The Citizen in the Pain Opioid Ecosystem

The Disease Metaphor and the Role of the Citizen

The US and western democracies in general are confronting monumental challenges that threaten our fiscal security and way of life. Although there may be some debate regarding the severity of the challenge, few would argue that the national, political conversation about major issues has been stymied by ideological rigidity, special interest driven rhetoric, misrepresentation of facts and general lack of constructive debate. The current presidential campaign further illustrates the dysfunction of the current conversation that many Americans encounter. The prevailing structure for debate driven by politicians, pundits, special interest lobbyists, has led to a more divisive, splintered and disengaged citizenry. It is clear that an engaged citizenry, informed, passionate and respectful, is essential not only for our democratic process, but also to achieve result that reflect the “common good” and achieve greatness for our nation.

An engaged citizenry, participating in a process driven by values of “shared recognition of our common humanity” and compromise, is an antidote to the current toxic conversation. What is lacking in a process that facilitates citizen participation as well as a framework for collaboration among citizens, government and stakeholders. Our efforts set out to provide a framework that enables a deliberative process for addressing the many challenges facing our nation and society. We borrow from the medical profession the disease metaphor as a framework to understand bio-psychosocial challenges and the Medical Case Presentation approach to address medical problems. The Medical Case Presentation offers a much needed change to the current political dialogue and reframes the challenges we face by asking the question:How can we all, including the private sector, non profits, government and citizens, best achieves effective solutions to our problems, solutions that will work in a complex world of escalating need and diminishing resources? We believe that together, following a treatment plan, we can solve the problems in an uniquely American and that we can be proud of, and change the political culture that has been so destructive.The use of the disease metaphor and treatment plan approach is not new to American political life. In one of the most important works of political philosophy Federalist 10, James Madison, the architect of the US constitution, evoked the notion of disease to describe the state of the continental US after the declaration of Independence and offered a "treatment plan" the US constitution as the treatment of the underlying disease.

We believe, had Madison been alive today, he would have embraced the disease metaphor and the Medical Case Presentation approach to tackle the challenges facing our body politic.As a physician I found Madison’s use of the disease metaphor intriguing. In particular what inspired me was Madison’s ability to communicate through the Federalist papers his reasoning for the constitution. Madison’s psychological insights and use of the disease metaphor, likely a consequence of his experience with disease, resonated with me. It is clear to me that what is missing from our current politics is a structure for meaningful “debate”. Madison’s writing in Federalist 10 and 51, considered one of the greatest political articles, offered a framework.

Had Madison been familiar with Cancer would he have designed the US constitution differently? We use an understanding of cancer to inform us and to make the system better.Similar to the activity of a physician treating a person suffering with 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.Learn more about The Case of the Pain Opioid Epidemic Learn more about the Medical Case Presentation


Elsewhere I describe my interest and “political agenda” that focuses on the role of the citizen and the opioid epidemic as a case study and a framework for better understanding and engaging with the body politic. The general considerations are framed in a citizen oriented focus and suggest activity for reclaiming the citizen role in the political ecosystem.

Shrink the Government

Psychological insight about our politics