My American Dream

In the days following the Republican National Convention I found myself in a state of persistent agitation and restless sleep, as my mind tried to wrap itself around what had happened to this country when my generation was supposed to be in charge of improving it. Then I had the strangest dream - backed by a band of angels singing "We Believe in America," Sigmund Freud appeared, and told me that I had to write a political essay. "But I don't know what to say," I responded. "It doesn't matter," said he. "I don't have any qualifications." I protested. "I'm a therapist, not a politician...I don't know what I'm talking about." He blew a smoke ring my way, and said "That never stopped me." "How many words?" I asked him. He just smiled and shook his head, as if to say "you'll have to answer that for yourself." I picked up my pen, and started writing...

My American Dream by Neal Spira

Is it possible to have it both ways- a prosperous society that provides us with liberty , and at the same time ensures justice for all? Or are we just dreaming?

One problem with the American Dream- perhaps a tragic flaw- may be that it is, in its essence, a dream, and therefore governed by the rules of dreaming. Freud (cited above) considered dreams to be the distorted expression of repressed wishes, unfettered by considerations of reality. Dreams operate according to the principle of wishful thinking that we employ as very young children, before we've discovered words, or time, or the reality that interferes with our pursuit of the wishes we are seeking to fullfill. Dreams replace real satisfactions with visual images that, at least in dreams, are just as good or better than what lies before us as we open our eyes. Alas, as we mature, this form of thinking takes a back seat to our developing reasoning ability. This permits us to delay gratification, put aside our immediate desire, and make plans that will help us obtain what we can only hallucinate in dreams.

As we move into the grand finale of our election season, each party has lined up squarely behind one or the other of two worthy ideals, ideals that have captured our imaginations since the birth of democracy in ancient Greece, and that came to fruition in the birth of our nation. These are ideals that seem, these days, to be mutually exclusive. Republicans cherish freedom. They believe that the pursuit of this ideal is the pathway to prosperity, and that prosperity will eventually lead us down the path to social justice.. From this perspective our federal government is, like King George in our national creation myth, the major obstacle blocking our way. Democrats, on the other hand, cherish social justice. They believe that there can be no prosperity without equality of opportunity for all. From this perspective, the federal government is the protector, the ultimate guarantor of a level playing field for all members of our American club, and the only path to a free and prosperous future. (As I recall we once fought a civil war over this difference of opinion, back in the days when Republicans were Democrats and Democrats were Republicans.)

Who knows what the answer is? Not me, certainly. Oh, I have my beliefs. Unfortunately, " I Believe" is not the same as "I Know." Beliefs are to knowledge as wishes are to reality. Wishes may create dreams, but they don't make dreams come true. We need to move beyond belief based thinking and get ourselves to the next level if we want to turn our American dream into reality. But where Is there a model we can follow to achieve such an aim?

Right under our noses, in our beloved healthcare system. I propose that one model to consider in healing our national ills is that provided by the evolution of the practice of medicine. Physicians, in their efforts to treat individual suffering, have always recognized that belief is an important element in successful treatment. We feel better when we have confidence in our doctors. The stock market goes up when we have confidence in our leaders. But belief without evidence leads to disastrous outcomes in medicine, just as unwarranted confidence led us to Bernie Madoff and the subprime mortgage meltdown. Belief without evidence is faith healing.

Physicians, in general, make a pretty good effort to base their interventions on evidence. Then they make treatment plans that are constantly subject to revision because they know that, no matter what they believe, they can be wrong. Physicians are trained to constantly review the impact of their interventions, and to reassess, modify, and try something else when the approach they are using isn't working. They have learned to embrace a team approach in order to make sure the treatment they intend is the treatment the patient receives. They know that the health of the patient is more important than being the one who has the best idea, and that ideas get nowhere without determined implementation by the entire treatment team.

So I propose that we take a similar approach when it comes to problems of national economic policy. Let's create a national bipartisan economic plan, where both parties commit themselves to a treatment planning orientation that transcends particular administrations, and that takes as its guide our clinical experience based on systematically applied government policies, subject to ongoing review and revision at regular intervals. SpiraCare.

What would be a counterpart to evidence-based medicine in the SpiraCare approach to governance? The evidence provided by our past. It's good to knowt has worked before and what hasn't, and we Americans have had a lot of experiences that can guide us in this effort. Then add the evidence we may obtain from our fellow nations, who have had even more experiences than we have because they've been around longer. Doctors consult their colleagues- shouldn't nations? In the world of SpiraCare, we we would be governed by the treatment team approach, based on long and short term goals. We could agree to objective quantitative measures of liberty, justice, and prosperity. Then we could agree on an initial treatment approach and give it our best efforts to ensure an adequate trial of treatment. If it didn't work, we would agree to change the plan. If one antibiotic doesn't work, try another. If one antidepressant doesn't work, try another. It's nothing personal. That's how we would get from "I believe" to "I know."

But here we come up against our American dream again. That dream is deeply rooted in a vision of America as a "New World" of fresh starts, clean slates, and pasts that are meant to be left behind. Such an orientation, based on forgetting, makes it hard to profit from anything that happened more than 5 seconds ago. And even if we were to overcome our reluctance to look backwards, who's to say there could be anything like agreement as to the correct way to interpret the evidence? The team approach in medicine that make successful planning and implementation possible requires a level of "we're in this together for the patient" agreement that has no counterpart in governance. I must be dreaming. Oh, that's right....I am!

Well, as long as I'm dreaming, I might as well take advantage of it. I wonder what else I can dream up? How about a universe in which nobody gets sick or old, all energy is renewable, and the Cubs win the World Series.. ....and, while I'm at it, how about I dream myself into the guest host slot on Saturday Night Live? Wait, I've got a better one- I'm Bruce Springsteen, playing to a packed audience of devoted fans.....I rule!

The scene changes....Freud's back. "What about liberty and justice for all?" he asks me. I hang my head in shame. "There are the dreams you would like to have and the dreams you really have," he says.

"I think I've reached my word count limit," I tell him.

When I awoke I was no less confused, but curious about the message my unconscious had sent me in the night. I sat down at my computer, and began to write: "In the days following the Republican Convention I found myself...."


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