Toxic Individualism and Service

At first I called it ‘abject individualism.’  Not sure which will be my final phrase—which will catch on?  Do you already know what I mean? 

It goes beyond selfishness, really.  It’s a culture, an ethos; it took root somewhere in early American history and has infiltrated the collective psyche with exponential acceleration in my lifetime.  This mindset values winning over service, status over integrity. “Eat What You Kill.” It is myopic, and it so permeates our daily interactions that we hardly even notice.  It steeps us in competition, scarcity thinking, and righteous anger.  Toxic individualism, while not the sole driver, contributes mightily to division, negative tribalism, and violence.

I won’t go into detail here, but I see it in so many realms: media, finance, environment, education, and healthcare, among others.  A cumulative movement in policy and deregulation that favors competition over collaboration, and removes incentives for long term resource renewal and sustainability in favor of short term gains, grips our culture.  It’s all about looking good and getting mine, to hell with everyone else.  Most of us probably don’t identify with this most of the time, but consider how we think and act under stress.  When we feel our own families threatened by circumstances like a pandemic knocking at our door, how did we instinctively respond?  Contract, protect, and suspect.

Of course, this is a natural survival response to threat.  I would never advocate for ridding ourselves of it.  And, when a culture’s balance between self-protection and group connection tips too far and too long toward the former, especially under collective stress, bad things happen.  Successful social living is always a give and take proposition.  In order for us all to be well, we all have to make sacrifices sometimes for the greater good, namely and often first and foremost, our comfort.

I will have facilitated two calls this week on ‘elevating our conversations.’  The central premise is that in order to communicate effectively across differences and disagreements, to problem solve in the face of divergent perspectives, we must tolerate more discomfort than our current cultural ethos often allows.  We must stand in openness, curiosity, humility, generosity, and fairness.  Too often today we are rewarded (instantly gratified) more for standing rather in defensiveness, stubbornness, righteousness, and ad hominem. 

This hyper-individualist attitude translates to the collective:  If you’re not with me (us) all the way, you’re with the enemy.  Dissent within a tribe is quickly suppressed and punished.  It’s us against them, black and white, right against wrong, no exceptions, no nuance, no discussion.

The antidote for this poison is service.  A service mentality puts the collective good at least on even footing with that of the individual, if not elevating it.  Service activities and professions center around giving, selflessness, and responsibility for others.  Teachers, healthcare workers, and military servicemen and women understand this intuitively.  We need one another—for us all to be healthy, we all need to look out for each other, thereby keeping each other healthy—for society, and thus all of its individuals, to truly thrive.

It’s not weak to need others.  Individual strength is necessary, important, and admirable.  So is interdependence, relational connection, and emotional cohesion.

Simon Sinek interviews General Stanley McChrystal on his podcast on quiet service .  Their conversation resonates with me so deeply right now.  It’s not either self or group. It is always both and, in dynamic balance, holding tension for some competition, and also much collaboration, creativity, synergy, and progress.  See some highlights of the “A Bit of Optimism” episode below.

What are we each doing to keep the fabric of society from tearing? As we care for ourselves, how can we also care sincerely for others? How will our culture be better for our having lived?

3:34  Sinek suggests that the call to service has declined.  McChrystal:  “That sense of responsibility… has decreased… In some ways you say well, everybody’s their own person…  The problem is it’s hard to run a society like that… It’s hard to have those things which we do better jointly than we do individually.”

4:27  Sinek:  “There’s a paradox to being human…every day we are both individuals but we’re also members of groups, and we have responsibilities to both…  We’re all trying to learn how to take care of ourselves, but where are we learning how to take care of each other?”

5:40  On civilian national service for young Americans, McChrystal:  “You can plant a seed through behavior, getting them to do something for a year… They won’t like it every day, but they’ll come out of it differently,… more thoughtful…  Healthcare, education, the environment… there is so much room for people to give…  and they come out differently themselves—they are the real product.”

7:40  Sinek, on the race to get mine or else someone else will get it, referencing Naval commander David Marqet:  “Force a change in behavior, then people change what they’re thinking,” rather than the othe way around.  McChrystal responds with the example of someone running for public office, asked how they have served.  Sinek:  We should ask of polilticians, do they serve us or do they serve themselves?

11:30  On the push for equality, McChrystal:  “Every young person… should have a roughly equal opportunity in life, should be our goal, shouldn’t be able to argue against that… (13:00) for example healthcare—every American (should have) healthcare not because it’s fair but because it’s smart for society…”

15:35  Sinek:  “How the heck are we going to inspire people to want to do something that comes at personal sacrifice?”  McChrystal:  “I think people want to be inspired… they’re just…waiting to be asked.”

24:33  Sinek on quiet service, humility:  “A lot of the stories you tell are about quiet, and about being humble…  Maybe the lack of service is a symptom that we’ve lost our humility, as individuals, as a nation…”

Revel in the Awesomeness

What’s really awesome for you lately?

I had such an endearing conversation with a friend this week.  A new empty nester, he reflected on this new perspective.  Having spent so much time and energy focused joyfully and lovingly on his children the last couple of decades, he now has some of that time and energy ‘back’, to do with what he chooses.  And it seems he chooses in part to appreciate the awesomeness of his life a bit more.  Fabulous marriage, meaningful and fulfilling careers for both him and his wife, a chance to make a positive difference in the world around him, and happy, healthy kids.  Yay! 

I absolutely love hearing people revel in awesomeness, don’t you?  Is it not totally inspiring?  When was the last time you looked around and truly appreciated the goodness all around you?  It’s a vulnerable act, if we’re honest.  Too often it feels like tempting fate, ‘jinxing it’, to call out all that is going so well, so right.  So we keep joy at bay, we keep striving, always looking for how it could all be better.  Huh.

What happens when we allow awesomeness to envelope us, penetrate us, move us? 

I think the first thing we get is a deep sense of wonder.  How could it be so good?  How is it even possible?  And it doesn’t even have to be anything big.  I have a cold—fever, congestion, headache, fatigue, body aches, mental fog.  And yet I can hydrate, medicate, and slow down, and still work (not in person!) and take care of the family.  The parameters for normal operation in the human body are remarkably narrow.  And yet multiple systems can be widely deranged, and we not only survive, we function at about 90% or better for the most part.  What an amazingly evolved machine, with perfectly orchestrated and automatically, effortlessly effective redundancies!  HOW AWESOME!? 

For me, from wonder grows gratitude.  Some people can’t actually tolerate a cold so well, but I can.  Some people don’t have access to excellent healthcare, but I do.  Some people don’t have the marriage, career, and kids that my friend and I have—but we do.  And we are grateful.  We don’t have to feel shame or guilt for having it ‘better’ than anyone else.  Everybody has their challenges in life, us included.  And still, counting our blessings is a great way to get perspective in any time, hard or easy.

Gratitude, then, is the fountain from which generosity springs.  I wrote about this in 2015:

When I feel grateful, there is enough. I am enough. Even just saying the word, seeing it on the screen, brings me to a more peaceful state of mind and body. It brings to mind the people in my life—my parents, husband, children, friends, colleagues. I recall instances when someone went above and beyond to help me, or when they thought of me and took to the time to call or write. I feel humble. I feel connected.  I want to share what I have with others.

When we truly revel in awesomeness, then allow wonder to infiltrate our psyche, then bask luxuriously in deep gratitude, how can we help but wish for everybody to have what we have, to feel what we feel?  If I can have all this, when life is this abundant, how can I help but share?

Finally, I believe reveling in awesomeness is the seedbed for my activist heart.  I have much and I strive to share freely.  I wish for everybody with much to share with those who have much less.  I wish for our culture and society to make it easier, through policy, for all to have more than enough, for that to be the default.  These days I have cynicism-optimism whiplash at ever higher speed and intensity.  I see so much self-absorption, biting competition, and scarcity thinking.  Sometimes I just want to shake people and yell, “Look UP!  We have so much potential for good here, if we only choose to see it!”  But I realize folks don’t always appreciate this approach.  So for now I can simply revel out loud for myself, in all the awesomeness I experience every day.  And like my friend did, I can share the light I see—emanate it—and I can keep making a difference starting from there.

New Body Signs of Stress

How does stress manifest physically for you? 

I’ve asked patients for years now.  Some people know exactly what I’m talking about and answer without hesitation—“Oh, migraines—MONSTER migraines.  As soon as I feel one coming on I know I’ gotta unplug and go for a run!”  Some need a little prompting—I give them other examples like chest tightness, loss of appetite, or insomnia.  For others, it helps to ask what their significant others or children tell them.  “What would your wife say if I asked her,” usually gets a pretty immediate and animated reply.  Very occasionally, even after all of that, some still don’t really understand the question, or deflect, and we move on.

I noticed neck pain as my stress signal sometime in my 20s.  I suspect my body learned this nerve pattern during residency, when my heavily laden white coat pockets dragged my posture toward the floor for well over 80 hours a week.  I remember taking the coat off (aaaaahh, relieeeeef), then picking it back up later to put it on (aaaaaarrgh).  I’d say it probably weighed a good 5 to 7 pounds.  If you’ve never experienced this, and you’re also looking for a great laugh, check out this video of the Try Guys wearing boob weights for a day. You’re welcome!

For years a simple backrub or even just a good night of sleep would take care of it.  But in spring of 2010 I started having a hard time sitting still at work.  Increasingly I was distracted by tightness, and eventually searing pain, all around my neck and shoulders.  It was diffuse and constant, and I could never find a comfortable position, day or night.  Ibuprofen would not help, and hour long massages only very briefly.  It had been six months since starting a new position, and I was ‘way more stressed than I realized.  The day before vacation I thought, I bet this goes away in Colorado.  And voila, by the time we landed in Denver I was already feeling like myself.  After a week in my happy place, I returned to work expecting the neck pain to recur.  Happily, it didn’t!  Hooray, all fixed!

Not so fast.

A month later I developed astonishing pain and sensitivity in my right forearm—cubital tunnel syndrome—to the point where I had to roll up my sleeve because I could not stand the touch of the fabric.  I barely got through CPR training one morning; I told my mind-body physician friend, thinking he’d recommend a supplement or something.  He listened compassionately and reflected how often he’d heard the same story from patients.  “Sometimes the body just puts it in another place,” he said simply. 

Thankfully at the end of that week, I went away to my first ever mindfulness retreat with other medical educators.  I could not remember the last time I had so much quiet time to myself, not having to rush somewhere, make a decision, or take care of someone.  After dinner we had free time and I climbed into a bay window and started writing.  On a random legal pad I dumped everything that had swirled in my mind for however long—deep, complex thoughts that poured forth from the pen in a torrent, pages and pages full.  By that night going to bed, my forearm felt normal, and that pain has not come back.  I’ve been journaling regularly ever since.

Over the years, the neck pain has come and gone, and improved significantly since I left that job.  But even in the last two years as I have taken on more at work, and in the past six months of utter chaos, it has only recurred mildly. 


Out of nowhere last week, I developed a sore throat.  Strange.  It came on and worsened suddenly over a few hours, then abated after an hour Zoom call with my Braver Angels pals and a big mug of honey tea.  I had no other symptoms—no fever, body aches, fatigue, nasal congestion, or headache—just a really irritated throat, and only on the right side.  On further reflection, I had also been doom scrolling, eating, and online shopping more. Huh. 

This is exactly what happened back in March, when I wrote four blog posts in eleven days about the pandemic.  Looking back, I see the same pattern of behavior—staying up late, reading voraciously, ruminating, anticipating, problem solving, and looking for things to do to help.  For days in a row I had mild, barely perceptible throat irritation and nothing else.  It came and went, without discernable patterns or correlations. 

New body sign!  How fascinating.

This time I had to call in sick to work.  The team sprang into action and rearranged schedules.  My patients all agreed to speak by phone; my colleagues did their physical exams in my stead.  Everybody was so understanding and gracious, their day turned upside down, all because I had a sore throat for a few hours. 

Rightly so.  What if it were an infection?  What if the person I was with 5 days earlier, who was now home sick, had COVID (they didn’t, and we were both masked and distanced, together for only 15 minutes)?  What if I ignored the sign of potential infection and came to work, and then transmitted to the team and my patients?  Yes, it was a huge hassle for everybody to make last minute workflow changes.  But that was nothing compared to the potential, exponentially larger hassles of a whole workforce having to stay home sick, all because of me.

Right now we should take no chances.  Now more than ever we must build, sustain, and advocate for work systems that support the health and well-being of the workforce.  We need to make it safe—and expected—for employees to take care of themselves, thereby caring for coworkers and clients.  Short term inconvenience is the investment for the returns of long term loyalty, cohesion, and success.

If we slow down and pitch in—if we all take care of each other on the team—maybe we will have the mental and temporal space to notice new patterns.  Not just new personal body signs of stress, but new community signs of need, new collective signs of connection, and new team signs of creativity, innovation, and core values expression.  Wow, wouldn’t that be something?