Living Large in Seventh Grade

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NaBloPoMo 2018: What I’m Learning

Did you know that Abraham Maslow never represented his hierarchy of needs as a pyramid?  I didn’t either!  To be clear, I have not read the paper I just linked; it was linked in a different article I read today, describing more about Maslow’s work than I have ever known before.  It’s in Scientific American, entitled, “What Does It Mean to be Self-Actualized in the 21st Century?” by Scott Barry Kaufman.

Especially later in his life, Maslow’s focus was much more on the paradoxical connections between self-actualization and self-transcendence, and the distinction between defense vs. growth motivation. Maslow’s emphasis was less on a rigid hierarchy of needs, and more on the notion that self-actualized people are motivated by health, growth, wholeness, integration, humanitarian purpose, and the “real problems of life.”

I was intrigued by this piece because I remember so clearly when I first learned about Maslow’s Hierarchy.  It was in seventh grade, and I can’t remember anymore the class or context.  I just recall that it made so much sense, and I felt such a swell of joy at the possibility that something so complex could be distilled and explained so simply.  It would have been fair to predict at that time that I would go on to become a psychologist.  The boy I had a crush on that year (and all through high school, actually) asked me where I saw myself on the pyramid.  I remember looking at the tiers and thinking, very clearly, oh, I’m at the top.  I felt a little sheepish, afraid I would be seen as bragging, but it was the honest answer, and I said so.  “Bullshit,” was his reply.  I can’t remember our verbal exchange thereafter, but I think I was able to convince him that I really felt like I was ‘there.’  And I left that encounter feeling both a bit more self-aware and also proud that I had stood my ground and defended a truth.  You could also have guessed I would later entertain a brief interest in law school.

Kaufman has revisited Maslow’s work, including his hierarchy of needs, and evaluated the components in the context of modern life.  Reassuringly, 10 of 17 of Maslow’s self-actualization characteristics still stand up to ‘scientific scrutiny,’ (not sure how he measured this).  He names the ten characteristics in the article, and you can ‘take the quiz’ to see how self-actualized you are today.  I love quizzes like this.  I have done the Myers-Briggs at least 5 times.  Others I love are Gregorc Mind Styles, Insights Discovery, and the Gallup Strengths Finder.  The most useful ones tell you what you already know about your strengths, and also offer advice and insights on how to manage your blind spots.

But the most interesting aspect of Kaufman’s article to me was Maslow’s interest in self-actualization and its relationship to self-transcendence.  We can understand self-actualization as ‘achieving one’s full potential’ and self-transcendence as ‘decreased self-salience and increased feelings of connectedness,’ (again, not read the paper; it’s linked in Kaufman’s article) or basically subsuming and/or integrating oneself within a greater whole.  At first you may think that these are mutually exclusive states of mind and being.  The coolest thing is that it’s not actually an either/or proposition; it is absolutely both/and:

While self-actualization showed zero relationship to decreased self-salience, self-actualization did show a strong positive correlation with increased feelings of oneness with the world.

Self-actualized people don’t sacrifice their potentialities in the service of others; rather, they use their full powers in the service of others (important distinction). You don’t have to choose either self-actualization or self-transcendence– the combination of both is essential to living a full and meaningful existence.

It reminds me of another subsection of Chapter 3 in Leading Change in Healthcare, wherein Suchman et al discuss holding the tension and balance between self-differentiation (clear sense of individuality) and attunement (deep awareness and acceptance of how we are connected and resonant with those around us).  It also reminds me of Brené Brown’s work on trust; she describes eloquently in Rising Strong how we can neither trust others nor be trustworthy ourselves without clarity and boundaries around who we are and our core values, and living in that integrity all of the time.

Once again, I find encouraging and validating evidence for something I really feel I have known since an early age:  We are all our best selves and our best communities not in competition, but in collaboration.   Cohesion in diversity weaves a stronger social fabric of connections, more flexible and elastic.  But that means we need to know exactly what we as individuals each bring to contribute.  Personal, intrinsic meaning and purpose are foundational for substantive interactions with others and resilient communal relationships.

Our world can meet each and every one of our physiologic, psychologic, and self-fulfillment needs—we can provide this for one another.  We can each strive for our own goals, alongside our peers, and still help each other on the rocky, uphill parts.  We really need to stop with the scarcity thinking and get on with the business of working together, maximizing each of our strengths, and making society better for all of us.

Onward.

Fear, Ego, and Control

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NaBloPoMo 2018:  What I’m Learning

In this post I will attempt to describe some exciting connections between readings from the Harvard Business Review, Dr. Anthony Suchman and colleagues, and Carol Dweck.

An HBR article landed in my inbox this week, catching my inner Imposter’s attention.  The title, “Ego is the Enemy of Good Leadership,” triggered my ‘Is that me?’ reflex.  Because much of the time, I think I’m a pretty good leader (“I’m awesome”).  But I’m forever fearful that my ego will get the best of me and make me exactly the kind of leader I loathe (“I suck”).  I saved the article to read later.

Meanwhile, I continued to Chapter 3 of Leading Change in Healthcare: Authentic, Affirmative, and Courageous Presence.  Basically this chapter deals with earning and building trust.  Chapter subsections include self-awareness, reflection, emotional self-management, clarifying one’s core beliefs, and accepting oneself and others.  In the part on core beliefs, the authors reference Dr. Suchman’s 2006 paper, “Control and relation: two foundational values and their consequences.”  In it, he differentiates between these two ‘foundational world views’:

Control

The beliefs, thoughts and behaviors of the control paradigm are organized around a single core value: that the ultimate state to which one can aspire is one of perfect willfulness and predictability. What one desires happens, with no surprises; all outcomes are intended. For the clinician, the control paradigm is expressed in the questions, ‘‘What do I want to happen here?’’ and ‘‘What’s wrong and how do I fix it?’’  Personal success or failure is judged by the clinical outcome, the extent to which one’s intended outcome was realized.

Relation

In the relation paradigm, the most valued state to which one aspires is one of connection and belonging. In this state, one has a feeling of being part of a larger whole – a team, a learning group, a dance troupe, a community, even the world itself. One’s individual actions seem spontaneously integrated with those of others to a remarkable degree, contributing to the evolution of a higher order process, i.e. one at a higher system level than that of the individuals of which it is comprised…  One asks the question, ‘‘What’s trying to happen here?’’ and, according to one’s best approximation of an answer, seeks to shape others and the world while also remaining open to being shaped oneself. This balance between control and receptivity puts one in the best possible position to recognize and make use of serendipitous events.

In Leading Change the authors write about control, “…This is a fear-based paradigm in which one trusts oneself more than others and holds tightly to power…  It predisposes leaders toward dominance, distracts them from cultivating relationships and leads them to set unrealistic expectations of control.”  And about relation, “This is a trust-based paradigm, anchored in the belief that the sources of order, goodness and meaning lie beyond one’s own creation…  It predisposes leaders to do their best in partnership with others, to attend to the process of relating and to personal experience (their own and others’) and to remain open to possibility.”

When I finally read the HBR article, the message about ego reflected the control paradigm:

Because our ego craves positive attention… when we’re a victim of our own need to be seen as great, we end up being led into making decisions that may be detrimental to ourselves, our people, and our organization.

When we believe we’re the sole architects of our success, we tend to be ruder, more selfish, and more likely to interrupt others. This is especially true in the face of setbacks and criticism. In this way, an inflated ego prevents us from learning from our mistakes and creates a defensive wall that makes it difficult to appreciate the rich lessons we glean from failure.

The ego always looks for information that confirms what it wants to believe [confirmation bias].  Because of this, we lose perspective and end up in a leadership bubble where we only see and hear what we want to. As a result, we lose touch with the people we lead, the culture we are a part of, and ultimately our clients and stakeholders.

Going to bed last night, I wondered, “Is Fear actually driving when we see Ego in charge?”  I think the answer is undoubtedly yes, but it’s more complex than that.  It’s not a fear that we feel consciously, or that we are even aware of.  It’s not sweaty palm, palpitative, panic attack fear.  Rather it’s a deep, visceral, existential fear—of being found out, of not being enough—akin to imposter syndrome, if not exactly that.  Control, Fear, Ego—they all seem lump-able with/in the Fixed mindset, as described by Carol Dweck.  The simplest example of this mindset is when we tell kids how smart they are, they then develop a need to appear smart, lest they lose their identifying label.  So they stop taking risks, trying new things, risking failure.  Their experiences narrow as they, often inadvertently, learn that control of outcome and outward appearance of competence is the primary objective of any endeavor.

Back in August I listened to Dweck’s book, having heard about it and already embraced its theory in the last few years.  I had already started making the connection between fear and fixed mindset, but this day I saw a sudden, reciprocal relationship between fixed mindset, confirmation bias, and imposter syndrome.  I love when these lightning bolt moments happen—I was in my car on the way to work, and this triad came to me.  As soon as I parked and turned off the engine I tore into my bag for the journal I carry with me everywhere and scrawled the diagram as fast as I could, as if the idea would evaporate if I didn’t get it down in ink.  Later I added the comparison to Growth mindset—holding space for learning, integration, and possibility.  I held it in mind for a while, and then forgot it (which is okay—that’s why I wrote it down!).  Then today, putting together this post in my head, I remembered it with excitement.

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The point of it all is that we are at our best, both individually and as groups, when we are in right relationship with ourselves and one another.  It all starts with relationship with self.  If I live in fear of being found out as flawed or imperfect, then I project that fear onto others.  I act out in an effort to control how others perceive me—when in reality I have no control over that whatsoever.  The negative perception of my ‘Ego’ by others then provokes myriad responses including fear, insecurity, false deference, resentment, disloyalty, and subversion, and the team falls into disarray.  If, on the other hand, I cultivate self-love and connection with others, I never feel that I am going it alone.  I am an integral member of a high-functioning, mutually respectful team, one in which I can admit my weaknesses and maximize my strengths.  We all feel confident that we can handle whatever adversity comes our way, and we rise to each and every occasion–together.

I’m still putting it all together, working out how it translates into daily behaviors, actions, and decisions.  For now I’m definitely paying closer attention to my feelings, especially in conflict, and taking a lot more deep breaths before speaking or replying to triggering emails.  I ask a lot more clarifying questions.  I try to make the most generous assumptions about people’s intentions, and remember always that we are on the same team—Team Humanity.

More learning happening around the clock, I say!  Hoping to articulate better in the sharing hereafter…

What do you think about all of this, does it make any sense at all??

Humanity

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NaBloPoMo 2018: What I’m Learning

I have festered all day drafting this post in my head.  Procrastinating.  It’s still a jumble, so I’ll give it my best shot:

Donald Trump is a human being.  As much as I want to hurl epithets and lob rotten tomatoes at the television every time his face appears, or take a sledgehammer to whatever device I hear his voice on, I know these are unproductive responses to the emotions he triggers in me.  Breathe.  Must. Do. Better.

Ever since the 2016 campaign started in June of 2015, three and a half years ago already, I have felt an almost daily rage like nothing in my life yet.  I’m happy in some ways to report that it has not improved—I have not normalized this aberrancy of an administration.  But the constant animosity is not good for my health.  And the escalating divisions and vitriol between various groups of people, ever more visible on phone cameras and instant video, erodes our humanity every day.  I think I’m also increasingly sensitive to it all now.  On one hand I’m glad because awareness of humanity, and opposing those who diminish it, is good.  But again, it costs me.

Donald Trump is the personification of dehumanization (oh, the irony).  Some may feel this is an exaggeration, too strong a word to use.  It is not.  He is a hardened master of this insidious craft, and we are each capable of the same, whether we admit it or not.  It starts with making people abstractions—by seeing them, even very subtly, as less than whole people with feelings and needs equally important as our own.  Simon Sinek discusses it eloquently in his book Leaders Eat Last; you can read an iteration of his thoughts in this interview.  He describes CEOs like Jim Sinegal and Bob Chapman who, in hard times, gave employees raises and decreased workers’ hours, respectively, rather than laying anyone off.  I learned during a lecture, though I cannot find the citation (Boehm, 2015?) that only 17% of healthcare CEOs take the well-being of their employees into account when making decisions.  Sinegal and Chapman sacrificed some numbers to save people, Sinek says.  Too many leaders sacrifice people to save the numbers.  Turning people into abstractions is both akin to and a step toward dehumanizing them.

I have a friend who used to criticize people, ideas, or things by saying, “That’s (he’s) so gay.”  He would deny his negative attitude, deny that he was using ‘gay’ as a derogatory term.  He would also deny that he was biased against homosexuals.  I believe he would never treat anyone badly because they were gay, let alone commit any kind of hate crime.  But ‘being gay’ was a negative abstraction to him.  It was abnormal, something to be derided and shamed—to be scorned.  His objection to the idea of homosexuality made homosexuals, as a group in his mind, less than.  I think we all do this more often than we know.  I wrote about it last year, describing how doctors in different medical specialties talk about each other in pejorative stereotypes.  We dehumanize each other every damn day.

Brené Brown describes this clearly in her book Braving the Wildnerness:

Dehumanization has fueled innumerable acts of violence, human rights violations, war crimes, and genocides. It makes slavery, torture, and human trafficking possible. Dehumanizing others is the process by which we become accepting of violations against human nature, the human spirit, and, for many of us, violations against the central tenets of our faith.

How does this happen? Maiese explains that most of us believe that people’s basic human rights should not be violated—that crimes like murder, rape, and torture are wrong. Successful dehumanizing, however, creates moral exclusion. Groups targeted based on their identity—gender, ideology, skin color, ethnicity, religion, age—are depicted as “less than” or criminal or even evil. The targeted group eventually falls out of the scope of who is naturally protected by our moral code. This is moral exclusion, and dehumanization is at its core.

Dehumanizing always starts with language, often followed by images. We see this throughout history. During the Holocaust, Nazis described Jews as Untermenschen—subhuman. They called Jews rats and depicted them as disease-carrying rodents in everything from military pamphlets to children’s books. Hutus involved in the Rwanda genocide called Tutsis cockroaches. Indigenous people are often referred to as savages. Serbs called Bosnians aliens. Slave owners throughout history considered slaves subhuman animals.

Again, you may think that I over-exaggerate here.  What’s the big deal, you say, when surgeons say internists wear flea collars (stethoscopes)?  Or when Trump calls Mexicans criminals and rapists?  When he calls women dogs, Miss Piggy, and Horseface, you say, it has no real effect.  Sociology begs to differ.  It is a slippery slope from thoughts to words to action, and Donald Trump has poured oil on the Slip ‘n’ Slide by the bucketful.  Don’t believe me?  How else could we countenance forcibly separating toddlers from their parents when they arrive on our doorstep, fleeing violence and seeking asylum, sending the children across our country and deporting the parents, with no intention of ever reuniting them?  If that’s not dehumanization I don’t know what is.

Once again, Brené Brown says it much better than I:

Today we are edging closer and closer to a world where political and ideological discourse has become an exercise in dehumanization. And social media are the primary platforms for our dehumanizing behavior. On Twitter and Facebook we can rapidly push the people with whom we disagree into the dangerous territory of moral exclusion, with little to no accountability, and often in complete anonymity.

Here’s what I believe:

  1. When the president of the United States calls immigrants animals or talks about grabbing pussy, we should get chills down our spine and resistance flowing through our veins. When people call the president of the United States a pig, we should reject that language regardless of our politics and demand discourse that doesn’t make people subhuman.
  2. If you are offended or hurt when you hear Hillary Clinton or Maxine Waters called bitch, whore, or the c-word, you should be equally offended and hurt when you hear those same words used to describe Ivanka Trump, Kellyanne Conway, or Theresa May.
  3. If you’re offended by a meme of Trump Photoshopped to look like Hitler, then you shouldn’t have Obama Photoshopped to look like the Joker on your Facebook feed.
  4. When we hear people referred to as animals or aliens, we should immediately wonder, “Is this an attempt to reduce someone’s humanity so we can get away with hurting them or denying them basic human rights?”

When we engage in dehumanizing rhetoric or promote dehumanizing images, we diminish our own humanity in the process. When we reduce immigrants to animals… it says nothing at all about the people we’re attacking. It does, however, say volumes about who we are and our integrity.

Dehumanizing and holding people accountable are mutually exclusive. Humiliation and dehumanizing are not accountability or social justice tools, they’re emotional off-loading at best, emotional self-indulgence at worst. And if our faith asks us to find the face of God in everyone we meet, that should include the politicians, media, and strangers on Twitter with whom we most violently disagree. When we desecrate their divinity, we desecrate our own, and we betray our humanity.

So I resolve to stop participating in the erosion of humanity.  When I hear dehumanizing language from anywhere, especially among my own tribes, I must resist the urge to respond in kind.  I will look for opportunities to call it out.  It is so damn hard, I feel so often like a pressure cooker waiting for the valve to release.  So I must practice patience, kindness, mindfulness, deep breathing, and all of the habits I reviewed here yesterday.  I must find it in myself to always hold another’s humanity as sacred as my own, even (especially?) the people I despise the most.  It will be a lifelong exercise in discipline and agape love.  As the Obamas teach us, we must stay Fired Up, Go High, and Be the Change.  I can do this.  Donald Trump is a human being.

Perspective Taking

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NaBloPoMo 2018:  What I’m Learning

I’m thinking a lot about empathy lately.  I am less cynical today than I might have been a few months ago, maybe.  I have uttered the words, “People suck” more this year than any other year in my life, perhaps.  But maybe writing about things I’m for rather than things I’m against, or reflecting on things I have learned and am learning, and from whom I’m learning them, has given me some hope.

Another person who gives me hope is Trevor Noah.  I mentioned in the first post of this month that I listened to his book, Born A Crime.  He really is an impressive and worldly young man, and I look forward to following his career and life for a while yet.

The best part about the book is the accents and impressions that Trevor does throughout his reading.  I have not actually read the book, but I am sure that hearing it on Audible is much, much better.  The second best part about the book is the actual book.  It’s a memoir, you must hear it!  In a series of non-chronological and yet expertly woven stories, he describes his childhood and adolescence in South Africa, son of a black Xhosa mother and white Swiss-German father.  Apartheid, outright racism, family conflict, domestic abuse and violence, crime, he lived it all.  Any of it would have probably killed me—jumping out of moving cars, for instance.  But he tells it both matter-of-factly, and with tremendous love.  I don’t mean that he loved all the terrible things that happened to him; rather I feel he has a deep and abiding love of humanity.  He accepts that it all happened and made him who he is today; I hear no resentment or bitterness.  He especially reveres his mother, and rightly so, she is a total Badass Mama Goddess.  I won’t give any of it away, you just gotta hear the book, she is UH-MAZING.  She is the best part of the book.

No, actually, the best part of the book is Noah’s ability to convey his understanding of everybody’s perspective in his life.  He translates for us the mindset of his independent mother, his stoic father, his wise grandmother, his friends from various, sometimes opposing, ethnic groups, and his hotheaded stepfather, among others.  At the same time he describes unbelievable atrocities committed by others, he does not vilify them.  There is never a hint of victimhood in a life story full of loss, poverty, and violence.  Hearing his perspective, and then his explanations of various other people’s perspectives, I was reminded that everybody’s point of view is shaped by so many things that I cannot possibly know even a part of it.  Every single human is a product and a manifestation of all of their genes, environment, experiences, and influences.  Every single one of us is unique.  And yet, most of the time, I make assumptions about what other people think, how they feel, what must motivate them, as if I know.  I think we all do this more than we’d like to admit.  I just wrote yesterday about how we humans have the capacity to relate, despite our disparate experiences.  Today I consider the flip side of that, which is ‘othering’ people by ignoring shared humanity, denying that capacity, repressing it.

Trevor Noah practices perspective taking as a routine.  I think that’s what makes him such a gifted comedian.  Comedy shows us our foibles so we might reflect but not so much that we feel shame.  He did this beautifully recently speaking about the migrant caravan from Honduras:

I’ve noticed other news networks in America specifically seem to focus on what the caravan means for America, and less on what the caravan means to the people in the caravan. 

He recalls growing up in South Africa, seeing news about Zimbabwe during the worst times of Robert Mugabe’s rule.  South Africans understood why Zimbabweans were leaving the country and coming to South Africa.  They may or may not have wanted them to come, but they nevertheless related to the motivations for migration.  He contrasts this with how Central American migrants are painted as threatening criminals, coming to pillage and plunder America.  This prevents us from acknowledging our shared humanity, from seeing ourselves in those around us.  It divides us unnecessarily and to the detriment of us all.

I have done a poor job explaining Trevor Noah’s comedic and humanitarian genius.  But seriously, just read (no, listen to!) his book, and watch his Between the Scenes videos on Facebook.  They are uplifting and fun.

Good night!

See, Do, Teach

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NaBloPoMo 2018:  What I’m Learning

When did you first notice you were led well?  Who was it, what was the circumstance?

See

I was in 7th grade math class.  The teacher was Joe Alt.  I met him 33 years ago, when I was 12, and I still consider him one of my greatest and most important mentors.  He could teach anything and make it interesting, and we learned not only math and science, but how to be good people.  In a class that included both uber-nerd me and ultra-headbanger dude, he helped us both to see each other as people and get along so we could all learn.

Later I would find leadership role models in my athletic coaches, professors, program directors, committee colleagues, and hospital administrators.  At their best, these people were/are:

  • Attuned
  • Empathic
  • Reflective
  • Articulate
  • Intrinsically Motivated
  • Actively Engaged
  • Personal
  • Approachable
  • Genuine

I have also studied on my own, seeking guidance from sources like Benjamin and Rosamund Stone Zander, Simon Sinek, Brené Brown, Daniel Goleman, Chip and Dan Heath,  Rachel Naomi Remen, The Harvard Business Review, most recently Anthony Suchman, and, soon again, Marcus Aurelius.  I’m always looking for the next new or old related idea, the next dot to connect in order to draw my leadership map with more depth and detail.

Do

Recently I asked a new mentor what books he likes to read about leadership, organizations, etc.  He said he reads some, but prefers to simply do, always learning, adapting, applying, and evolving along the way.  I have had small leadership roles at school and work, in my professional society, as well as in my community, over the years.  They have all given me tremendous opportunities to practice what I read.  More and more, I see the value in getting my nose out of the books, looking up, and stepping forward.

Teach?

I spoke with a high school freshman athlete recently.  She plays two sports, both teams comprised of both upper and lower class(wo)men.  She contrasted the coaches’ personalities and styles, and how she learns about the respective sports as well as teamwork, integrity, etc.  We noted how much better it feels when the coach knows you personally, and pays attention to your state of mind as well as your performance.  The team with the less attuned coach will soon choose a captain for next year.  It’s usually a senior, perhaps regardless of leadership skill or potential.  She described the various candidates to me, and why she thought they would be good captains (or not).

I asked her whether the team feels like a true team, or more like just a group of individuals.  She said right now, it’s the latter.  I asked how she would show up if one of the less desirable candidates were named captain.  She had not really thought about it other than to continue working on her own sports skills.  I then found myself offering copious unsolicited advice:

You have a few choices, I told her.  First, you could remain an individual, holding your own goals as primary.  You may or may not improve, your team may or may not do well, and your personal contribution to the success of the whole will be proportional to your own individual performance.  Second, as you progress in your skills and newer kids join the team, you can help teach and mentor them.  You could observe the new captain, identify her weaknesses. If possible, and if you’re so inclined, you can fill in the gaps for the team—lead from within the pack.  You could help build morale, create a true team from its inside, cultivate relationships that will make the whole greater than the sum of its parts.  You could set your sights higher than your own personal achievement and really help the team succeed.  Third, you could take it to the next level by cultivating an advisory relationship with the captain herself.  If you have her trust, and exercise tact, you could help her see and maximize her strengths, navigate around her weaknesses—you can ‘coach up.’

The latter choices are, obviously, harder and more labor intensive.  I would also argue that they would make membership on the team exponentially more meaningful for everybody.  By serving as a connector among teammates (with boundaries, realistic expectations, and self-care, of course), this young athlete could make connectors of her teammates, too.  And a few years from now, if she herself is tapped to lead, she will have already earned her peers’ respect.  They’ll follow out of course; it will feel only natural.  And, they may then already be the cohesive team that she really wants to serve as leader.

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These ideas poured forth in a torrent of consciousness, forming sentences before I could actually think them.  As happens so often, I found myself saying words, advising someone else, that I myself needed to hear at exactly that moment.  Most of the time it’s about eating, sleep, or exercise.  This was an A-ha! moment on my personal leadership journey.

Now I see the true meaning behind the phrase, “See one, do one, teach one.”  It’s not about becoming a teacher.  It’s about always remaining a student, because the best way to truly understand anything is to try teaching it.

See, do, teach.  It’s not linear.  It is, no question, completely cyclic.

The Feels Are Good

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NaBloPoMo 2018:  What I’m Learning

I’ve been working for many years now on feeling my feelings rather than thinking them.  Rationality and analysis in service of self-awareness and understanding are great, but I have tried too long to will my hard feelings away, or experience them all as anger rather than what they really are—sadness, shame, fear, etc.

With books like The Art of Possibility, Mindsight, and Rising Strong, after multiple readings, along with years of therapy, I have acquired the skills to allow these feelings to emerge, engage, and pass.  I understand much better now the purpose of emotions: they are simply signals.  They are meant to draw our attention to something meaningful in our existence.  This could be a threat, a connection, a relationship, anything.  We modern humans spend a lot of time judging our emotions (and thus one another’s), trying to suppress the ones that make us feel bad, masking them, numbing them, and offloading them.  For whatever reason, we are not good at simply allowing them, learning from them, and letting them go.

I started following Nate Green on Facebook just before he deactivated his page.  He now communicates with readers through email newsletters, and his is one of the few I actually read.  This week he sent a rare second message, linking to his recent article for Men’s Health, “There Will Be Tears: Inside the Retreat Where Men Purge Toxic Emotions.”  If you read nothing else this weekend, read this.

Nate participates in an Evryman retreat in Big Sky, Montana, a project “aimed at teaching men how to access and express their emotions.”  When I saw the headline I felt a squirming in my gut, which surprised me.  We, especially we women, are always urging men to be more ‘in touch’ with their feelings, right?  Don’t we always want our men to be more sensitive and caring, more empathic and expressive?  Don’t we want them to role model all of this for our children, especially our boys?

Nate describes the retreat and its exercises:

My thoughts are racing. I shift my feet. Andrew shifts his. We continue to stare at each other. Finally, Andrew takes a deep breath and speaks. “If you really knew me, you’d know that I smoke too much pot and use it as a coping mechanism. And you would know I’m ashamed of it.”

His gaze lowers, embarrassed. He looks back up and we lock eyes. Now it’s my turn.

“If you really knew me, you’d know that I sometimes drink too much alcohol and it worries me.”

I have never spoken those words out loud before. I instantly feel lighter, like a giant
weight I didn’t even know was there has been lifted. Andrew smiles, happy to not be alone in his confession.

“Thanks,” he says.

“Thank you,” I say.

…To our left and right are 16 other men, paired off just like us. Behind us sits a gigantic log cabin that will be our home for the next two nights. After that, we’ll carry 50-pound packs into the backcountry of Yellowstone National Park, where we’ll walk and sleep among the grizzlies, mosquitoes, and stars for three more nights.

We all met maybe an hour ago.

Yikes.  I’m pretty emotionally confident and open, and this would be hard for me.  Imagine (or maybe you don’t have to) how hard it would be for outwardly strong, independent, and stoic men to do this.  What would it take for you men to go on a retreat like this?  Women, how do you picture the men in your life going through something like this?  How would we react if our men disclosed their innermost fears to us, cried openly in front of us, at home, at work, on the field?

For a long time I did not understand how hard this is for men.  I thought they were all just shallow and simply did not have emotions (other than anger and sarcasm).  In Daring Greatly Brené Brown writes how she learned about the severe threat that vulnerability really is for men.  After one of her presentations she was approached by an older man, a husband and father of her superfans.  He pointed out to her that though we say we want men to show more vulnerability, the moment any man does, he immediately pays a steep price.  I like to think we would welcome it, but I have a feeling many of us would react with shock and dismay, at least initially.  We complain about how women are perceived as weak and ‘hysterical’ when showing emotion, and if I’m honest, I might feel the same or worse about a man doing it.

So our mission should be to make it okay for all of us, men included, to ‘be emotional.’  That does not mean losing control and acting out.  It does not mean using emotions as an excuse for abusive behaviors.  It means allowing and holding space for our common human experiences to affect us at our core, and acknowledging how it feels.  It means helping each other breathe and walk through it all, holding each other up through the hard parts.  In Rising Strong and Dare to Lead, Brown takes us through steps she and her team have developed for working through hard emotions, called the Reckoning, Rumbling, and Revolution.  I’m getting really good at the first step, also known as the Shitty First Draft.

I know I have included multiple links here with minimal explanation.  It’s late.  And you can click and read at your leisure.  Or maybe you don’t need to; maybe you know exactly what I’m referring to and you march with the same mission already.  If so, let’s connect.  Let’s find all of us who understand the profound need for this shift in culture and society.  Let us form a chorus and sing loudly to whomever will listen, and make the world better for all of us—men, women, children—all of us for one another.

 

Culture of Medicine, Part II

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NaBloPoMo 2018:  What I’m Learning

So, what did you think of how trainees described the Culture of Medicine?  If you’re in medicine, how much did you resonate?  If you’re not in medicine, how much were you surprised, or not?  How do you think this affects our relationships with you, our patients?

Do you wonder how we get through any given day?

I asked the group:  What are characteristics or traits of Culture of Wellness (COW) Leaders?  Once again, I present their responses here, in order of discussion.

  1. “They ask how people are doing.” They are proactive about it, opening the door, making it safe to talk honestly about how we really are doing.  They exhibit the ‘body language of listening.’  It’s still hard to talk about it, one student pointed out.  The best leaders explicitly carve out time to talk, to invite feedback.  It also matters what they do with the information once they get it—empathizing and acting on it if needed, rather than dismissing.
  2. Mentor. This is someone who knows you and whose role it is to help you ‘unconditionally,’ different from any of your evaluators—maybe an advisor.  It can be an informal relationship, maybe just someone you want to emulate.  Trainees agreed that it often happens organically, and they seek it actively.  One resident identified her program director as ‘absolutely a COW leader.’
  3. Walk the Talk. Examples: work/life balance/integration, acceptance of mistakes, admitting when you don’t know something.  NO DEFLECTING; OWN YOUR SHIT.  This one hit home with me—this is Integrity.  As Brené Brown says, integrity is “choosing what’s right instead of what’s fun, fast, or easy.  It is living your values rather than simply professing them.”

The next several descriptors emerged in a flurry.  The atmosphere in the room swelled with positive energy as one label after another of what we admire about our teachers and colleagues overtook the downtrodden mood just moments before:

  • Consistency
  • Proactivity
  • Openness
  • Empathy
  • Personally engaged
  • Curiosity
  • Caring
  • Kindness
  • Vulnerability—willing to share
  • Positivity—seeing mistakes as learning opportunities. Encouraging—“We’ got this!”
  • (Understand the importance of) Food: attending to physical needs
  • Humor—acknowledging the challenge and weight of the work and also holding it loosely
  • Validating
  • Appreciative
  • Grateful

The last one triggered a story.  One student rotated on an inpatient service.  Critically ill patients poured into the hospital; all work hour restrictions were necessarily violated.  Nerves were more than frayed, and people were at their worst.  He witnessed open hostility by senior residents toward interns, backstabbing, undermining.  The attending, present only minimally, was oblivious.  And, “They never said thank you.”  The student, who had planned to enter this field, considered switching.  It was that bad.  But somehow, he was able to get perspective and remind himself that this one bad experience did not represent the whole of this specialty.  It had been an unusually busy month at the end of a long, hard year.  Maybe the cumulative exposure to some of his COWL role model traits had rubbed off, and buoyed him when he stepped onto a leaky boat.

A senior student admitted that when she started medical school she had heard of burnout.  “I initially didn’t believe it could happen to me…  Then later I realized it can happen to anybody—it could absolutely be me, if I don’t take care of myself.”  I asked what that means, taking care of yourself?  They answered:

  • Sleep
  • Nutrition: “Any food your intern year; choices matter more when you’re PGY (post graduate year) 3!”
  • Outside interests
  • Finding a practice situation that fits: eg caring for the underserved, women’s health, hospital medicine, etc.
  • Find Your Tribe. The trainees did not use these words, but this is what I wrote in my notes—they expressed a need for belonging.
  • People at work: truly collegial relationships, especially across specialties
  • Confidants: safe people to share with, your emotional support network
  • Physician-Patient relationships: mutually vulnerable and open

I asked them what they needed to take care of themselves.

  1. Purpose
  2. Time—to be given by the system, and also to be responsible and efficient with themselves.
  3. Habits—established and also adaptible

Overall the discussion felt productive and successful in the end.  We had just mapped out the way(s) to Be The Change we seek in our profession.  Some of them took pictures of my notes (so Millennial), which made me feel gratifyingly connected.  I had tried to question more than lecture, to explore and facilitate more than ‘teach.’  I wanted each of them to own their own path to leading from any chair, now and forever.  I proposed that they could start the moment they walked out of the conference room door—no elevated status or title necessary.

This is why the calling still resounds compellingly, why our enthusiasm for the work persists resolutely, despite the hardships.  It’s Hope.  And at its foundation lies the bedrock of our best relationships—with ourselves, with one another, and with our patients.  On the march toward a true Culture of Wellness, real leaders go in front and set the example.  The rest of us learn by mimicking.  Thus we all have leadership potential and, dare I say, responsibility.  We are the system; we make the culture—each and every one of us makes a unique contribution.  Nothing we do is too small to matter.

Onward.