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Sad story all around. I feel compassion for all sides, and all parts. But if this incident puts on the front burner a serious discussion of how we must completely transform the healthcare system in US, good can come from it. The right of all to healthcare is inconsistent with profit motive. The ACA (Obamacare) increased access to insurance, but what good is having health insurance if claims, coverage, medical treatments are denied? Incremental changes haven't helped reform the current system sufficiently. We must fight for Medicare for All -- Healthcare is a human right.

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Lissa, I put you in a category with Marianne Williamson. You, like Marianne, in my-not-too HO, are so far ahead, thought-and understanding-wise, of where humanity is in general. I only hope and pray that we, as a species, will evolve to see the wisdom of what you already see, namely, that we humans are truly whole organisms, and we cannot cut parts of ourselves off without disastrous consequences, individually and collectively, to the whole. I have saved every single email/blog I’ve received from you in the past 2+ years, and I refer back to them often. I think your words and reflections as they relate to Luigi Mangione, our disastrous “sick care system”, the robber baron health insurance middlemen (and women, too, I’m sure), are spot on, and you see the system we’ve created for ourselves as it truly is - sick, and about as unwholistic as it can possibly be. My hope and prayer is that someday, most likely past your lifetime and mine, but who knows, maybe sooner (🤞🏼🤞🏼), enough of us will see your perceptions for what they are: beacons of life and light and hope that we can move towards. We know what dispels darkness: light. Keep writing, Lissa. You’ve got a very avid reader here in your corner.

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Ah, thank you Mitzi. I'm touched and grateful for your validating affirmations of my words and contribution. It's always a pleasure to hear from you and have you in our classes.

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Hi Lissa, I wish that you had included, and will include in the future, a discussion of structural violence, which is ignored and wallpapered over in this country, and physical violence, which is shoved down our throats by the deeply corrupt mainstream media evey day. I also would like to ask you to suggest and ask for suggestions on the high-impact ethical actions that we can take to build movements that can shift society away from the systems that uphold the most powerful amoung us, who are most often exploiting the rest of us and the Earth while engaging in double-speak and greenwashing their actions.

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I so appreciate your requests. Can you teach me specifically what you mean by "structural violence" or refer me to a resource to learn more about what that term means?

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Thanks for your wonderful question! I'm not an expert on the topic, but I thought the Wikipedia entry on "structural violence" was a decent overview. Here's the section of that Wikipedia entry that addresses the structural violence inherent in our medical system: "Access to health care:

Structural violence affects the availability of health care insofar as paying attention to broad social forces (racism, gender inequality, classism, etc.) can determine who falls ill and who will be given access to care. It is therefore considered more likely for structural violence to occur in areas where biosocial methods are neglected in a country's health care system. Since situations of structural violence are viewed primarily as biological consequences, it neglects problems stimulated by people's environment, such as negative social behaviours or the prominence of inequality, therefore ineffectively addressing the issue.[5]

Medical anthropologist Paul Farmer argues that the major flaw in the dominant model of medical care in the US is that medical services are sold as a commodity, remaining only available to those who can afford them. As medical professionals are not trained to understand the social forces behind disease, nor are they trained to deal with or alter them, they consequently have to ignore the social determinants that alter access to care. As a result, medical interventions are significantly less effective in low-income areas. Similarly, many areas and even countries cannot afford to stop the harmful cycle of structural violence.[5]

The lack of training has, for example, had a significant impact on diagnosis and treatment of AIDS in the United States. A 1994 study by Moore et al.[15] found that black Americans had a significantly lesser chance of receiving treatment than white Americans.[5] Findings from another study suggest that the increased rate of workplace injury among undocumented Latino immigrants in the United States can also be understood as an example of structural violence.[16]

If biosocial understandings are forsaken when considering communicable diseases such as HIV, for example, prevention methods and treatment practices become inadequate and unsustainable for populations. Farmer therefore also states that structural forces account for most if not all epidemic diseases.[5]

Structural violence also exists in the area of mental health, where systems ignore the lived experiences of patients when making decisions about services and funding without consulting with the ill, including those who are illiterate, cannot access computers, do not speak the dominant language, are homeless, are too unwell to fill out long formal surveys, or are in locked psychiatric and forensic wards. Structural violence is also apparent when consumers in developed countries die from preventable diseases 15–25 years earlier than those without a lived experience of mental health."

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Thank you for all this Mary Anne. You're totally right about the importance of including this is any conversation about health care.

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Please add “alleged” here or at least qualify your post. He has not been convicted as a “murderer.” Our justice system is premised on the critical idea that one is innocent until proven guilty. There are way too many people who have been easily chalked up and tossed out as guilty when they did not actually commit the crime. That he has not been convicted as a “murderer” (or pled guilty) should be acknowledged in any discussion of the crime(s) here. From this perspective and without such qualification, the conclusory use of the term “murderer” to me is just shocking. (I am not denying there are people with murderer parts or taking issue with that premise.)

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thank you for opening the discussion about yet another tragic incident of gun violence, wounded perpetrators and innocent victims now being lauded as another dark hero. who was it that first said a white privileged male could shoot somebody in new york and get away with it or turn it into some sad sick three ring political circus where there is no justice for harms done. Do I have parts that can relate to the feelings of moral outrage and injury for and with Luigi? absolutely -- yet if my outraged parts can be rehabilitated so can our collective culture's with a shift in the media consciousness. It appears to me, there is no cure for the poisonous medical system as it is and making it faster and bigger is no solution whatsoever. Insurance company execs will admit this is their business model and they plan to return to business as usual -- unless they continue to take heat from the citizens. What can we do to speak up about the badly fragmented system, infiltrated by profiteering and polarized to serve political interests that have no business being in the field of medicine?

Why not add great images like the one you posted of our new "Saint Luigi" who will soon disappear in the dust of the next shooter who takes center stage as we follow the media' down the rabbit hole. an all too tiresome disaster response. Lets watch a bunch of cops with guns, cop cars and another media circus following the crime like this is a sick form of entertainment masking as "news" Meanwhile back to a rerun of ...let's see "who dunnit" and why did they do it so we can prevent it by adding more cops, more military hardware to our schools churches and previously safe public venues like that is a solution to another industry that profiteers off of our deeply wounded psyches. ugh Guns drugs and surgical medicines. Me and all my parts will look forward to see you in Write to Heal soon, Dr. Lissa!

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What a thoughtful comment, Sage. I really appreciate you sharing your point of view. And yeah! I'll see you in Write To Heal soon!

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I really appreciated the IFS lens through which to view this situation. I too am appalled by the lack of trauma informed health care and the separation of mind and body that is normalized in the US. Medical trauma makes things worse! Trauma gets piled upon trauma, and complicates the healing process even more. I hope Luigi Mangione and Brian Thompson’s family will find support in their healing process, maybe through IFS.

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This is the first time I have been disappointed in one of your articles. Missing from this article is structural, historical and, most especially, philosophical context. Is violence never the answer, or are there some situations which it is? Therein lies the divide, and in my view, the flaw at the heart of this article. Are problems ever solved with violence? I would guess that the answer most would give immediately is ‘no.’ But, what if someone broke into your home to kill you - is violence the answer to saving the lives of your family or yourself? Is there an exception or excuse in that case? Is it ethical to end the life of someone intent on ending yours or someone else’s? Perhaps then it’s not ‘never,’ but usually. So if there are some rare exceptions, must these exceptions be pre-authorized and sanctioned to be deemed justified violence (such as police and state violence), or are there instances that one can take it upon their own authority to determine when violence is ethically justified, whether or not legally justified? I am anti-war, and I would be surprised if many people reading your work would identify as pro-war. Yet, if adversaries invaded your country to wipe out everyone you know and love, is it immoral to resist with violence? Should you bless your executioner and willingly allow your life, children and neighbors to be slaughtered? Should you cling to a moral high-ground and insist that only our state military is morally justified to use violence to defend? The questions beg for an answer: is there truly “no excuse” for violence? To quote Glinda the ‘good’ witch, “Are people born wicked? Or do they have wickedness thrust upon them?” What makes an action moral or immoral? Wicked or good? Is it the act itself, the actor, the motive, the cause, or the outcome that determines its ultimate morality?

Psychoanalyzing Luigi completely bypasses the far larger questions this event raises. Boiling him down to “a murder” dismisses the humanity you came close to granting him in this piece. His actions have personal significance, yet the way he chose to act is not reflective of his personal vendetta as much as it is clearly collective declaration. The message was heard, and has profoundly resonated and reverberated into a unified voice of resistance to the slow violence millions like Luigi face daily. The collective has awoken: ‘we will not go quietly into the night.’

This conversation isn’t about Luigi, it’s about us.

Luigi was deeply interested in ethical philosophy; online he discussed two counter philosophical ideas: utilitarianism and virtue ethics. Utilitarianism is concerned most with acting for the greatest collective benefit, favoring it over individual moral judgment of action or the individual. The “Trolly Problem,” a famous utilitarianism thought experiment, illustrates the inconvenient conundrum humanity finds itself facing more often than we’d like - who would you save? On the other hand, virtue ethics focuses on the individual morality of a single action. It boils things down to good and bad, but with more flourish. Due to its convenient, clean conclusions, virtue ethics remains our dominant normative ethical theory in society, which I see reflected throughout your article. Virtue ethics is woven into our social contract, and keeps the system stable so long as the majority adheres it. It genuinely is a helpful framework for personal conduct, as well as community interaction, but fails to provide clear guidance on what to do in moral dilemmas: such as a solution the monolithic problem of structural and systemic violence inherent to our healthcare system. If Luigi’s solution is immoral, then what is the moral solution that *should* be deployed instead? If speaking out, pleading, protesting, lobbying, etc produces no meaningful change or end to the mass slow violence being carried out on millions of Americans every single day through our broken, for-profit healthcare infrastructure, what then? When people are daily dying in mass, how much time is reasonable (or moral) to wait for a solution? Whose responsibility is it to procure a solution? And if we can identify whose job it is to provide solutions: why haven’t they done it yet? These are the ethical and philosophical questions that Luigi wrestled with, and why the collective is celebrating his actions. As individuals we feel bound to the individual virtues ethics we’ve been taught and learned in movies; in the face of structural violence that has no regard for your/our individual lives or wellbeing, we have no template for recourse available. Difficult questions have difficult answers, and Luigi understood this (if he is indeed the shooter, and not an accomplice or patsy). I could not and would not take the path he did; but I cannot and will not judge the choices he made. No person or organization has yet to bring even an ounce of the attention to this problem than this single act of violence. If one death saves 10 lives, is it immoral and without excuse? If it saves 1000, or 10,000, or 100,000, or 100,000,000, does it become more moral? Who determines the line? The questions and conclusions in this article feel far too simple and surface to be the end all of this collective conversation.

This event is asking us to DIG DEEP - not into the safety of moral superiority, but into the messy, gritty and uncomfortable side of our collective human existence, which us self-identified spiritualists tend to avoid or bypass. But I know we can do it. It is overdue to stand arm in arm in solidarity with our neighbors and countrymen. People are dying and suffering by the millions - it’s time to get off our high horses and stand together in solidarity.

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Wow Abigail, what a wonderful, provocative, and thoughtful comment. I'm sorry I disappointed you but very grateful you took the time to share your point of view. You're not wrong here, and I don't know the answers to most of your questions. But I appreciate the questions. They're definitely the right lines of inquiry...

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Thank you for writing this, Lissa. Reading this made me feel like you had done the hard work of articulating the murky responses I had to this event, thoughts that had been floating around in the back of my awareness and not quite managed to pull together.

I expect that some people might find this very hard to read, partly because it is different to mainstream news and opinion, and because you refuse to demonise or beatify the whole person. Most people want simplicity and order and to put things in labelled boxes and not have to think about things more than necessary. What you’ve written is complex and nuanced and points to the messiness of human nature in the context of so many overlapping variables. I wonder if, despite your clear statements about not condoning murder (!!), whether anything other than a strongly polarised view might be too much to process, leaves people with more uncertainty and confusion.

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Thank you for sharing your thoughts and experiences. Thought-provoking.

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Lost me at schubiner. He is a monotheist who can’t diagnose😂. Tragic

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Well, yes, the conversation may have started, but we are so ADHD as a nation these days, I wonder how far it will go. i worked, paying claims, for a major health ins. company from 1970 to 1982, and again in the 90s, and was always of two minds about the whole set-up. When I left, i took home a desk drawer full of thank-you notes, but also a head full of memories of threats and tough negotiation times. I never got it resolved in my head. We badly need a system of health care that is democratic, and shows care, but over so many years, beginning with the patriarchy of early medical schools, we have almost an entrenched history of abusing the system. Also, there are no successful working systems that we could emulate on such a scale as ours. If anyone would care to go back to some drawing board...?

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Wow! Such a polarizing and tragic event. Thank you Lissa for your always thoughtful and compassionate perspective. I have lived with chronic, debilitating back pain for over fifteen years. My Kaiser doctors have offered physical therapy and medication. PT has been helpful, no medication so far. And what has truly supported me all these years is acupuncture, Bowen bodywork, homeopathy, anti-inflammatory diet, EFT tapping, swimming and walking. I manage my own health and wellbeing and feel for those who don’t have access or wherewithal for complimentary treatments.

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Lissa, I'm in agreement with your words. Thank you. John

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Lissa, yet again you’ve managed to take the myriad of complicated thoughts that many of my parts have been bringing to my attention around a topic and articulate them with beautiful coherence and nuance! So from my parts to yours - thank you for taking the time to write this and also for your vulnerability in sharing it. Reading through the FB comments was validating for some of my parts and activating for others and so I’ve been sitting here with curiosity for all of their perspectives and also in tremendous gratitude for courageous communities like this. Choosing to step outside of black and white, polarized, binary thinking is messy, difficult work, almost invariably unpopular and yet more necessary than ever. Thank you for continuing to not shy away from the messy and difficult! 🙏🤍🪶

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