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Medical Whistleblower Advocacy Network

Human Rights Defenders

“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”

 Universal Declaration of Human Rights

Article 1

Re-Victimization

Society has a tendency to blame the victim for not being able to simply being able to “get over it” and this cultural lack of support can be classified as secondary wounding and promotes re-victimization which treats the victim as defective or deficient.  During this secondary re-traumatization, the loss of Medical Whistleblower’s human potential is incalculable.  The first action necessary to enable a Whistleblower to find their own pathway to personal healing is to stop the continuing harassment and create safety and security for them both physically and emotionally. Our society views many objects as disposable and when an object is tarnished or dented the tendency is to deem its value gone, throw it away and rush to the stores to replace it.  When Medical Whistleblowers become targets of retaliation in an effort to silence them,  their value as highly competent and experienced professionals becomes forgotten in the rush to strip them of their professional credientals in order to discredit their allegations against the wrongdoers.  Telling the Truth to authorities often means permanent loss of the Medical Whistleblowers extensive professional skills and abilities and financial ruin for him/her and their family.  We must remember that human beings are not disposable objects and we must value the personal and professional characteristics of each whistleblower and remember that the growth potential available through the healing process is infinite.

“When someone is a victim, he or she should be at the center

of the criminal justice process, not on the

outside looking in”.

 President William J. Clinton

Rose Garden, June 25, 1996

 

National Victims’ Constitutional

Amendment Network

 

“Even in states with a victims’ rights constitutional amendment,

 the overall protection of victims is varied and uneven.

In addition, without federal constitutional protection, victims’ rights

are always subject to being automatically trumped by defendants’ rights.”

Robert E. Preston, Co-chair,

National Victims’ Constitutional

Amendment Network

 

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Secondary Victims of Trauma - Vicarious Trauma

Trauma Informed Support & Care

Trauma Informed Support & Care


Our goal at Medical Whistleblower is to provide advocacy for Medical Whistle-blowers and to help stem the tide of secondary victimization by their care providers, friends, family and co-workers. We provide educational materials, newsletters on critical topics of interest and referrals to care professionals who are knowledgeable in trauma informed care.

 

“Even in states with a victims’ rights constitutional amendment,

 the overall protection of victims is varied and uneven.

In addition, without federal constitutional protection, victims’ rights

are always subject to being automatically trumped by defendants’ rights.”

Robert E. Preston, Co-chair,

National Victims’ Constitutional

Amendment Network

Pathway to Healing from PTSD

Healing is a pathway from vulnerability to strength.  Those with PTSD will pass through these stages sometimes going from one to another during the same day.  Healing occurs over time and when a person spends most of their day in the later stages of healing then they are improving and becoming more healed.  When a person is retraumatized they revert back to the vulnerable stage and thus loose the ability to feel safe and secure.  When that happens they lose their ability to be the complete person they are meant to be - to celebrate their individuality and to be a fulfilled and happy person.

 

These are the steps to that pathway to healing.

 

Vulnerable

Elimination of Danger

Denial of Vulnerability

Identifying Safety Needs

Exploring Protection Needs 

Sharing with Others 

Compensation - Self Esteem Needs (Sense of Belonging)

Overcoming Vulnerability  - Recognition

Celebration - Self Actualization

"Human beings, like plants grow in the soil of acceptance, not in the atmosphere of rejection.”   

John Powell, S.J.

Understand Maslow's Heicharcy of Needs

Maslow's Heicharcy and Whistleblower Trauma

Maslow's hierarchy of needs is a theory in psychology that Abraham Maslow proposed in his 1943 paper A Theory of Human Motivation. Maslow's hierarchy of needs is often depicted as a pyramid consisting of five levels: the four lower levels are grouped together as being associated with Physiological needs, while the top level is termed growth needs associated with psychological needs. Deficiency needs must be met first.  The need for food, water, clean air, shelter and basic medical care are physiological needs. These are the most basic needs for life and they must be recognized and satisfied first. Then there are the needs for security and safety and these must be met before a person can be fully healed from life wrenching traumatic experiences.   Higher on the scale are the social needs.  Every person has the need for human companionship and a social life and the right to association with others.   There are even higher needs of self esteem.  Once these are met, seeking to satisfy growth needs drives personal growth and self actualization.  The higher needs in this hierarchy only come into focus when the lower needs in the pyramid are satisfied.  Once an individual has moved upwards to the next level, needs in the lower level will no longer be prioritized.  But it is possible for a person to fluctuate between one level and another even within the same day depending on what is happening in their life.  A sudden incident that frightens them will immediately then prioritize the safety and security needs.   If a lower set of needs is no longer being met, the individual will temporarily re-prioritize those needs by focusing attention on the unfulfilled needs, but will not permanently regress to the lower level.   For instance, a businessman (at the esteem level) who is diagnosed with cancer will spend a great deal of time concentrating on his health (physiological needs), but will continue to value his work performance (esteem needs) and will likely return to work during periods of remission.


This theory has special relevance to those facing whistleblower trauma.  Whistleblowers are often persons who have reached a high level of professional competence and  skill.   Many have been working in a stressful work environment for years,  when suddenly they, because of ethical considerations,  feel they must report something they see as wrong.  This may be motivated by a need to protect the vulnerable - such as a child, the elderly or the disabled.  Or it may be motivated by the need to right a systematic injustice such as racial hatred or economic injustice to the poor.  These Whistleblowers are persons who in the Maslow's Hierarchy of Needs were intially self actualized persons.   But when whistleblower retaliation takes place,  and the whistleblower becomes defamed, discredited, and blacklisted at work,  the economic and social realities of the person's existence dramatically change.   Some Whistleblowers have faced such severe economic hardship that they have become homeless and fighting for the basic physiological needs such as food, water, shelter and basic medical care.   So the pathway to recovery for a traumatized Whistleblower is up through the Maslow's Hierarchy of Needs.

Self- Actualization

“Better indeed is knowledge than mechanical practice (of religious ritual). Better than knowledge is meditation. But better still is surrender of attachment to results (of one's actions), because there follows immediate peace.”

Bhagavad Gita 12:12

Cognitive Behavioral Theapy CBT

CBT or Cognitive Behavioral Therapy has been found to be helpful to those suffering from PTSD.  Cognitive-behavioral therapy is based on the idea that our thoughts  cause our feelings and behaviors, not external things, like people, situations,   and events. CBT is Briefer and Time-Limited.  Clients understand at the very beginning of the therapy process that there will be a point when the formal therapy will end.  CBT therapists believe that the  clients change because they learn how to think differently and they act on that learning.  Therefore, CBT therapists focus on teaching rational self-counseling skills.   Most emotional and behavioral reactions are learned.  Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting. 

For Further Information: 

National Association of Cognitive-Behavioral Therapists

http://www.nacbt.org/

“When someone is a victim, he or she should be at the center

of the criminal justice process, not on the

outside looking in”.

 President William J. Clinton

Rose Garden, June 25, 1996

 

 

 

EMDR - Eye Movement Desensitization and Reprocessing

Eye Movement Desensitization and Reprocessing (EMDR)  is an integrative psychotherapy approach.  This therapy is based on information processing.  EMDR therapy discusses past experiences that trigger dysfunctional emotions, beliefs and sensations and the positive experience needed to better adaptive behaviors.    During the process the person pays attention to past memories and present triggers while focusing on a set of external stimulus.   The positive outcome is the emergence of insight, changes in memories and new associations.

 

For Further Information:

The EMDR Institute, Inc.

http://www.emdr.com/index.htm

 

Workplace Bullying

Workplace bullying is usually seen as acts or verbal comments that  could 'mentally' hurt or isolate a person in the workplace. Sometimes,  bullying can involve negative physical contact as well. Bullying usually  involves repeated incidents or a pattern of behaviour that is intended  to intimidate, offend, degrade or humiliate a particular person or group  of people. It has also been described as the assertion of power through  aggression.

 

Workplace Violence

Workplace Bullying

How Should We Address Workplace Bullying

"When a person responds to the joys and sorrows of others as if they were his own, he has attained the highest state of spiritual union."

Bhagavad Gita 6:32

 

Counseling

General open ended long term psychological counseling will achieve little if the cause of the  stress is not addressed. So removing the person from the hostile workplace environment is crucial to the healing process.  This is sometimes the most difficult challenge we face in getting health and healing for our whistleblowers.

PTSD is caused by response to stress so creating an atmosphere conducive to the person feeling safe and secure is essential to the healing process.  People who advocate deliberately confronting a frightened and anxious person with what they fear should reconsider this approach and recognize that confronting one's fears can only be done when there is a base of emotional support and safety already established, otherwise the person may be forced into flight or fight mode and the situation could be dangerously escalated. 

Often those whose wrongdoing the whistleblower is exposing will deliberately try to push on the trigger points that frighten the whistleblower, so as to precipitate an acute stress reaction and anxiety.  This is meant to discredit the whistleblower  and their complaint or allegations.  This tactic is often used to defame their professional and personal character.

Long term open ended counseling which digs deeply into one's personal life is itself  a stressful process and as such should be entered into cautiously and may be contraindicated for people who are already suffering from significant acute stress. 

General counselors are often trained largely in dealing with people's endogenous or intra-psychic problems (those which come from within), and may be highly skilled in doing so.   However, they may have less training or experience in dealing with employment-related concerns such as stress and/or workplace bullying, where the source of the difficulty is external. Misplaced or misguided counseling, however well intentioned, can do serious damage to stressed and bullied people by feeding and reinforcing their own feelings of failure and self-blame, challenging their reality, and pushing them further into stress breakdown.   Employees may feel concerned that their confidentiality could be compromised, and this concern is not entirely groundless.  Hostile psychiatric evaluations used to remove the targeted Whistleblower from his/her employment are commonplace, so is a Fitness for Duty examination that removes the Whistleblower’s badge or security clearance.   Medical Peer Review practices are aimed at removing the medical license from the Medical Whistleblower not at assisting them in Telling Truth to Power.   Referring stressed people for work-based counseling helps perpetuate the myth that it is the person who is the problem, rather than the working environment.   In addition, where workplace bullying and whistleblower retaliation is involved, and/or the whistleblower’s continued employment is under question, there can be boundary problems.   Where the stress has been caused by workplace harassment and bullying, it also allows the perpetrators to switch the focus of attention away from their own abusive behavior by inferring, usually under the guise of sympathy and support, that the person they are targeting is mentally ill, and that it is their "mental illness" which is responsible for the current problems within the workplace.   The whistleblower may feel safer talking to someone who is further removed from their situation.   A better option would be to tackle the actual problems in the working environment.   A responsible employer should look to see what changes can be made in the working environment, and to reduce the expectations on the stressed person.

 

 
"For he has not despised or disdained the suffering of the afflicted one; he has not hidden his face from him but has listened to his cry for help."

Psalm 22:24

Post Traumatic Stress References

Post Traumatic Stress References

Post Traumatic Stress Disorder: the invisible injury, 2005 edition, David Kinchin, Success Unlimited, 2004, ISBN 0952912147

Supporting Children with Post-traumatic Stress Disorder: a practical guide for teachers and professionals, David Kinchin and Erica Brown, David Fulton Publishers,  12.00, ISBN 1853467278

Stress and employer liability, Earnshaw & Cooper, IPD, 1996, 16.95, ISBN 0852926154 (updated edition in preparation)

Why zebras don't get ulcers: an updated guide to stress, stress-related diseases, and coping, Robert M Sapolsky, Freeman, 1998, ISBN 0716732106

The Body Bears the Burden: Trauma, Dissociation and Disease, Robert C Scaer, MD, The Haworth Medical Press, NY, ISBN 0789012464

Recovering damages for psychiatric injury, M Napier & K Wheat, Blackstone Press, 19.95, ISBN 1854313525

Understanding stress breakdown, Dr William Wilkie, Millennium Books, 1995

Understanding stress, V Sutherland & C Cooper, Chapman and Hall

Trauma and transformation: growing in the aftermath of suffering, R Tedeschi & L Calhoun, Sage, 1996

The Railway Man, Eric Lomax, Vintage, 1996, ISBN 0099582317 (a poignant story of undiagnosed PTSD from World War II)

The Inner Bookshop, 111 Magdalen Road, Oxford OX4 1RQ: mind, body, spirit, esoteric, holistic, paranormal, contact experience etc.

European Journal of Work and Organizational Psychology (EJWOP), 1996, 5(2), whole issue devoted to bullying and its effects, including PTSD. Published by Psychology Press, 27 Church Road, Hove, East Sussex BN3 2FA, UK.

British Journal of Psychiatry, (1997), 170, 199-201, The 'glucocorticoid cascade' hypothesis in man: prolonged stress may cause permanent brain damage, Dr John T O'Brien MRCPsych, Department of Psychiatry and Institute for the Health of the Elderly, University of Newcastle.

Cortisol - keeping a dangerous hormone in check, David Tuttle, LE Magazine July 2004

T cells divide and rule in Gulf War syndrome (and asthma, TB, cancer, ME), Jenny Bryan, Immunology section in The Biologist, (1997) 44 (5)

  Traumatic stress under-recognised
5% of males and 10% of females will develop PTSD in their lifetime says the National Institute for Clinical Excellence (NICE): http://news.bbc.co.uk/1/hi/health/4373367.stm

David Kinchin's own web page and PTSD workshops

The late Professor Heinz Leymann was one of the world's pioneers and foremost authorities on mobbing (bullying) and PTSD, with over a decade of experience. His web site is essential reading for anyone studying the effects of bullying on health.

David Kinchin, author of Post traumatic Stress Disorder: the invisible injury, 2004 edition

BBC News Online: bullying at school causes PTSD, name calling and verbal abuse worse than physical bullying

Ex-soldier Michael New wins 620,000 damages for PTSD: http://news.bbc.co.uk/1/hi/wales/4725455.stm

US soldiers return from Iraq with PTSD: http://news.bbc.co.uk/1/hi/world/americas/4474715.stm

Untreated PTSD may mean a lifetime of impoverished physical health including heart disease and cancer: http://news.bbc.co.uk/1/hi/health/4179602.stm

Bullied workers suffer 'battle stress' and show the same symptoms of armed forces personnel who have been engaged in war: http://news.bbc.co.uk/1/hi/business/3563450.stm

National Center for PTSD factsheets  & their site.

 

Helpguide for Post-traumatic Stress Disorder (PTSD): Symptoms, Types and Treatment

High percentage of youth in the USA report symptoms of Post Traumatic Stress and other disorders; study involving 4,023 adolescents finds that exposure to interpersonal violence (including bullying) increases the risk for PTSD.

PTSD Public Service Announcement Website

Patience Press aims to ensure that other people never have to be alone with the pain of PTSD, struggling to heal without help or support.

The Traumatic Stress Clinic in London has good online information about PTSD.

UK Trauma Group web site.

Contact information about local specialist resources in the UK offering advice about the assessment or treatment of people with psychological reactions to major traumatic events.

NICE guidelines for PTSD: http://www.nice.org.uk/

CODT - Cooperative Online Dictionary of Trauma, a dictionary of trauma terms:

The National Institute for Clinical Excellence (NICE) page on Post Traumatic Stress Disorder (PTSD).

American Psychiatric Association (APA) public information

Dave Baldwin's site at http://www.trauma-pages.com/ contains comprehensive links.

A Valuable Stress Information Resource Website

Stress Spot is a stress information resource with links to Post Traumatic Stress Disorder web sites.

The Panic Center.

Brain Injury Resource Center page on Post Traumatic Stress Disorder

The Trauma Center in Alston, Massachusetts. The Medical Director of the Trauma Center is Dr Bessel van der Kolk.

Partners with PTSD by Frank Ochberg, M.D.

Why a broken heart hurts so much; social rejection may affect your brain as much as physical pain

Legal Abuse Syndrome: how the courts and legal system may cause Post Traumatic Stress Disorder

Essentials for litigating Post Traumatic Stress Disorder (PTSD) claims: http://www.lawandpsychiatry.com/html/Litigating%20PTSD%20Claims%20-%20Final.pdf

Descriptions of Post Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD).

Gift From Within is a private, non-profit organization dedicated to those who suffer post-traumatic stress disorder (PTSD), those at risk for PTSD, and those who care for traumatized individuals.

Articles from Psychology Today: When Disaster Strikes by Hara Estroff Marano, Recovering From Trauma and Life Lessons by Ellen McGrath Ph.D., plus Trauma Do's and Don'ts

The Healing Centre Online is at http://www.healing-arts.org/

Ask the Internet Therapist

The International Society for Traumatic Stress Studies (ISTSS) has a comprehensive web site on various aspects of trauma and its causes.

The European Society for Traumatic Stress Studies (ESTSS) web site.

The Invisible Epidemic: Post-Traumatic Stress Disorder, Memory and the Brain by J. Douglas Bremner, M.D.

Information for for ex-servicemen & servicewomen who think they are suffering from PTSD.

PTSD and dissociation

Information on Falsification of Type (Dr Carl Gustav Jung's description for an individual whose most developed and/or used skills were outside one’s area of greatest natural preference) and PASS (Prolonged Adaption Stress Syndrome) is at http://www.benziger.org/pass.html

Links to PTSD and PTSD-related sites are at http://www.ptsd.com/

Gillian Kelly, barrister at law, looks at the development of Post Traumatic Stress Disorder and the legal recognition thereof on her web site at http://www.telecoms.net/law/index.html

Hope E. Morrow's Trauma Central contains a large collection of links to online articles on trauma and related subjects.

Risk Factors in PTSD and Related Disorders: Theoretical, Treatment, and Research Implications, Anne M Dietrich MA, Doctoral Candidate, University of British Columbia, Canada

See the ability, not the disability list of PTSD links

 

"There will be no peace among the nations without peace among the religions and no peace among the religions without dialogue."

 -- Fr. Hans Kung

"Freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed."

Martin Luther King

In his autobiography, You Can’t be Neutral on a Moving Train, Howard Zinn wrote:

“To be hopeful in bad times is not foolishly romantic. It is based on the fact that human history is a history of not only cruelty, but also of compassion, sacrifice, courage, kindness. What we choose to emphasize in this complex history will determine our lives. If we see only the worst, it destroys our capacity to do something. If we remember those times and places – and there are so many – where people have behaved magnificently, this gives us the energy to act, and at least the possibility of sending this spinning top of a world in a different direction. And if we do act, in however small a way, we don’t have to wait for some grand utopian future. The future is an infinite succession of presents, and to live now as we think human beings should live, in defiance of all that is bad around us, is itself a marvelous victory.”

 

 

 “Courage is a special type of knowledge. The knowledge of how to fear what ought to be feared and how not to fear what ought not to be feared.”

David Ben-Gurion, former Israeli Prime Minister

A Little Inspiration

"The three parts of the theory are analytical ability, the ability to analyze things to judge, to criticize. Creative, the ability to create, to invent and discover and practical, the ability to apply and use what you know."

Robert Steinberg

Principles of Trauma Informed Care

   
Problems and Symptoms are inter-related responses to the trauma of retaliation and represent coping mechanisms developed by the Medical Whistleblower in order to deal with their personal trauma.   It is critically important to empower the Whistleblower by providing choice, autonomy and control in their care support and networks. This is central to healing.   Primary goals are defined by Medical Whistleblowers themselves and focus on recovery, self-efficacy, and healing. Advocacy must be proactive – preventing further crisis & avoiding further re-traumatization.

"People are like stained glass windows,  they sparkle and shine when the sun is out; but when darkness sets in, their true beauty is revealed only if there is a light within" 

Elizabeth Kübler-Ross

 

TREATMENT APPROACHES TO PTSD

 

Trauma-informed

Problems/Symptoms are inter-related responses to or coping mechanisms to deal with trauma.

Providing choice, autonomy and control is central to healing.

Primary goals are defined by trauma survivors and focus on recovery, self-efficacy, and healing.

Proactive – preventing further crisis & avoiding retraumatization.

Traditional Approaches

 Problems/Symptoms are discrete and separate.

People providing services are the experts. Trauma Survivors broken, & vulnerable.

Primary goals are defined by service providers and focus on symptom reduction.

Reactive – services and symptoms are crisis driven and focused on minimizing liability.

 

Triggers

Triggers

People with PTSD may experience a variety of somatic and psychological complaints, including sleep disturbance, outbursts of anger, or an exaggerated startle response. (They jump at sudden noises or movements).   A characteristic of PTSD is the remembering of the trauma, and sometimes actually reliving the events in the mind.   Medical Whistleblowers have recurrent recollections of the event, distressing dreams about what happened, or some other form of   psychological rehashing of the event.   As a result, the Whistleblower avoids all situations that might be a reminder of the trauma, and tends to react with significant anxiety whenever there is a reminder of the event.  These precipitating events are called Triggers.   These violent recollections can have a serious impact  on a person's feelings, and the physiological reactions  to these feelings, become patterns of anticipation,  which in turn create more maladaptive feelings.

"It does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds"
- Samuel Adams


This mutual interaction between anticipation and fear  promotes what has sometimes been described as “isolation and paralysis of the mind.”  Social relationships  often suffer, as the person becomes more withdrawn and detached.   There is a dehumanising aspect  of the trauma that creates a sense of not being connected to humanity and the human race and a lack of the ability to keep an empathic connection.   There is often a profound lack of trust, isolation from society,  emotional numbing and a fear of feeling– called anhedonia.   This fear of feeling or emotional distance is very hard on intimate relationships and many Medical Whistleblowers find themselves loosing their  loved ones right when they need them most.   To promote healing and to empower the Medical Whistleblower,  loving and understanding colleagues, friends, partners, and family are necessary to counteract the dehumanizing effects of the trauma.   Social networks need to be established to provide comfort and support to family members and the close personal network of the Medical Whistleblower. 

Changing Jobs


For the sake of their health, Medical Whistleblowers  may need to move as soon as possible to a new position away from the stress, but often discover that they were being hindered by fabricated allegations in their professional references.  Often in an effort to find safety and security in their lives,  Medical Whistleblowers move from one job to the next, each step with lower pay, longer hours and less benefits.   This causes significant financial stress on the family and can strain personal friendships  and religious and social ties.   The stressed person struggles even harder to prove they can cope.  But this is a recipe for disaster, as almost inevitably the person will suffer further problems with retaliation which may eventually force them to resign or retire. 

 
Humble yourselves, therefore, under God's mighty hand, that he may lift you up in due time. Cast all your anxiety on him because he cares for you.

1 Peter 5:6-7

Be on your guard; stand firm in the faith; be men of courage; be strong.

1 Corinthians 16:13

 

"Don't let life discourage you, everyone who got where he is had to begin where he was."
--Richard L. Evans

 

Life shrinks or expands in proportion to one's courage.
--Anais Nin

 

"We must believe in ourselves or no one else will believe in us; we must match our aspirations with the competence, courage and determination to succeed."
--Rosalyn SussmanYalow

 

  Any intelligent fool can make things bigger and more complex... It takes a touch of genius --- and a lot of courage to move in the opposite direction.
--Albert Einstein 

"Courage doesn't always roar. Sometimes courage is the little voice at the end of the day that says I'll try again tomorrow."

~Mary Anne Radmacher

"In times of change, the Patriot is a scarce man; brave, hated and scorned. When his cause succeeds, however, the timid join him, for then it costs nothing to be a Patriot."

-Mark Twain

Drs. Zoellner and Bryant talk about PTSD

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”
 
― Leo Buscaglia

Medical Whistleblower Advocacy Network

MEDICAL WHISTLEBLOWER ADVOCACY NETWORK

P.O. 42700 

Washington, DC 20015

MedicalWhistleblowers (at) gmail.com

CONTACT

"Never impose on others what you would not choose for yourself."  Confucius

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

Theodore Roosevelt- Excerpt from the speech "Citizenship In A Republic", delivered at the Sorbonne, in Paris, France on 23 April, 1910