Moral Health Michelle Bernabe, RN

The Sackler family - a name that resonates through the chilling caverns of the opioid crisis, their legacy a symbol of the suffering that has descended upon countless lives. But in this bleak tableau, they inadvertently unveiled a critical paradigm we'd previously overlooked in healthcare: the role of pain as the fifth vital sign.
Now, let's reclaim this revelation. Instead of quantifying the fifth vital sign as physical pain, let's assess something that the Sacklers seemed to have tragically mislaid: a moral compass. Welcome to an era where 'vital signs' take on a deeper, more profound significance. In this world, your encounter with healthcare takes on an entirely new dimension.
Imagine, for a moment, stepping into the hushed tranquility of a clinical space. The routine melody of health checks ensues. Blood pressure - check. Pulse - check. Oxygen saturation, respiratory rate - check, check. But then, a shift in the cadence, an unexpected note. An exploration into your moral health.
Embark on this thought experiment with me. Questions, not of physical wellness but of ethical vitality, begin to unfurl: "Do your daily actions echo the rhythm of your core values? Does your family life breed tranquility or unleash tempests? Do your social interactions ignite fulfillment or spark disquiet? Does the ethos of your workplace align with your moral compass or veer off course? In your interactions with nature, do you feel an exultant connection, indifference, or a pang of guilt? Are the decisions of your government, the laws and policies that orchestrate your life, harmonious with your beliefs or do they strike a dissonant chord?"
This is not a rhetorical exercise; you're prompted to chart these facets on a scale from one to ten. Each number, a reflection of your moral equilibrium within the grand tapestry of life. Your moral health, thus, revealed not as an abstract notion, but as a tangible, measurable entity, ripe for introspection and growth.
Could the way we make moral decisions, how we interpret and act upon what we perceive as right and wrong, be intrinsically linked to our health? This thought might appear to be hanging by a thread at first, but give it a chance, let it steep in your mind for a moment.
The concept of 'moral injury' might help tie these seemingly disparate domains together. To break it down, moral injury is the damage done to our conscience, our moral compass, when we commit, witness, or fail to prevent acts that transgress our deeply held moral beliefs. Now think about the unease, the restlessness that lingers when we go against our core values. We might try to numb it, drown it under indulgences - food, leisure, shopping, alcohol, or drugs. But in the quiet moments, it seeps out, a gnawing discomfort that refuses to be silenced.
This isn't merely a philosophical musing. What if this moral discomfort, this nagging 'injury,' plays a significant role in our overall mental and physical health?
A Lawyer's Struggle with Morality and Addiction
With this backdrop, allow me to introduce you to Greg. A wonderful human I met while working at an ultra-high-net-worth rehab in New York City. He isn't just a man grappling with the complexity of life, but a soul wounded by the profound betrayal of his moral beliefs by a system he trusted. His personal tragedy paints a vivid picture of how societal corruption, and individual choices, infiltrate our being, deeply influencing our emotional, mental, and physical health.
In the tranquility of the upmarket rehab, Greg and I found ourselves nestled on plush armchairs, splitting a tub of Ooey Gooey Butter Cake ice cream as the Statue of Liberty twinkled outside the panoramic windows. The ambiance of the room echoed a quiet yet luxurious solitude.
"Greg," I said gently, "Would you feel comfortable sharing with me the point in your life where you felt alcohol started to take a greater hold over your life?"
His spoon stilled mid-air, and for a moment, he was somewhere far away. Then,

Greetings directly from the heart of the 2023 American Psychiatry Association Conference! I'm presently enveloped in a profoundly illuminating talk on a topic close to my heart - "Making Good Trouble in Psychiatry". In the course of this compelling session, the healthcare contributions of the Black Panther Party (BPP) have taken center stage, and I'm eager to share these revelations with you.
The mention of the "Black Panther Party" usually conjures vivid images of bold socio-political activism. However, their contribution to the healthcare domain often remains under-appreciated and is a fact that can take many by surprise. History buffs and avid readers may be aware of the BPP's wide-ranging impact, including its pioneering social programs, such as one of the country's largest free breakfast programs. Yet, few are familiar with their establishment of free acupuncture clinics and their ground-breaking initiative on Sickle Cell disease, the first of its kind in the U.S.
Their holistic approach to healthcare, manifested in an extensive network of community clinics, provides an insightful case study of personal, community, and systemic transformation. When you really get to know the Black Panther Party model of healthcare, it’s not far off from ideas that have attracted millions in funding from the likes of 8VC, Sidewalk Labs (Alphabet), Thrive Capital, Maverick Ventures, Town Hall Ventures, EmblemHealth, and more.
Free High-Quality Whole-Person Clinics
One of the most enduring contributions of the Black Panther Party to the realm of healthcare was undeniably the creation of the People’s Free Medical Clinics. These 13 free clinics were spread across the United States during the late 60s and 70s, a time when marginalized communities faced significant barriers to healthcare access.
Offering a diverse array of essential medical services, from hypertension, diabetes, and lead poisoning screening to advanced diagnostic services, these clinics weren't merely notable for their medical provision. Their groundbreaking aspect lay in the fact that these services were available at no cost.
Lowering Costs: Healthcare Access Sans the Price Tag
The BPP's decision to provide free healthcare services in America was a revolutionary move, serving to dismantle the socio-economic barriers that stood between impoverished communities and healthcare. This effort was a clear pushback against entrenched health disparities, casting healthcare as an inalienable human right rather than a luxury afforded by financial means.
Better Outcomes: From Reactive to Preventive Care
These free clinics went beyond providing reactive care to illness. They pioneered preventive health measures, offering health education to promote healthier lifestyle choices and early detection of diseases. This focus on prevention was transformative because it represented a shift from simply treating illnesses to fostering wellness and equipping communities with the knowledge and tools to take charge of their health.
Better Experience: Putting the Community in Health
The BPP's strategic positioning of the People’s Free Medical Clinics within the communities they served was no accident. By placing clinics within these communities, they ensured that the particular health needs and concerns of the communities were directly addressed.
Furthermore, these clinics were staffed by members from the communities they served. This fostered job opportunities while cultivating trust and mutual understanding between patients and healthcare providers.
By offering localized, free, and comprehensive care, the Black Panther Party's healthcare initiatives played a significant role in reducing barriers to health services for marginalized communities. The footprint they left behind continues to inform the operations of contemporary community health centers. Their legacy remains a potent reminder of the possibilities for health equity when healthcare is universally acknowledged as a fundamental right.

Dear Moral Health Readers,
As a nurse, I've come to understand that comprehensive health—encompassing both physical and mental well-being—requires us to consider the broader picture. We must truly zoom out. If you've been following Moral Health’s work, you might be under the impression that it's solely about individual change—transform yourself to transform the world. Here, I'd like to add a layer of complexity to that narrative. The best things in life are often paradoxes. Our health isn't merely about us as individuals; it's equally about the complex network of external factors that shape our well-being. Everything is interconnected. And we, good scientists of life, know that. Today, we're going to delve into the symbiosis between healing and the world around us, drawing from the insights of adrienne maree brown. We'll also discuss what this means for us in terms of doing the right thing for our health.
In a compelling metaphor, adrienne maree brown gives us a great way to think about this - she compares healing to a river. She says, "Sturdy like something in motion that is also changing and that requires the balance of the world. The river can dry up if there’s not the balance of the world." This imagery not only highlights the delicate equilibrium between our individual healing processes and the collective harmony of the world we inhabit, but also underscores the need for active engagement in the pursuit of not only taking ourselves to the doctor but also the world.
"Sturdy like something in motion that is also changing and that requires the balance of the world. The river can dry up if there’s not the balance of the world."

Our health is influenced by a complex web of factors, from societal challenges and environmental stressors to interpersonal relationships and power imbalances in the world of business. Take, for example, the Bayer-Monsanto merger, which points to a troubling connection between environmental toxins and the very medicines designed to treat the illnesses they cause. In a world where businesses profit from both the problem and the solution, the cycle of harm continues. So, where does the opportunity to heal lie?
Deep-rooted issues, such as harmful power dynamics, systemic discrimination, and climate change, significantly impact our well-being. Harmful power dynamics in relationships, schools or workplaces can lead to various mental health conditions, including depression, isolation, anxiety, and post-traumatic stress disorder (PTSD), according to the American Psychological Association. Systemic discrimination, as per a study by Williams and Mohammed (2013), has been linked to a range of health outcomes, including heart disease and mental health disorders like depression and anxiety, due to the chronic stress of enduring regularity of discrimination. Lastly, climate change, according to the World Health Organization, is predicted to cause approximately 250,000 extra deaths annually between 2030 and 2050 due to factors like heat stress and malnutrition. And these are merely the most overt examples.
It's time we cast a critical eye on the system we're immersed in. We must pose some challenging questions - can our communities truly find healing while ensnared in a matrix of systems that perpetually foster injustice and imbalance? Is it pragmatic to believe that the path to genuine health lies solely in the hands of our primary care doctors and therapists? This is a pertinent question, especially when some of our relationships and business practices seem to prioritize profit and harm, knowingly or not. This misalignment incites more disharmony externally and internally rather than cultivating equity, healing, and balance.
However, let's not mistake this as a dismissal of the role of healthcare professionals. On the contrary, their expertise is indispensable. But the point I wish to highlight here is that health extends beyond the clinical realm. It is also fundamentally a social issue, embedde

As I eagerly first stepped into the bowels of the New York City Hospital, a disquieting dissonance washed over me. This city, so known for its ceaseless dance of lights and unabashed extravagance, seemed a world away from the hospital's dimly lit corridors and the stifling air of abandonment that pervaded its halls. How could a place so vital to the health of a city so vibrant be so disheartening and forlorn?
The staff, visibly strained from overwork and underappreciation, teetered on the edge of breaking. The equipment surrounding us seemed like relics of a bygone era, desperately in need of modernization. And to make matters worse, there were never enough supplies to meet the demand. The scene unfolding before me was a tragic comedy, where laughter served as a coping mechanism to grapple with the harsh realities.
My debut as a psychiatric emergency room nurse catapulted me into a world of intensity and chaos—a place where each decision held the power to sway the delicate balance of life and death. Virginia, one of my enigmatic mentors, seemed to saunter through the hospital's chaos with a grace that commanded respect and admiration. There was something in the way she navigated the storm, a poise and determination, that set her apart.
Virginia and I were as different as night and day. I was a hopeful novice, green and eager, while she was a seasoned realist on the cusp of retirement, her hair streaked with gray and her face lined with wisdom. Our contrasting dispositions often led to clashes, but her candid demeanor helped me develop a deeper understanding of life. Virginia's sharp wit and unrelenting honesty were an enthralling mix, and though her words could sting, I found myself drawn to her unvarnished truth.
One day, she led me out of the depressing confines of the hospital and into the gritty embrace of the city streets. It felt as if I'd stepped right into the heart of a raw, unfiltered New York City film.
Leaning against the cold brick of the emergency entrance, Virginia stood as a pillar of unwavering strength, her face etched with the fierce determination that I would come to know as her signature.
With a casual air, Virginia pulled a cigarette from her pocket and lit it. She drew in a deep breath, and as she exhaled, tendrils of smoke swirled in the crisp air. I glanced around nervously, half-expecting a stern supervisor to materialize and chastise us, but Virginia seemed unconcerned with potential consequences. She was a vision of unyielding defiance, radiating an indomitable sense of self-assurance.
"What about the hospital's no-smoking policy?" I ventured cautiously.
Virginia rolled her eyes, releasing a plume of smoke. "Oh, honey, breaking the rules is what makes life worth living," she said with a dark chuckle. "Besides, we all gotta die of something, right?" Watching her smoke with such audacity, I grasped that Virginia represented more than just a mentor to me. She embodied the grit and tenacity needed to not only endure but thrive in a harsh and unforgiving system. I couldn't help but wonder if I had what it took to survive.
Gathering my courage, I asked Virginia for her honest opinion of me. She flashed a wry smile and took a puff of her cigarette before responding, "You, my dear, are a clay pigeon - just waiting to be shot." Her words served as a sobering warning, but at the time, I was too young and inexperienced to fully grasp my vulnerabilities within such a massively misaligned system. So I laughed it off instead.
In the first month of shadowing Virginia in the psychiatric emergency room, I was plunged into adventure and turmoil, a bizarre fever dream that seemed to defy reality. To compound the already bewildering bedlam, Virginia – a steadfast conservative with a penchant for debate – took delight in goading me, as if it were a sport.
One incident, in particular, remains etched in my memory. With a devilish grin, Virginia shared how she used to release patients from the psych ER directly t

Greetings, friends! Welcome back to Moral Health, a substack dedicated to inspiring reflection, fostering transformative insights, and uniting a community of individuals who are passionate about personal growth and moral progress. Together, we'll explore the intriguing realms of reparative memoirs, narrative medicine, and moral leadership, all while spotlighting the fascinating and often wild world of healthcare.
In today's post, we provide a housekeeping update by revisiting the core principles that govern this Substack, along with presenting a necessary disclaimer!
Foundations Rewind: Setting Intentions, Embracing Accountability, and Healing Together
Let's begin by revisiting the core principles that we’ve built thus far:
The Smoke Signal: Building a Community of Growth - We openly share our values and aspirations in order to attract kindred spirits, creating a tight-knit, supportive community of remarkable individuals eager to grow together.
Beyond Cancel Culture: Accountability Embraced - We foster an environment that transcends cancel culture by valuing accountability, embracing a reparative mindset that encourages growth, understanding, and compassion for one another.
Healing and Evolving Together: A Journey of Equals - As we embark on this journey, we recognize that each of us is here to heal and evolve, learning and growing with each step we take.
Narrative Medicine and Reparative Memoirs: Illuminating Characters, Stories, and Catalysts for Personal Growth
As we move forward with Narrative Medicine, we will introduce reparative memoirs that illuminate a vibrant array of characters and stories from both my own and others' experiences. These memoirs will serve as catalysts for personal reflection and growth, interpersonal repair, and systems change, helping us contemplate and process the complexities and challenges present in the realm of healthcare (and beyond!).
The Disclaimer: A Restorative Twist on the Usual Memoir Disclaimer
At Moral Health, we take a unique approach to writing that blends personal experiences, and restorative justice principles. Occasionally we will use narrative stories as a means to promote reflection and foster change. Throughout this narrative medicine journey, we'll share a series of "moments" that represent composite scenarios of people, challenges, and situations encountered within the healthcare system. To protect privacy and promote restoration, all names and identifying characteristics have been altered, and some events and dialogues have been condensed or recreated.
Our goal is to use these composite scenarios to spark reflection and discussion around systemic issues within healthcare, with the aim of driving restorative and transformative change. It's important to understand that while these moments may feel familiar, they do not depict any specific individuals. Rather, they represent composites of people and experiences that we can all learn and grow from.
The opinions expressed by the authors in this Substack represent their own personal reflections.
Kindly note that these thoughts are solely attributed to the authors listed with each post and do not reflect the positions of their employers or colleagues.
Embarking on the Transformative Journey Together
Now that we’ve gotten our housekeeping out of the way, I'm thrilled to embark on this journey with you as we explore the reparative memoir genre and our unique approach to narrative medicine and moral leadership. We'll confront uncomfortable truths, meet intriguing and, at times, uncomfortable characters, and challenge ourselves to become better individuals and community members.
So, let's dive in together and begin our transformational journey. Thank you for being an essential part of the Moral Health community. We couldn’t do it without you.
In solidarity,
Michelle and Moral Health
Reflect. Write. Transform: Narrative Medicine Meets AI
Prepare to embark on a contemplative journey as we explore the world of Narrative Medici

Hello Moral Health friends!
As we continue our journey toward building the foundational components for Moral Health, calling in community, and adopting a restorative mindset, we now turn our focus toward ourselves.
Our next community cornerstone honors the wisdom of the late Grace Lee Boggs, a trailblazing activist and philosopher. Her mantra, "Transform yourself, transform the world," challenges us to examine our personal lives, jobs, and relationships as the frontlines for cultivating new systems.
As we strive to improve healthcare, it's important to consider whether positive change can occur without individuals within the system committing to personal growth, healing, and introspection. While change is inevitable, it's crucial to ask if it can be directed towards progress without inward focus. This is where the concept of Moral Health becomes crucial as a catalyst for driving substantive change.
Healing and Evolving Together: A Journey of Equals
One thing that should be made clear from the outset is that everyone at Moral Health, myself included, is joining you on this journey as equals, not from a position of moral superiority. We're all in this together, learning and growing with each step we take. In the spirit of "the healthy don't need a doctor," despite healthcare being full of them, we acknowledge that we are all here to heal and evolve. Boundless humility, unwavering accountability, and insatiable curiosity define the essence of our shared pursuit.
Embracing the Unfolding Healthcare Revolution: Could Facing Your Demons Unlock the Future of Healthcare?
A recent PwC survey of 2,000 CEOs revealed that 40% believe their companies will cease to exist within a decade, and nearly 60% feel they should invest more time in transformation. Healthcare, as an integral component of this landscape, confronts a seismic shift that presents a multitude of challenges.
To successfully navigate this transformation, we—healthcare professionals, patients, and administrators—must be adaptable, innovative, and courageous. Dave Chase, a healthcare visionary, recently underscored the necessity for resilience and resourcefulness amidst the "Innovator's Dilemma." We are called upon to embrace new ways of thinking and develop groundbreaking solutions to the challenges we face.
Building on Dave's insights, could it be that we have missed a vital element in our quest to revolutionize healthcare? What if an additional component to transformation lies in prioritizing our personal healing? By bravely confronting and resolving our inner traumas, biases, and struggles, we become clearer and more creative effortlessly. I contend that leaders and business builders who take an integrated mind-body approach with themselves can be more effective in establishing an adaptable healthcare system that values and respects the worth and dignity of every individual. This is because they have learned to do the work on themselves first, enabling them to build systems that reflect their inner empathy, authenticity, and compassion for the people they serve. Although this trauma-informed leadership approach is often overlooked, I am convinced that it can play a critical role in addressing the many challenges facing healthcare today.
When people carry unresolved pain, they not only inflict harm on others but also contribute to perpetuating dysfunctional systems.
The healthcare industry, worth trillions of dollars, is a lucrative space that rewards even the most unskilled and unfeeling among us. However, if we truly yearn to go beyond profiting off the pain of others and create a healthcare system that is truly transformative, then we must make self-healing a top priority. Neglecting to acknowledge and address our own wounds and traumas will only serve to uphold an unjust and dysfunctional system.
Are we willing to acknowledge the role our own personal growth and healing can play in creating a more equitable and just healthcare system? Can we dare to question how