hard for separation of church and state. As our Fourth President he served two terms, and was married to Dolley Payne Madison who is said to have “set the template for the role of First Lady” by helping establish American traditions and maintaining them through the War of 1812.

My interest in Madison centers around how he dissected the problems of his day and tried to eliminate them by finding solutions that benefited the country as a whole. As both a citizen and a psychiatrist, I hope we can do this together today instead of escalating war in the streets.

One way to observe and diagnose our political situation as Madison did in his day would be to look at the role of today’s citizens, the role of good government, and then present a case study to illustrate what could be done to improve things for all people.

Citizens Today: 

Americans (as well as other citizens throughout the Western World) increasingly believe the political and economic systems are rigged. For example, polls show that sixty-five percent of Americans say the economic system in this country unfairly favors powerful interests while only thirty-one percent say it is generally fair to all. These numbers concern me because it is so evident that the majority no longer trusts the government that was put in place to serve them.

Today’s media often makes things worse. 

We must remember as we watch the news that long-time journalists say the Internet has shut down many media outlets; others are too lean to make the difference they once did; while others simply play the “what bleeds leads” card vying for ratings to snag advertiser’s money to keep afloat. Editorializing and commentary have gradually slipped into hard news during the last twenty years so that you see and hear something, and are then told how to interpret it. Although there are some media who keep to the absolute truth, we must be careful and always know our source, “follow the money” behind our print publication and broadcast station, knowing that the views of the management are in some way related to what is shown and what is not.

Citizens need to become involved at a grassroots level. Together we can make a difference by turning our anger and distrust into a unified effort to diagnose and solve the problems plaguing our fragile national peace.

The role of government

For Madison, the role of government was to form a “more perfect union,” by establishing justice, ensuring domestic tranquility, and providing for the common prosperity. The “DNA” of an intelligently designed governmental structure builds on division between federal and state authority, with checks and balances, and having “regular” citizens involved at every level.  

As Madison said, “Knowledge will forever govern ignorance, and a people who mean to be their own governors must arm themselves with the power knowledge gives.” In other words, government should be of and by the people, not a select few.

It is a shame that for decades we have witnessed an increasing inability of our political system to address the challenges facing our nation. This political dysfunction leads to more and more distrust, and has given rise to Tea Party and Occupy Wall Street (OWS) activism. The political debate in Washington has become partisan, hyper-charged, and fueled by lots of money. 

It is imperative that we examine the structure and complexity of government as the Congress and President continue their battle over the: budget, deficit, debt ceiling, sequestration and the ideological special interests and hardened personal positions rather than using a rational approach to what needs to be done.

Madison’s example of examining the system he helped put in place gives “the system its proper validity and energy,” because it needs ratification of the people, and not merely from the authority of Legislatures. This is just as important today, because so many of the people feel they are being left out. 

Compromise: how much regulation is needed to protect the people while ensuring their liberty

When Madison examined the newly- formed government, he repeatedly insisted upon taking up the issue of Amendments to the Constitution. This was not a popular position and he was met with both indifference and vocal opposition. Yet he asserted that the House needed to  take up the issue anyway. He proposed that “there be prefixed” to the Constitution, a declaration that clearly defined the supremacy of the citizen and the role of government.

He knew then, and told his peers in the House, of the great majority of dissatisfied citizens. His statements about the “great majority, many of whom are respectable for their talents and patriotism… who are dissatisfied..” and called for the return of moderation of government regulation.

An important feature of Madison’s approach was always compromise and respect; both of which seem lacking today.

A treatment plan: the U.S. Constitution  

Madison’s and the other founding fathers’ treatment plan for the failing Federalist government was the Constitution. For 233 years, it has provided a fairly-stable framework and achieved remarkable success in creating a government that has seen peaceful national elections and a succession of political power. During this time, the U.S. became a global superpower.    

The three branches of government: The Executive, Legislative and Judicial, serve as checks and balances on each other. But with the distrust of government by many people, and special interests being served, a way must be found to explore and diagnose the problems in each.


The best way to begin could be by doing a case study, like in a medical trial. First, we can examine the symptoms, make a diagnosis and then look for ways to address the symptoms and provide possible cures. 

It has occurred to me, building on my experience in psychiatric practice, that a case addressing a specific challenge can be informative and highlight how citizens can play an important role in political life. I found the opioid epidemic a case study that builds on the understanding of the complexity of the pain-opioid ecosystem; including pain management, opioid use disorders, overdoses, public policy, law enforcement, criminal justice, and related challenges. The opioid problem provides a possible framework for reclaiming the role of the citizen in our times. More recently  the COVID 19 Pandemic, which exposed the many failures of governing institutions to arrest the devastating impact globally, provides a case study.

Here’s how.

In other words, what would James Madison do today?

We can look at a Madisonian metaphor, for “disease in the body politic” as a basis for “treatment” of the pathology in our politics.

First, we must diagnose it- both in politics and medical disease, likening politics to the opioid epidemic.

The diagnosis of the threats to the early American nation and Madison’s central role in developing the Constitution point out that “violence of factions” with special interests and money in politics contribute to instability, injustice and confusion. This is also our current “mortal disease” and requires an updating of the treatment plan.

Washington, as well as Madison, was especially concerned with divisions and fractions made up of people that manipulate the government for their own  ideological and personal benefit. 

The  eight years of the Obama presidency and more so during the past years of the Trump presidency, have been a great demonstration of the impact of party and factions. The political parties, ideological factions and special interests have committed themselves to blocking legitimate legislation that does not serve their narrow interests.

Madison noted that “violence of factions like this have their truth in mortal diseases under which popular governments have “everywhere perished.”    

We must monitor progress of the systems of both the body and the body politic, before we can fix them or perish.

Only then we can attempt to cure it.

There are two methods of curing the mischiefs of such factions: one, by removing its cause, and the other by controlling its effects.

It could never be more truly said than of the first, the  remedy is worse than the disease. Liberty is to factionalism  what air is to fire; without air fire instantly expires. But it could not be less folly to abolish liberty, which is essential to political life, because it nourishes faction, than it would be to wish the annihilation of air, because it gives fire its destructive energy!

The focus on the medical case presentation as a framework for citizen engagement is a good way to explain to citizens what they can do to help.

I set out to bring a framework to an experiment, utilizing Madison’s framework, that seeks to reclaim the centrality of the people in the political ecosystem. The 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 us. Then we must provide each other with the tools and information necessary to solve such complex problems; first in our own communities and then nationally. You can view the COVID 19 Citizen Commission Version 1.0 and take part by visiting. It is our plan to build on The COVID 19 Pandemic to apply the lessons to other challenges facing our society, communities and political culture. The project is an ambitious multi-phase undertaking that has as its goal to achieve the best practice outcomes for individuals within the system.

The conclusion

I have tried to outline the Madisonian approach to the problems of his day in hopes that readers will become active in finding solutions to problems instead of dividing against each other. At a time when America is searching for leadership and so many feel left out, some phase of The Citizenism Project has a place for every citizen who wants to make a difference. 

As a physician, I found Madison’s use of the disease metaphor to advocate for the ratification of the Constitution intriguing. As a psychiatrist, I find Madison’s understanding of human nature and its role in the body politic relevant. I have come to believe that if Madison was alive today, he would embrace the disease metaphor and the Medical Case Presentation approach to tackle the challenges facing our body politic. 

Will you join us? Click on any of our links to find out more.





Shrink the Government

Psychological insight about our politics 


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