Independence Day: Fighting for Our Agency

By Alan “Tony” Amberg, APRN PMHNP-BC 

(With help from Sara Purfield RN, APRN Trainee) 

July 4th, 1776, celebrated as the American Independence Day, is not actually the day Americans became independent. The American revolution lasted 7 more years, until 1783. And for people of color, independence came 90 years later, on Juneteenth. 

However, July 4th 1776 was the day of ratification of the Declaration of Independence – our statement of principles for independence.  It was a denunciation of the perceived unfair exercise of control of a far off, invading and interfering government, taking away the agency of the colonial self-government.  

Previously the colonies had much autonomy over their own affairs.  The sudden loss of agency and dictation of how to manage one’s affairs sparked a war and a new nation (thank you Hamilton, et al!).

The Loss of Agency

Might we say the same about our patients? Generally, we see people who, admittedly, must answer to families, bosses, and governments.  But usually, each of us still have a lot of agency in living.  Our bodies are a collaboration, an ecosystem of bones, organs, cells, and non-human biome creatures that allow a tremendous freedom to live, love, and prosper. The ineffable organizing principle that unifies all these beings in the ecosystem - something called the “Self” - has wide powers to shape the collective destiny that is each of us.   

Suddenly, something happens to that independence and agency. We might be invaded from the outside, like COVID or HIV.  We might be invaded from the inside, such as cancer.  The glorious harmony may be suddenly displaced in an accident or environmental toxin. This beautiful Self is now plunged into a war to regain its autonomy.

The Battle Engaged

Suddenly we are now “patients.” To the outside nurses and doctors, appearances can be deceiving: bedridden, we could appear to be “doing nothing,” while internally the immune system launches attacks.  In the “stillness,” our bodies are attempting to generate new tissue and bone and sinew.  While externally “sedated,” we are fighting for our lives.   

Our agency is stripped by weakness, anxiety without the ability to fight or flee, loss and grief, pain without the ability to escape the noxious agent.   

Helping Them Fight on Multiple Fronts

All our patients want back is their independence. They come to the hospital or the clinic to make their personal Declaration of opposition to the tyrant who has taken their autonomy.   

So, they hire us, the professional officers, and soldiers to analyze, strategize and bring the big guns to fight for them and with them.  Frequently, they have tried everything they knew on their own.  We go to work.  

Independence, they discover, is not a single event.  It’s learning to be free of the tyranny of the unknown.  It may be learning to experience pain without panic.  Perhaps, we have to learn to accept our mortality and death.  Often, it is independence from the confines of a higher level of care, to a freer lower level of care.  Always, it is about integrating our experience and crafting a “new normal.”  

Fighting for Our Independence 

For us as Nurse Practitioners and Physicians Assistants, we declared our willingness to devote our lives to the fight for freedom.  We threw our hats into the ring to become providers to have a higher role in shaping successful campaigns.  We worked alongside our physician partners/mentors to grow areas where we could be comfortable and safely practice with autonomy.  Every day we start again with new patients and help each of them ratify a new personal Declaration of Independence from a variety of would-be tyrants. We will engage in all necessary battles.  

And, we must continually work our own battles, fight our personal struggles to examine what takes away our agency and robs us of independence - so that we can better help them. These are the invisible freedoms that come along the way.  In psychiatry, I examine the edicts, roles, myths, and beliefs that shaped my life. I ask which of these, if any, I want to be ruled by going forward.  I identify whom I am trying to please (sometimes I am trying to make loved ones happy who are long dead.)  I learn to observe our thoughts and feelings without judgment and without letting them command me.  I ask what is truly important in life and what I am willing to trade to have it.  I do this work for myself, so I can help patients do it.

The war may have a long time yet to run, but we assert that the present shall not stand.  We engage the enemy to win.