Category Archives: culture

What Anger Makes Us

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Trail near The Lodge at Whitefish Lake, Whitefish, Montana

Dear Readers,
I wish you all the curious, thoughtful, open, and loving friends like I have!
The same person I mentioned in “What Does Love Make Us?”, Sean, helped inspire this post tonight, coaxing insights to emerge just by being his curious, thoughtful, open, and loving self. Earlier I wrote a brief list of what I think love makes us:
Vulnerable. Courageous. Powerful. Forgive. Willing. Selfless. Grow. Better.

So what does anger make us? A dichotomy emerged in conversation today:

Adversaries
We see it everywhere: Rage poured forth, one person onto another, groups against each other. It’s us against them, no question, no nuance, no reflection, ‘no quarter.’ Yikes.

It’s understandable, of course, and sometimes even justified, this adversarial mindset and approach to the opposition, ‘the enemy’. Longstanding experiences of socially accepted marginalization, dismissal, and oppression fester and seethe, then spew forth like pus under pressure. As with any abscess, lancing that pent up wrath relieves pain, even as the initial incision stings momentarily.

Then we ‘go to war,’ as some might say. We ‘fight’. We take both an offensive and defensive stance, we weaponize our words, and we make all the worst assumptions of those we pre-judge as against us. We close our minds to alternative perspectives, plow forward with agendas that we believe can only be achieved by vanquishing all who resist. Even if our mindset is not this extreme, we risk sliding down that slippery slope. Abstraction and dehumanization of anyone ‘on the other side’ happens all too easily, my friends, and the louder the adversarial voices around us, the more pressure we feel to follow suit.

Where and what does this get us?

Looking back on my own life, on policy and human history, I can think of few tangible examples where the adversarial approach has benefited us, individuals and the collective alike, in the long run. And when it does, the costs are extraordinarily high, often borne by those with the least power or choice. Death, destruction, trauma, and lives irrevocably shattered–the adversarial route of anger scorches the earth.

Advocates
I have a friend who exudes rage and has suffered relationship and reputation damage from it. It makes me cringe because I understand the origin of their anger as protectiveness, righteous outrage on behalf of others, and a belly full of fire to do good.

I have also witnessed them advocate for their causes with diplomatic, almost loving assertiveness toward total strangers. They are bold but respectful, strong and friendly, a force of nature, like a stiff wind that envelopes and nudges you firmly but not forcefully from behind, getting you to where you might have been going just a little faster and with more urgency. People receive their words and advocacy with openness, curiosity, and a willingness to consider action; how often do you see interactions like this?

In January I wrote “Tested and Called“, feeling angry and a little hopeless after Alex Pretti’s murder by border patrol agents. It was my first documented “DIY pep talk“, I see now. I wrote about anger and courage, ‘hope’s two daughters.’ I reminded myself that in the face of all that makes me angry, I can and must continue to show up and ‘fight’ for things and people I care about. Better writers than I have made the distinction between fighting for and fighting against. It’s a subtle attitude shift that matters.

Fighting against–being adversarial–too easily devolves into ad hominem and caustic division: name calling, shaming, othering, dismissing, dehumanizing, and even violence. The external focus and negative energy depletes us, and when we see little to no progress we burn out. Fighting for, or advocacy, on the other hand, carries a light from within, an intrinsic motivation of renewable energy, fostered and amplified when any progress is made. Advocacy attracts allies, grows a movement, and creates sustained and sustainable change agency.

The language of advocacy centers the cause, not the opposition. It informs, educates, inspires, and empowers. Advocacy demands accountability of the systems it seeks to change, as well as its own advocates themselves. The strongest and most effective advocates strive always to walk the talk.

I have written this blog for eleven years. Surely there are posts that I would not write, or write differently, today compared to when they were published. Information evolves, and I along with it. My attitudes and opinions change with age and experience. But I can stand with confidence by the intent of every post here as non-adversarial advocacy of some kind–even when the execution misses the mark. I look for others with a similar ethos, especially in medicine and science.

Whom do you admire for their non-adversarial advocacy?
What good do you see them doing in the world?
How can we amplify them?

Below are Instagram accounts that I follow for their strong advocacy in the face of threats to the integrity of our scientific and medical institutions. Some of their posts verge on adversarial, but for the most part I perceive an earnest, professional, and evidence-based mission to protect public safety. And of course I think of Braver Angels and Builders for their work to bridge division and move us away from adversarial political engagement.

Lastly, apologies for this second delayed post–life! Quality time with Son and Daughter, both home from college, took precedence over sitting at the laptop. Worth it! May we all have such meaningful and fulfilling choices to make!

Fired But Fighting

Illinois Department of Public Health

Stand Up For Science!

American College of Obstetricians and Gynecologists (ACOG)

DogGlauc: Will Flanary, MD

Collegial Love And Then Some

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Audible Narrator Hall of Fame Class of 2018 and 2026 Inductees

Who are your colleagues?
What connects you?
What do you share with these people that others do not and cannot understand or relate to?

Last week Audible celebrated their second cohort of Hall of Fame narrators, including a couple of my favorites, Andrew Eiden/Teddy Hamilton, and Steve West/Shane East. Andi Arndt, Hall of Fame Class of 2018, gushed about her colleagues on Instagram the night before, reminding me of that deep collegial love that I feel every day in medicine. My impromptu comment on her post stuck with me all week.

The photos of celebration and connection, the joy and energy of the Audible event moved me, too. I haven’t been to an American College of Physicians national meeting since 2019 (it was next weekend in San Francisco, but I came to Portland, Oregon instead, to visit with friends–hence this delayed post), and I miss seeing my colleagues from all over the country, going to sessions and learning together, having coffee, sharing stories, catching up.
Voice acting can be very solitary work, so I imagine these artists relish opportunities to gather and commune, especially when it centers around celebrating their shared love of the work.

I wrote to a VA acquaintance once, “I hope (imagine) that you get enough positive feedback, validation, and reinforcement for your work! 😀 I also hope you get enough contact and connection with your colleagues. I can always walk down the hall and consult mine on challenging cases or difficult encounters. We are friends. My professional support network is at my elbow and fingertips; I hope yours is too!”

I spent time this weekend with Christine, my life coach and friend of 20+ years. She described her experience of ‘supervision,’ wherein she was required to debrief with elder colleagues during a segment of her training, exploring potential personal pitfalls and blind spots that client work may uncover, and how to beware of and manage it all. As coach and physician, our conversations weave in and out of mutual support and informal ‘supervision’ in organic and collegial ways. Our work overlaps with that of therapists, nurses, and probably any other helping profession. Walking along the Willamette River with Grant today, we reflected on how easily we can apply our professional training and skills in any domain where humans interact.

Back in 2017, the night before presenting at general surgery grand rounds (unusual for an internist), I wrote about tribal pride and tribalism:
“We all need our tribes. Belonging is an essential human need. To fit in, feel understood and accepted, secure—these are necessary for whole person health. And when our tribes have purpose beyond survival, provide meaning greater than simple self-preservation, our membership feels that much more valuable to us. But what happens when tribes pit themselves against one another? How are we all harmed when we veer from ‘We’re great!’ toward ‘They suck’?”

Nine years on, how do we assess the relationship between tribal pride and tribalism in any given domain on the current geopolitical landscape? Surgery vs. medicine, staff vs. leadership, conservatives vs. progressives, advocates for vs. against AI… How can we maintain our human connections above all, no matter what our divergence? I have often thought of myself as a ‘lumper’ as opposed to a ‘splitter’–always looking for connection, commonality, and relationship everywhere, among all people. In the same message to my VA acquaintance:

“Acting and medicine: What do you imagine are the overlapping aspects of our respective work?  I see it mostly in story—empathy for and holistic understanding of the full human experience, from the euphoric highs to the most sorrowful lows.  For both of us, to be truly excellent at our work, we must call forth real and sincere empathy from our own depths, which is vulnerable and courageous in a lot of ways, don’t you think?  For you, the stories are complete, and you get to interpret and bring them to life, to present them for our benefit.  I get to elicit the stories, coax them to emerge in real time, and interpret them along with my patients.  What stories do people tell about their health, their lives, their agency to influence it, and the outcomes they can/not achieve?  We get to dissect and discuss and then act on our shared interpretation.  We edit and revise together over time.”

So this weekend I communed with two of my coaching friends. I spent quality time with Phara who has a degree in psychology, and Heather, a fellow writer. We bonded over parenting–the unique mental load of moms, especially working moms. This theme has emerged powerfully in my medical practice, no matter the moms’ day jobs and no matter our kids’ ages.

Colleagues share language, training, experience, and perspective. We compare notes, tell stories, and connect. But we do this not just in professional circles. Our tribal memberships intersect and overlap, often in ways we could not predict or design. So really, we can find love in commonality anywhere, with anyone, if we just open up and ask, no?

What a fun exercise to come across an idea on social media, feel it in my heart, react in real time, then process it for days and see what arises in stream-of-consciousness blogging while stuck at the airport! Tomorrow I get to co-present on health and wellness to the Illinois Judiciary–another esteemed tribe of helpers, as I see them. What a privilege.

My tank is so full from a long weekend of deep and thick connection with my amazing friends here in the Pacific Northwest. I will miss this year’s chance to commune with my fellow internists nationally, but I’ll get back to the office this week and soak it all up locally. How lucky I am, truly. I hope whatever your profession, whomever you call colleagues and friends, that you get to enjoy this deep, collegial love born of shared humanity. And if you can recognize and strengthen it across domains, even better. That’s what will save us all, I am convinced.

In Person, Face to Face, One on One: Crowns Lesson #3

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“Openness to our minds changing is NOT weakness. It is the strength of intellectual humility.”

How do you come to really understand and know anyone, then overcome differences?

Many of my friendships have begun remotely–on Facebook, this blog, interest groups, even on the phone. But they do not solidify until we meet in person. It is the natural progression of relationship, to be in each other’s presence. The energy is profoundly different, the connection tangible and tactile.

Throughout the Crowns Trilogy, relationships develop and transform through repeated in person meetings, between lovers, adversaries, allies, strangers, and family members. Communication occurs through letters and messengers, posture and political actions, but it is the face to face encounters that challenge biases, build trust, and solidify alliances. Repeated rupture and repair in indispensible relationships, committed and restored in person through words, expressions, or acts, reminds us that there is no substitute modality for true connection.

Physical proximity is not enough. Connection requires emotional and psychological presence, the offering and acceptance of attention, and the mutual willingness to engage in good faith.

The main characters in Crowns overcome traumatic and tragic barriers to connect, and save their kingdoms, driven by two primary motives: Love and Peace. Why can’t we do the same? Norah, Mikhail, Alexander, and Soren engage one another and also themselves with intensity, ambivalence, and serious conflict. But they keep showing up, never abandoning their commitments to do the necessary bridging work for the people and causes that matter most to them. Consider how the following patterns apply to your encounters with people who disagree with you, politically or in any other domain. Can we practice these for the sake of love, peace, and saving ourselves from one another?

Multiple meetings. Important issues almost never resolve in one try. Anyone who leads knows this. The larger and more complex the organization or issue, the more iterative the solutions necessarily must be. Sustainable progress only occurs when participants practice transparency, honesty, and accountability. This requires vulnerability, courage, and a willingness to compromise over time. Sometimes meeting is unavoidable, such as in family or workplaces. We can choose to stonewall or refuse to engage in this case, but that is not an option for connection and conflict resolution. Concerted effort in repeated negatiation and exchange in good faith–diplomacy–is a life skill.

Cultivating connection. All of the above does not emerge immediately. We humans sense threat and danger acutely. It takes multiple meetings to prove safety and earn trust, during which commitments are honored and confidences kept. This is how relationships are built. I identify with Norah in Crowns because she is so often the one initiating and sustaining contact and engagement, and she almost never declines invitations offered by others. She exercises patience, persistence, and celebration of any progress, as do I.

Mutual respect. Over and again, Norha, Mikhail, Alexander, and Soren recognize and acknowledge their rivals’ strengths and merits. They and the supporting characters exercise objectivity in assessing one another’s achievements. When in the other’s domain, each learns and adheres to customs therein, even as they disagree with the beliefs behind them. There can be no peace or lasting conflict resolution without mutual respect.

Commitment to possibility despite heavy resistance. Countless times others tell Norah that peace is not possible, that war and death are inevitable, that people and systems cannot change. They cling to wariness and stubborn disbelief, rigid negative assumptions and prejudices as if they are immutable truths. But she holds possibility in front, with the primary assumption of and commitment to preserving shared humanity. Because of her advocacy and mediation, spanning the boundaries of belief and experience, the others eventually, begrudgingly, recognize and acknowledge the limitations of their prejudices and come around. Her idealism overcomes their cynicism and wins the day.

In the end everything has a cost.
Polarization, division, and mutual adversarial attempts to vanquish the opposition, at their worst, cost lives, whether through small violent confrontations or full on war. Social, operational, and economic costs also escalate, with lasting deleterious effects.

What does bridging work cost? For us regular people, it costs our comfort, for sure. It takes time, energy, and even resources to acquire and practice the skills. What would bridging work cost elected leaders, in addition? What if they all sat down in person, face to face, one on one, more often and earnestly?

What are the costs of not bridging our differences? I have heard too many stories of relationships torn apart by unresolved disagreements; the loss and grief are real and tragic. Openness in relationships also suffers, causing people to self-censor honest expression for the sake of ‘keeping the peace’–a fragile and hollow peace. These psychological and relational costs are exactly what fester and fray our social and personal fabric.

We all get to decide what benefits of bridging work are worth what costs to ourselves. I am convinced that in order to elect leaders who possess the skills and capacity to engage regularly, respectfully, and in good faith, we must be willing to do so ourselves, as citizens. It is now the era when we regular people must lead by example.

Because if not us, then who?