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Either markets are universal and everything is bought and sold, as some economists insist, or personality is universally acknowledged to be intrinsic to social relations, as most humanists would argue. But institutional dualism of the sort outlined here, forcing individuals to divide themselves, asks too much of us. Consequently, not only has the structure never been fully realised in practice, but it has been breaking down for some time in the face of people’s need to integrate the personal and impersonal dimensions of their lives. They want to integrate division, to make some meaningful connection between themselves as subjects and society as an object. This process has been aided by the fact that money, as well as being the means of separating public and domestic life, was always the main bridge between the two. That is why the project of bringing together the different spheres of exchange into some meaningful unity is more likely to succeed through developing new approaches to money than by turning our backs on it.

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Civic Learning and Democratic Engagement Network
Since the release of A Crucible Moment, AAC&U has convened a group of 13 national organizations called the Civic Learning and Democratic Engagement (CLDE) Action Network to coordinate with one another and use the breadth of their national outreach to serve the larger communities of practice and advance A Crucible Moment's ambitious agenda. This reflects AAC&U's ongoing commitment to help all students achieve the essential outcomes of a 21st century liberal education, including personal and social responsibility—an important cornerstone of essential learning outcomes, reflecting a consensus by colleges and universities.


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Anthology was built over on the other end of the spectrum, where “value” is still rooted in what’s “valuable” — meaningful, exceptional, personal, meant to endure; like music that touches your soul.

Mauss believed that reciprocity probably had its origin in sacrifice, do ut des, I give so that you will give to me. Faced with the overwhelming forces of the natural world, primitive man gave up something material in the hope of making a spiritual connection which would be translated into a reciprocal social relationship with unseen powers, the gods. [8] The next stage in this speculative evolutionary sequence he called “total prestations”, meetings between whole communities in which everything was exchanged, much in the manner of medieval fairs. Mauss imagined that gift-exchange might be a step towards individuation of these collective encounters, leading as it does to the threshold of authoritarian rule. Giving in the form of alms or charity exchanges material support for moral deference in evolved systems of social stratification. Finally, individuals confront each other as equals in markets, without benefit of social or spiritual ties. And this enables, on the face of it, a clean separation of persons and things to occur, so that buyers can walk away from sellers, knowing that any obligation between them has been wiped out by the equivalence of whatever has been paid.


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I have suggested that living in two strongly contrasted spheres of the economy, in the impersonal world of work and the personal world of home, poses intrinsic difficulties for our humanity. At the root of the problem is the way we work for each other through the market, when the buying and selling of services (as opposed to objects) is becoming by far the largest part of the human economy. A market economy may be said to be “capitalist” when people are paid to work, mainly outside the home in establishments controlled by the owners of money. There was always a tension between the needs of domestic or local organisation and participation in market networks; but this was manageable, as long as the bulk of livelihood was generated outside the market. Wholesale conversion to the wage labour system simultaneously made the market more central to economic life and reinforced the division between work and home. Morality itself was banished from public life, leaving individuals with no responsible or meaningful connection between private and public life. Yet the security of families depended on maintaining access to wage employment which was granted or withheld by remote agents in the public sphere. This is, of course, intolerable; and people responded in a number of ways.

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At a time of dynamic change in medicine, improving the experience of the caregivers is essential, and is dependent on recognizing the costs of burnout and the value of a fulfilled professional workforce. Recognizing and quantifying the problem of burnout is the first step toward meaningful systematic change. Creating the organizational foundation for Joy in Medicine™ can be achieved by addressing issues within the three domains of physician well-being: efficiency of practice, culture of wellness and personal resiliency.