Donald J. Trump gets re-elected president, and some people express regret, dismayed by what their vote really meant. Example: “My government contractor colleague voted for Trump and then found out after the election that he intends to fire federal contractors on day one.”
The CEO of UnitedHealthcare is murdered, and people unleash cruel, despicable comments on social media: “Unfortunately my condolences are out-of-network.” The slaying has tipped off a contagion of threats against health industry leaders, forcing an examination of security practices by corporations and spotlighting the complex challenges of protecting executives who face rising risks in the internet age.
This goes beyond malaise.
These anecdotes signal something deeper — something jagged and raw — coursing through the social fabric. It isn’t just dissatisfaction or unrest; it’s a simmering anger, a wellspring of cynicism so powerful it spills over into public discourse with the same frequency and familiarity as the weather. Our collective capacity for hope, patience, and even basic kindness seems to be eroding.
New York Times opinion columnist Paul Krugman, reflecting on his retirement from The Times after a quarter-century, wrote, “What strikes me, looking back, is how optimistic many people, both here and in much of the Western world, were back then, and the extent to which that optimism has been replaced by anger and resentment,” which he attributes largely to “a collapse of trust in elites…the people running things.”
The question isn’t just “Why are people angry?” but “Why has anger become our most reflexive response?”
A Cultural Atmosphere of Neglect
At the heart of this phenomenon is a growing sense of betrayal — by leaders, by institutions, by systems that promised stability, fairness, and opportunity. For decades, Americans have been sold visions of progress: upward mobility, an inclusive society, better lives through innovation. But for many, these promises have proven illusory. Economic inequality, the shredding of social safety nets that ensure access to healthy food and healthcare, and the commodification of healthcare and education have left countless people disillusioned.
It’s easy to ridicule the government contractor who voted against their own interests, but how many of us truly understand the machinations of the systems shaping our lives? Most people grasp onto the narratives presented to them, only to discover — often too late — that those narratives were hollow.
Healthcare, that perennial thorn in the side of American life, is not absent blame. The murder of the UnitedHealthcare CEO is a stark reminder of the system’s failures — not because his death was justified (it wasn’t) but because of the reactions it elicited. “Unfortunately my condolences are out-of-network” isn’t just gallows humor; it’s a cry of desperation disguised as a joke. Our patients feel trapped in a system that profits from their suffering.
Cynicism as Armor
This pervasive negativity — expressed as regret, sarcasm, or outright cruelty — is a defense mechanism. Cynicism is easier to wield than vulnerability. If you joke about a rigged system or mock the absurdity of politics, you don’t have to confront how powerless you feel. But this armor comes at a cost. It isolates us, diminishes empathy, and reduces our ability to imagine alternatives.
Beyond Anger
If this moment goes beyond malaise, it also goes beyond anger. Beneath the surface lies a yearning for something better — a system that doesn’t exploit, leaders who don’t betray, and communities that support rather than divide. The challenge is figuring out how to channel that yearning productively.
Hope isn’t naïve, nor is kindness. These qualities are necessary for the repair work ahead. We can critique systems without dehumanizing individuals. We can acknowledge mistakes — our own and others’ — without descending into bitterness. And we can demand accountability while remaining compassionate.
As bleak as things seem, they don’t have to stay this way. The first step is recognizing that cynicism and anger, though understandable, cannot sustain us — this is something I’ve often reminded patients over the years. To go beyond malaise, we need something deeper: courage, imagination, and the will to rebuild. These qualities are not abstractions — they are the engines of renewal that have propelled individual patients as well as entire societies out of despair and into periods of positive transformation.
Courage: Choosing Peace Amid Injustice
Courage often means standing firm in the face of adversity, but it also involves choosing a path of nonviolence when others might call for retaliation. During the Civil Rights Movement, Martin Luther King Jr. championed peaceful protest and non-violent resistance as a form of courage. Sit-ins, marches, and boycotts challenged segregation and systemic racism without resorting to violence, even in the face of brutality.
In stark contrast, the murder of the UnitedHealthcare CEO represents a darker response to frustration — a path that amplifies harm instead of inspiring change. King’s philosophy reminds us that courage isn’t only about action but about how that action aligns with our values and long-term goals.
Imagination: Envisioning Radical Healthcare Transformation
Imagination in healthcare is often about seeing beyond immediate limitations to create systems that better serve humanity. A compelling example is the transformation of Rwanda’s health system after the genocide of the 1990s. Left devastated, Rwanda rebuilt its healthcare infrastructure with an innovative approach that emphasized universal access, community health workers, and public-private partnerships.
By rethinking traditional models, Rwanda achieved remarkable outcomes: reduced child mortality, near-universal health insurance coverage, and significant improvements in life expectancy. This imaginative re-engineering of healthcare not only served a struggling nation but became a global model for equitable care in resource-limited settings.
The Will to Rebuild: A Patient’s Journey
The will to rebuild can also be intensely personal. Consider David Fajgenbaum, MD, a physician who nearly died five times from Castleman disease, a rare and deadly condition. When traditional treatments failed, he turned his experience into a mission to find answers. Fajgenbaum systematically analyzed his own medical data and repurposed an existing drug to save his life.
His recovery wasn’t just a testament to perseverance; it showcased how determination can lead to breakthroughs that benefit others. Fajgenbaum now leads research efforts that are giving hope to patients with rare diseases worldwide. His story illustrates the extraordinary resilience needed to rebuild a life — and, by extension, a path forward for others.
Applying These Lessons Today
In moments of crisis, it is tempting to retreat into cynicism or inaction. But previous challenges remind us that courage, imagination, and the will to rebuild are antidotes to despair.
Today, as we face challenges like climate change, political polarization, and systemic inequality, including in healthcare, these qualities are more important than ever. Courage is needed to confront powerful interests and demand change. Imagination is required to envision sustainable, equitable systems that serve all people. And the will to rebuild must sustain us through the hard, unglamorous work of implementation and adaptation.
Renewal is possible, but it begins with a decision to reject hopelessness and embrace the possibility of transformation. Just as others have done in the past, we too can rise above malaise to forge a future worthy of our aspirations.
Arthur Lazarus, MD, MBA, is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Story Treasures: Medical Essays and Insights in the Narrative Tradition.
Please enable JavaScript to view the