Honesty and Integrity

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NaBloPoMo 2018:  What I’m Learning

Last day!  I’m feeling a little elated.  Not sure if it’s Day 30 relief and success, the abnormally large caffeine load I had today, or my awesome breakfast date…

I wish you all to have a friend like Donna.  She is one amazing woman.  A leadership coach, wife, mom, and fellow cosmic journeyer, I count myself infinitely lucky to know her this time around on earth.  I bet we’ve known each other longer than that, though.  We met in this life about 9 years ago.  I can count on one hand the number of people I remember propositioning for a coffee date on our first meeting, and Donna is one.  We meet every two or three months to commune, share, and grow.  I consistently experience two or three separate intellectual and spiritual epiphanies each time.

Today was no exception, and possibly even an exponentially positive anomaly.  Like I said, I’m caffeine loaded and coming off a 30 day freestyle writing challenge—I was primed!  The conversation was so profound I had to type out some notes afterward, as I sense future writings to spring therefrom.  Day 30 was the perfect day to meet her!  I have synthesized and integrated deeply this month thanks to this daily blogging discipline, and sharing with Donna was the quintessential culmination of it all.  I now share with you my favorite segment from our egg-and-toast-laden love-in.

I described a values exercise I did reading Dare to Lead by Brené Brown.  From a list of over 100 words including accountability, courage, faith, openness, respect, and truth, I had to choose two core values, or think of two of my own.  Brown writes:

The task is to pick the two that you hold most important.  …almost everyone…wants to pick somewhere between ten and fifteen.  But you can’t stop until you are down to two core values.

Here’s why:  The research participants who demonstrated the most willingness to rumble with vulnerability and practice courage tethered their behavior to one or two values, not ten…  and when people are willing to stay with the process long enough to whittle their big list down to two, they always come to the same conclusion that I did with my own values process:  My two core values are where all of the ‘second tier’ circled values are tested.

Values list

Dare to Lead, page 188

I listened to this book twice before I received my hard copy from Amazon.  I could. not. Wait!  In anticipation of doing the exercise, I thought the whittling process would take a long time—that I would agonize over it.  But as I skimmed the pages approaching the list, in a cosmic flash, I realized my two: Honesty and Integrity.  It was one of those ‘you just know’ moments, but I had to check in.  Really?  Was I sure?  How did I know?  How could I prove it?  I turned the page and scrutinized every word, comparing it in importance to these two.  Accountability?  Yes, but not as much.  Equality.  Fairness.  Gratitude.  Learning.  Openness, Optimism, Stewardship, and Wholeheartedness:  all important, but not nearly so much as Honesty and Integrity.  I was done.  As surely as I felt self-actualized in seventh grade, I am sure these are my core values.  A few days later, I was describing this moment to another thoughtful and astute friend.  She mulled for a moment and said, “Yes, I agree, I see these as your core values, too.”  Wow, I cannot think of a higher compliment.

Today when I told Donna, her first response was, “Honesty and Integrity… What is the distinction between the two?”  What a great question!  I had a vague, intuitive idea, but had never taken the time to think it through.  As happens so easily when I’m with Donna, and as a person who talks to think, the answer poured forth after only a few seconds.  I used a real life example:

Let’s say my friend asks me, “Does this dress make me look fat?”

Honesty compels me to answer truthfully.  Yes.  Honesty keeps me from lying.  That is outside of my core values, no can do.

Integrity helps me choose my words.  This dress does not flatter your figure the way a different style would.  We are here to choose the dress that makes you look positively stunning and we will not leave until our mission is accomplished!  Integrity frames my response in line with all of my other, ‘second tier’ values: kindness, diplomacy, empathy, love, loyalty, and all the rest.

Thus, Honesty tells me what I cannot do.  It gives me constraints and standards.  Honesty is the guardrail, the floor for my code of conduct.  Integrity then tells me what I can and must do.  It defines the realm of possibility, meaning, and purpose—the Why, How, and What.  How can I be the best friend, mom, doctor, wife, speaker, and leader?  It is the accelerator and steering mechanism that keep me in the lane of who I am.  Or, Honesty is the launch pad; Integrity creates the universe of potential.  I swear I got goosebumps.

Phrases that recur often in my speech and writing are “walk the talk” and “lead by example.”  I always ask myself if I exemplify these, and they are the yardsticks by which I measure all those who lead me.  One cannot do either without Honesty and Integrity at work all of the time.  Brené Brown calls integrity “living into our values rather than just professing them.”  Hallelujah.  I feel the most at home, confident, and grounded when I know I’m living deeply in my Honesty and Integrity.  When I’m outside of these, I feel viscerally uneasy.  I cannot tolerate it, or I can only with great suppressive efforts to manage the dissonance.  I lose sleep; I get irritable and restless.

Practicing Honesty and Integrity is not always easy, though.  Facing the ugly and disappointing truths about myself and my dysfunctional patterns, and then holding myself to a higher standard of conduct—internal benchmarks of behavior and relationship—these aspirations create stress and tension on multiple levels of consciousness.

In the end, though, I know that as long as I hold these two values in front, they will light my right path.  I know I will make mistakes.  There will be times when my behavior absolutely does not exemplify these values.  I wanted to write a blog post right after my A-ha! moment reading the book.  But I was afraid someone would recall a time they witnessed the opposite of these values in my actions, and call me out on it.  But I’m not afraid anymore.  I’m not perfect.  And I’m striving every day.  That’s good enough, because it is my best.  Honest—I swear on my Integrity.

 

 

Recentering—Vaccine post #3

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NaBloPoMo 2018:  What I’m Learning

When you buy a red car suddenly you notice so many red cars on the road.  I write two posts on vaccines, and now I see all these vaccine posts on my Facebook feed. One made me sad for multiple reasons.

Dr. Jennifer Chuang , a pediatrician who ran for the state legislature in New Jersey, posted this:

In 2017, I was moved to run for office in the NJ State legislature because of bills being introduced that were harmful to public health. Among the areas that I stood firm on were the importance and safety of vaccinations, and I was harshly attacked for that, even threatened.
However, NJ should not be proud of introducing the most pieces of legislation that would have made our children at risk for vaccine preventable illnesses. The current measles outbreak in New Jersey has now grown to 18 cases. Legislative decisions have consequences, especially to public health.

“From 2011 to 2017, New Jersey lawmakers introduced the most pieces of legislation that would make it easier for children to skip vaccines, according to a new study by Drexel University researchers.”

She linked to this article, detailing the anti-vaccine legislative history in New Jersey and lawmakers’ rationale, compared to the scientific literature.

I’m sad that there is such a fight against proven public health initiatives, and I’m sad that legislative bodies, who write our health and medical policies, include remarkably few clinicians.  But I’m most sad at the meanness in the fights.

A woman immediately commented, “Shut up already” on Dr. Chuang’s page.  When challenged benignly by others, she replied telling them to fuck off and calling them assholes.  Her page is apparently public, so I visited.  The posts that I could see were vehemently opposed to vaccines of all kinds, at least in 2016 and 2017.  She apparently lost a son this year, in his 24th year of life.  She has posted about eating healthy, self-care, and seeing intelligence as ‘not because you think you know everything without questioning, but rather because you question everything you think you know.”  So while I feel acutely put off and dismissive of her vile reaction to Dr. Chuang’s post, I also imagine that she and I may have things in common and might even be friends, if circumstances facilitated.

Somehow I came across another woman’s page tonight, similarly militantly anti-vaccine.  She and the first woman both posted a lot of memes and sayings implying that people who advocate for vaccines are brainwashed and ignorant, and not worthy of engagement.  Huh.  Sounds to me just like many of the ad hominems hurled by vaccine advocates against women like them.  It’s exhausting.  Who does it help, this mutual shit-flinging?  In Rising Strong, Brené Brown points out the pitfalls of false dichotomies and binary decision trees.  If you hear people shouting that you have to choose one side or another, that it’s all or nothing, be suspicious.  Look for the beneficiaries of that feud.  Often it’s the politicians who leverage our warring tendencies to stay in office.  Or maybe it’s physicians who, when they refuse to care for patients who decline vaccines, can feel decisively self-righteous rather than uncomfortably ambivalent.  Or maybe it’s the anti-vaccine parent, who feels embarrassed to express fear and uncertainty (because she has been shamed too many times for questioning a sanctimonious medical community), and so finds her voice in combative rage instead.  And could it be that anytime one of us shows up in attack mode, we incite our counterpart to take a mirroring stance, even if that was not their original intent (this is a rhetorical question)?

Regardless, I’m tired.  Social media and loud, mean, public debate are not venues that yield any meaningful interactions (I see the irony of my writing this on a blog).  It feels too slow, but experience teaches me that we win hearts and minds face to face, quietly, intimately.  Nothing good ever comes from a collision of two oncoming bullet trains.  It’s wildly destructive more than anything else.

Thankfully, my good friend posted Max Ehrmann’s poem “Desiderata” tonight.  I first read, transcribed, and posted this poem on my wall in high school, and have not seen it in a couple decades.  It really captures the essence of inner peace and right relationship, with self, humanity, and the earth, and it soothes me.  It’s a late Thursday night of another long week.  I leave you with Mr. Ehrmann’s master work below.  Good night.

Desiderata

Go placidly amid the noise and haste,
and remember what peace there may be in silence.
As far as possible without surrender
be on good terms with all persons.
Speak your truth quietly and clearly;
and listen to others,
even the dull and the ignorant;
they too have their story.

Avoid loud and aggressive persons,
they are vexations to the spirit.
If you compare yourself with others,
you may become vain and bitter;
for always there will be greater and lesser persons than yourself.
Enjoy your achievements as well as your plans.

Keep interested in your own career, however humble;
it is a real possession in the changing fortunes of time.
Exercise caution in your business affairs;
for the world is full of trickery.
But let this not blind you to what virtue there is;
many persons strive for high ideals;
and everywhere life is full of heroism.

Be yourself.
Especially, do not feign affection.
Neither be cynical about love;
for in the face of all aridity and disenchantment
it is as perennial as the grass.

Take kindly the counsel of the years,
gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.
Beyond a wholesome discipline,
be gentle with yourself.

You are a child of the universe,
no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you,
no doubt the universe is unfolding as it should.

Therefore be at peace with God,
whatever you conceive Him to be,
and whatever your labors and aspirations,
in the noisy confusion of life keep peace with your soul.

With all its sham, drudgery, and broken dreams,
it is still a beautiful world.
Be cheerful.
Strive to be happy.

Max Ehrmann, Desiderata, Copyright 1952.

 

Talking to the Opposed About Vaccines

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NaBloPoMo 2018: What I’m Learning

Go figure, I’m having conversations about flu and vaccines every day right now.  Today I described my post from yesterday to a new friend.  He stands firmly in the ‘vaccines are good’ camp.  His sister, however, does not.  Her son has autism.  After hearing about my post, he asked me what I would say to her, if she told me she would not vaccinate her child ever again.  It was a great opportunity to think and practice, and I’m grateful that he asked.  I had already thought earlier today about writing a separate post on communication around vaccines.  So here goes!

First I would tell her that I understand why she would not want to vaccinate, if she blames vaccines for her son’s autism.  I don’t know any kids with autism, but I have friends whose kids are autistic, and I see how stressful and exhausting it can be.  As a mom of kids with anaphylactic food allergies, I also know the feeling of absolute guilt for being the one who gave my kids the things that made them sick.  If I were a mom whose kid was diagnosed with autism after receiving vaccines that I consented to, and I were convinced that the latter caused the former, I would definitely want to protect my kid from anything else that might hurt him, especially anything that I have control over.

Some additional background:  We are a lot better at recognizing and diagnosing autism spectrum conditions now than a few decades ago.  That diagnosis is commonly made in the toddler years, also around the time kids have received a boatload of vaccines.  So it’s easy to see a correlation, but causation cannot be proven.  One could argue that it also cannot be totally disproven, but given the number of children who receive all of their vaccines and the very small proportion of them all who go on to be diagnosed, the evidence definitely leans away from vaccines causing autism.  That is little comfort for a family and a child affected with the disorder, who may always wonder.  As humans, we naturally look to assign blame; vaccines are an easy target.  And why on earth would we repeat actions that have previously caused us trauma, real or perceived?

This year I read an article about a mom of three.   She had vaccinated her two elder children as per guidelines.  After her third was born, however, she started to read lay literature online stoking fear of vaccines.  She had no negative experiences herself, but started to wonder, what was really the best thing to do for her family?  She decided to stop vaccinating when her son was 6 months old.  At 18 months, he got pertussis, or whooping cough.  He almost died.  She posted videos of him coughing and turning blue, captioned with a heartfelt mea culpa, urging other parents to vaccinate:

“This is whooping cough,” she wrote. “This is Brody. An 18-month-old boy. Our third child. Our first son.

“This is a mother that sees ‘anti-vaxx’ all over social media and becomes terrified. Unsure whether or not to give vaccines (even though she did for both of her girls). Terrified to ‘pump her baby with poison’ … so she stops vaccinating after six months.”

“This is pure hell. This is guilt. Guilt of putting not only my son at risk, but my community too …This is embarrassment.”

She wanted to impress the fact that she’s not “bashing” the anti-vaxx community – or blaming or judging anyone.

“The decisions I made were MY decisions. Based purely on my lack of knowledge and fear,” she said.

“This is to show the consequences of not vaccinating my child correctly.”

I wonder about her conversations with her son’s doctors.  Did they try to shame her into vaccinating when she initially expressed a desire to stop?  If so, could this have just made her more resistant?  It could easily look something like a conversation that I would bet happened all over our country today:

Doctor:  Have you gotten your flu vaccine yet?

Patient: I don’t do flu vaccine.

Doctor: Seriously?  Why not?  It’s perfectly safe, you know, and tens of thousands of people die every year from flu.  If you don’t get vaccinated, you could pass it on to everybody you know.  Aren’t your parents elderly?  Don’t your kids have asthma?  You’re putting them at risk for serious illness or death, you know that, right?  And you don’t get flu from the vaccine, that is a total myth.  (Insert list of facts and evidence for benefits of flu vaccine here.)  Really, you should get it (suppressing eye roll).

Patient:  No, no thanks.  Can I go now?

I see and hear my colleagues complain all the time about vaccine-resistant patients.  When they are particularly tired or moody, they can get judgmental and even a little mean.  I understand.  It’s frustrating to watch people we care about making choices we think are against their best interests, especially when it also puts the community at risk.  I fear for my kids if their classmates are not vaccinated—both of my kids have asthma that’s triggered by respiratory infections.  Even if our whole family is vaccinated, they are still exposed to hundreds of snotty, sneezy, coughing faces every day at school.  Flu season is essentially six months long, most of it when we are all stuck inside basically slobbering all over one another.  High. Risk.

But does it really help for me to come at my patients with my ‘advice’ before I understand the origins of their decisions?  What are my assumptions about them when I do that?  Some patients claim science as the basis of their refusal; others admit that it’s totally irrational.  Regardless, how can I best conduct myself?  Here is my current approach:

Cheng: Do you do flu vaccine?

Patient: No, not really.

Cheng: Can we talk about that?

Patient: Do we have to?

Cheng: I would really appreciate it.  I won’t try to pressure you, I just want to understand your rationale.

Patient:  Gives their reasoning.  If it’s like my friend’s sister above, or I otherwise understand that they are resolute in opposition, I thank them for sharing, shift to strategies for illness and transmission prevention (see yesterday’s post), and ask permission to talk again next season.  This happens in a minority of cases, actually.  Most often they say something like, “Well, I just don’t really think about it, I feel like I don’t need it, I think it’s strange that it’s recommended every year, it doesn’t really seem to work from what I hear, and what’s the big deal about flu, anyway? …Do you really think I should get it?”

Cheng: Yes, I really recommend it.  Can I tell you why?

Patient: Okay, sure.

This is when I go through all the evidence that I reviewed yesterday and the rationale above.  If I know something meaningful to them that relates, I make sure to highlight the connection.  At the end I make sure to reiterate that they are free to vaccinate or not; I am honestly unwedded to a particular decision. I invite them to consider and let me know, or just show up to a pharmacy clinic if they decide to get it.  Most people are appreciative of the time spent; many say they learn something they did not previously know.  We end the conversation at least with no hard feelings, and often with positive ones (at least on my end).

It occurred to me this morning, what is my primary objective when I conduct these conversations this way, coming alongside my patients rather than coming at them?  Initially I thought it was to keep people healthy, to prevent death, serious illness, and suffering.  But now I think my primary objective is actually to cultivate our relationship.  I usually have this conversation with new patients, because if I know them already then I know their vaccine patterns and I don’t have to ask, “Do you do flu vaccine?”  If they refused last year I can simply start with, “Can we please talk about flu again?”  When we are new to each other, the way I present sets the tone for our relationship and has an outsize impact on patients’ receptivity to my advice.  The flu vaccine conversation is a prime opportunity to prove that I can listen to, empathize with, respect, and honor their values and autonomy.

On the contrary, when I come at them, bent on convincing them to vaccinate now, what is my primary objective?  Thinking of other times I present this way, if I’m being honest, I’m just trying to prove I’m right and win an argument.  I don’t think that approach has ever really helped anybody.

 

 

What Doesn’t Kill Me

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NaBloPoMo 2018:  What I’m Learning

What does your doctor tell you about flu vaccine?  What about shingles vaccine?  Antibiotics?  This week I have had a series of both unifying and gratifying conversations around these topics.  I thank my patients for sharing their opinions and questions, which stimulate and sharpen my thoughts and expressions, all in service of making us healthier.

People have a lot of reasons for declining flu vaccine.  It’s usually something around not believing it does any good (it does), feeling they don’t need it and are not at risk for serious illness or death (we all are), and a general aversion to ‘putting something in my body that isn’t natural.’   Most people who decline flu vaccine still accept tetanus/diphtheria/pertussis, hepatitis, meningitis, or other vaccines.  I find this interesting.  The rationale behind all vaccines is the same—saving lives and minimizing serious illness and complications, especially for vulnerable populations like babies, the elderly, and people with immune-compromising conditions (pregnancy, cancer, diabetes, autoimmune disorders).  We are contagious before we feel sick—this is the natural genius of viral survival and spread.  So this flu season, cover your face with your arm when you sneeze, wash or sanitize your hands after every encounter with any surface, and don’t share drinks or utensils with anybody.

Shingles is interesting.  You cannot get shingles unless you have had chicken pox or the chicken pox (varicella zoster) vaccine (though shingles after vaccination is rare).  After the acute illness (and sometimes after vaccination), the virus does not go away.  Like other herpes viruses, it lives in your body permanently and reactivates under certain conditions.  In my experience the most common trigger for shingles (zoster) is stress, either physical (eg sleep deprivation) or mental and/or emotional—often both.  The virus resides in the spinal cord and reactivates usually along a single nerve root, hence the typical pattern of a band of blisters on one side of the body.  For someone who has not had chicken pox or the vaccine, infection occurs through contact with respiratory droplets from someone with either chicken pox or shingles illness.

Here is my best analogy for how vaccines work:

Think of your immune system as law enforcement or a military operation.  Its job is to hunt down offending agents, apprehend them, subdue them, and kill them, if possible.  All such operatives need training to be effective.  Vaccines are like battle simulators.  We deploy them into circulation and trigger a drill response from immune system troops, making mobilization for the real, live attack more efficient and successful.  In the case of flu, offenders are shapeshifters, constantly changing their outward appearance to evade capture.  So simulators must be updated annually to prepare the troops in kind.

For shingles, think of varicella zoster virus (VZV) as the prisoner, your spinal cord as the prison, and your immune system as the prison guards.  Usually VZV breaks and enters when we are young, when our guards are also young, fit, and agile.  Over the years, our guards age.  With age comes sluggishness, memory loss.  The prisoner, however, remains as virulent as ever.  So it looks to escape through one window or another—maybe a left thoracic nerve root this time, a right lumbar next.  Shingles vaccine takes our dad-bod prison guards back to boot camp and reminds them what the enemy looks and acts like, so they may better thwart any escape attempts.  The new shingles vaccine, Shingrix, is recommended at age 50.

So, vaccines are basic training for our immune system soldiers.  I’ve never been anywhere near the military (God bless all of you who serve, and does residency count for something?).  For those who have, do you agree that there may have been times during training when you questioned your likelihood of survival?  And when you did survive, did you not emerge stronger and more confident for the experience?  What doesn’t kill me…

It’s the same for bacteria exposed to antibiotics.  There is no question, we use antibiotics too much.  Now think of bacteria as a horde of enemy invaders.  Our immune military wages war with these throngs at every orifice and mucus membrane of our bodies every day.  Every time we take antibiotics, however, it’s like coming over the battlefield with an imprecise explosive device aimed at the bad bacteria, but that also can cause collateral damage (eg friendly fire on our good gut bugs).  The problem with antibiotic overuse (and, in theory, shortened or incomplete courses of antibiotics) is that the bacteria who were already equipped to survive the blast now make up the majority of the surviving invasion party who can procreate.  They will pass on these survival traits to their progeny, and voila, antibiotic resistance.  The next time you have a respiratory infection, do not automatically assume you need antibiotics.  Talk to and/or see your doctor.  If it’s an uncomplicated viral illness, ask what else you can do to suffer less while your troops battle this transient, non-lethal invader.  Support them by hydrating, sleeping, eating healthy, and avoiding caffeine and alcohol.  Support yourself by medicating for the symptoms.  You’ got this.

What does not kill me makes me stronger.

It works both ways.

Things We Take for Granted

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NaBloPoMo 2018:  What I’m Learning

When I’m sick the sinus congestion often resists the efficacy of all medication.  I lie awake at night mouth breathing, almost choking every time I have to swallow my own secretions.  Those are the times I really appreciate when I’m well.  The past year, even though I am mostly recovered from knee surgery, I’m still always aware of my one-sided non-normalcy.  When I do my single leg exercises, it’s staggering how I can just do it on the right, and on the left I honestly struggle, as if I could never do some of these things before.  This morning, driving the kids to school and then myself to work navigating slush, sleet, poor visibility, and the inevitably slower traffic, I was grateful that I could simply push the ‘SNOW’ button on my center console and suddenly I had a 4-wheel drive.  You can actually feel the incremental increase in stability and traction—amazing!  Thank you, my engineer friends and family!

Last night was the first real snow of the season in Chicago.  Part of me still hates living here—I absolutely abhor the weather.  But today I found myself grateful more than annoyed.  My kids are old enough to get themselves out of bed, dress, groom, and feed themselves.  We all leave together, and though that morning time in the car can be groggy and silent, it’s still time together.  I drive a car I really like to a job I really love, where I work with a team of generous, funny, kind, and collaborative people.  I have this really warm Land’s End parka with the big, foofy faux fur hood, and I can walk from the parking garage to the office in total comfort on most cold days.

I have job security, health insurance, a great house (with reliable heat and running water, a home gym, and plenty of space for us all to both spread out and gather together), more books than I can read (right now), two healthy parents, a boatload of amazing friends, a universe of information at my fingertips, digital connections with people all over the planet whenever I want, and a phone that takes and sends pictures, for crying out loud.  I don’t have a formal gratitude practice right now, but holy cow, this is a lot to be thankful for.

Not sure what makes me think of the things we take for granted:  Our health, the people in our lives, our homes, our livelihoods.  Think of the thousands of people devastated by wildfires all over the west this year.  In the blink of an eye, imagine all your possessions and the physical spaces of so many cherished memories—all memories themselves.  Imagine your sister, daughter, son, nephew, best friend–missing.  When did you last see them, talk to them?  What transpired between you?  Imagine going about your life, assuming you can handle flu if you get it, then an hour later feeling like you’ve been hit by a truck, then dying of flu a week later.

I’m not trying to be dark or macabre here.  I’m just noticing how much I have, and how much I don’t truly appreciate it most of the time.  I try to be present to the kids as much as possible, engage fully when they talk to me (and fail more than I want to admit).  I really notice their smiles and laughter.  I look through my Facebook feed for pictures of friends and their kids.  I stop to admire flower buds every day in the spring, and bugs on the sidewalk.  I have gotten better at seeing the trees turn gradually green in May and golden in October.  I see pictures of the kids as toddlers and it feels like a hundred years ago and just yesterday, all at the same time.  And don’t even get me started on photos from high school, college, and med school—OMG we were kids!

Another day tomorrow.  Who knows what will happen, how my life could be turned upside down or inside out?  Or not?  Will it feel mundane or miraculous?  I’m learning—reminded, really—that most days, I get to decide.  That’s pretty groovy, I say.

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.

8-31 triad update

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??