How Do We Get Better?

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It is Week 5 of sheltering in place for many of us.  How are you feeling?  What emotions occur most often?  To where and on whom are they directed?  How do you see the future, and what does that feel like?

Who do we want to be on the other side if this crisis?

For all our sakes, I hope we can be more patient, kind, empathic, open-minded, thoughtful, intentional, and connected.  The COVID-19 pandemic shows us what ultimate paradox really means—trauma and grief on a scale not seen in generations, as well as an opportunity for unprecedented growth, both as individuals and as a society.

I think about the risks and possibilities as both a clinician and citizen.  The experiences overlap, as do the strategies to mitigate suffering.  I am so grateful that physician burnout and well-being has already been addressed in so many institutions, and at so many levels, before this crisis hit.  Programs like physician peer support and Balint Groups show us that our leadership cares for our well-being, or at least recognizes the need for organizational support of it.  Employee Assistance Programs and the like are much more visible now, and hopefully barriers to access are also down.  Everywhere I see offers for formal organizational support and ‘wellness.’

But what will really make the difference in the end?  How will we really grow into our best selves through this, the greatest global challenge of most of our lives so far?

I think it will be in our small, day to day, apparently mundane interactions.

Too often we underestimate the impact of our milieu on our attitudes, thoughts, words, and actions—how we are impacted by our environment, and how we impact it in return.

A wise friend observed two groups of people responding to COVID-19.  One sees the pandemic in terms of ‘what’s happening to me.’  The other experiences it as ‘what’s happening to all of us.’  This is a falsely dichotomous oversimplification, obviously.  But it may be instructive to notice one day this week, if we were to categorize our own thinking/feeling/speaking/acting with regard to COVID, where would we land more of the time?

I’m reminded of the stages of tribal culture described by David Logan and colleagues in their book, Tribal Leadership, and presented eloquently in his TED talk.  I have discussed this idea in previous posts.

The visual above encapsulates Logan et al’s theory of tribal culture.  Their work aims to advance groups from lower to higher levels of culture and performance.  In this framework, the currency of cultural economy is language.  Each tribe member’s dominant cultural stage mindset emanates in their words, and is represented/encapsulated in each stage’s mantra above.

Those who experience COVID-19 as ‘what’s happening to me’ likely live in the lower three stages most of the time—self-absorbed, competing, uninterested in personal or societal connection and growth.  Those able to see how ‘this is happening to us all’ have made the shift toward an Outward Mindset, seeing their node selves as inextricable members of a larger, interconnected system.  For a system to function well, grow, and sustain itself best through crisis after crisis, it must achieve a collective “We’re great” or “Life is Great” mindset.

Whom do you know on your team, among your friends, or in your family, who lives these words (most of the time)?  How do you feel when you’re around them?  What do you hear them saying right now? What energy do they exude?  When I meet people like this in my life, I feel calm, soothed.  They remind me to be humble, and to remember what I can do to help, both myself and others.  I feel connected in their presence; I recall my strengths and potential for contribution, and I’m motivated to act accordingly.  They give me hope.

So what do I hear them saying, what language do they speak that elevates our communal culture?

First, they avoid ad hominem.  They refrain not just from political rhetoric and attacks; they don’t make generalizations about groups based on race, gender, geography, social class, etc.  They also withhold judgment—they entertain various stories about people’s motivation, circumstances, and values, rather than jumping to oversimplified conclusions based on their own biases.

Second, they empathize.  They strive to relate to each person they’re with, as well ‘the others’.  And if they can’t do that, they validate the others’ feelings.  “That’s so hard,” can be the most soothing words a person can hear when they’re struggling and suffering. And “Well, we don’t know what they’re living,” reminds me to be humble.

Third, they offer hope.  But it’s not false hope or superficial, Pollyannish positivity.  They honestly believe in and see the light at the end of the tunnel, and they point to it for our benefit.  They do this by asking, “What do you need?”  “How can I help?” and saying simply, “I’m here.”

When I come across people like this, I want to be around them more.  I want to emulate them.  I point out their words and actions to others, and show the positive movement they inspire in me and others.  Stage 4 and 5 tribal leaders lead by example.  And make no mistake, they are everywhere.  They often don’t have a title or any designated authority.  But the team/organization/family is always better for their presence.

If you have people like this on your team, consider:  how can you be more like them?  What do they inspire in you?  If you are this person, how can you bring people along in this mindset?  This is how we get better through our current crisis:  We find the leaders who speak the language of We, Together, Growth, and Hope.  We find and follow those who set the example, and we strive to set it ourselves.  We take advantage of the programs and support systems around us.  We get help, get better, and then turn around and help others.

Yes, there is much trauma and grief.  There is also boundless love and connection.  We find the latter easily when we look, and it sustains us.  We can absorb that energy, join that movement, and make a difference in every encounter with our fellow humans.  We can absolutely be better.

 

Synthesis and Integration: Self and Other Focus

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Hey friends, how was your week?  Learn anything new and interesting?  Anneal any new ideas to existing frameworks in your already complex world view?  I did!  And it came in another big wave after my presentation on Friday.

I wrote last week about how I put together a new presentation.  For the first time, I added the idea of medicine as a complex adaptive system to a talk I gave to physicians at various levels of training and practice.  The objective of the presentation was for people to understand the scope of physician burnout, and leave with some ideas of how they could not only cope better themselves today, but also influence the system and move it toward a healthier, more compassionate state in the future.

As usual for my talks, I focused first on personal resilience.  Many physicians push back at this idea, and rightly so, as many medical organizations have instituted physician wellness programs aimed mainly at ‘fixing’ the doctors with yoga and meditation classes, while allowing the system that burns them out to continue its toxic trends toward over-regulation, loss of physician autonomy, and driving metrics that lie outside of, or even counter to, our core values.  I worried that my talk would be taken as just another attempt to tell physicians we aren’t good enough at self-care.

Thankfully, the feedback so far has been positive and I have not heard anyone say they felt berated or shamed.  I hope it’s because in addition to tips for self-care (eg 7 minute workout, picnic plate method of eating), I talked about how each of us can actually help change the system.  In a complex system, each individual (a ‘node’) is connected to each other individual, directly or indirectly.  So, difficult as it may be to see in medicine, everything I do affects all others, and everything each other does affects me.  This means I can be a victim and an agent at the same time, and the more I choose one or the other (when I am able to choose), I actively, if unintentionally, contribute to the self-organizing system moving in one direction or another [URL credit for image below pending].

Nodes in Complex System

My primary objective in every presentation is to inspire each member of my audience to claim their agency.  Before that can happen we must recognize that we have any agency to begin with, then shore up our resources to exercise it (self-care and relationships), and then decide where, when, and how that agency is best directed.

 

In 5 years of PowerPoint iterations, including and excluding certain concepts, I have always incorporated David Logan’s framework of stages of tribal culture.  Basically there are 5 stages, 1-3 being low functioning, and 4-5 high functioning.  The tribal mantras for the first three stages are, respectively, “Live sucks,” “My life sucks,” and “I’m great”.  Stage four tribes say, “We’re great” and in stage 5 we say, “Life’s great.”  The gap between stages 3 and 4 is wide, as evidenced by the traffic jam of people and tribes at the third stage.  In my view, the difference is mindset.  In the first three stages, most individuals’ implicit focus is on self, and subconscious mindset centers around scarcity and competition.  Victims abound in these cultures, as we focus on recognition, advancement, and getting ours.  We cross the chasm when we are able to step back and recognize how our mutual connections and how we cultivate them make us better—together—we see the network surrounding and tied to our lone-node-selves.

This week I realized that crossing the stage 3-to-4 chasm relates to two frameworks I learned recently:

The way I see it, in Logan’s tribal culture structure, one initially works toward self-actualization, essentially achieving it when fully inhabiting stage 3, “I’m great.”  But crossing to stage 4 requires self-transcendence, as described by Abraham Maslow, by recognizing a greater purpose for one’s existence than simply advancing self-interest.  In the same way, through stage 3 we live in what the Arbinger Institute describes as an ‘inward mindset,’ and we cross to stage 4 when we acquire an ‘outward mindset’, which is pretty much what it sounds like.  Essentially in stage 3 we mostly say, “I’m great, and I’m surrounded by idiots,” and in stages 4 and 5 the prevailing sentiment resembles, “We’re great, life’s great, and I’m so happy to be here, grateful for the opportunity to contribute.”

An astute colleague pointed out during my talk on Friday that we do not live strictly in one stage or mindset in serial fashion.  Depending on circumstances, context, and yes, state of mind and body (hence the importance of self-care!), we move freely and maybe often between stages, sometimes in the very same conversation!  The goals are to 1) look for role models to lead us to higher functioning stages more of the time, and 2) model for others around us to climb the tribal culture mountain with us, spending more and more mindset and energy at higher and higher stages.

The problem is the system, and we are the system.  So, onward.  Progress moves slowly and inevitably.  It will take time, energy, and collective effort.

We’ got this.

Shoots in the Poop

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It’s December 4th… Time to look back?  Honestly, I’d rather just get this year over with and move on,  because I have already been looking back all this time.  Since January I have counted—weeks and months since the knee injury, months since starting the new job, since surgery, since a spring crisis, since the last this or the first that.  What was it all for?  I think I was just reminding myself that there’s been a lot going on, reassuring myself that I’m not just whining, not being weak for letting my personal health habits slip.

I’ve felt like a relative slug for the last 6 months, despite my best efforts.  I think I must have eaten a pint of ice cream every two days for most of the spring and early summer.  Looking back on the calendar, I stopped using smiley stickers to mark workouts around July—their intensity was only worth hand-drawn smileys.  By and since August they aren’t worth smileys at all—I just jot down what I did in shorthand.  Some weeks it was barely anything.   I judge myself every day—perhaps less harshly than I might have a few years ago, and also less compassionately than I might a few more years from now.  I still struggle with the fear of self-indulgence if I allow myself too much self-compassion.  I am still learning self-compassion.  I know it takes time to rewire our limbic brain patterns with knew learnings from our cognitive brains.  So I will keep trying, because I know it’s helping.  And I’m modeling for the kids.  We can do our best and still fail.  The key is to keep moving.  We can practice admitting we need help, seek it from the appropriate sources, lean on it heavily, and stand back up eventually.  And then we remember those who helped us, and prepare to be helpful in return.

I have leaned on so many this year, I feel almost speechless at the outpouring of support and love.  The only way I don’t collapse from this weight of gratitude is by storing it like a battery—ready to be discharged, full power, when someone needs to plug into me.  This may be my favorite thing about humanity—that we are wired to connect so tightly, to help one another in webs of mutual love and kindness that can extend ad infinitum.

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So I’ll look back a little.  This week I feel a turning.  Did I say this already recently?  Oh yes, it was November 12.  I was making more room for books, trying to stay off of my phone, off of Facebook.  Being on the laptop every night to post to the blog stymied that last part, but it also bought awareness of how I find loopholes in the best plans for self-discipline.  And the daily writing practice also contributed loads to this internal revolution.  This was my fourth year doing NaBloPoMo.  It was by far the most fun, the smoothest, and the most rewarding attempt yet (I think I also said this last year?), and now I miss writing every day (definitely have not said this before).  Maybe it was the daily dopamine hit of views and likes.  But I think it’s more than that.  Through the daily discipline, I had a chance to process and synthesize so many ideas and connections that had been marinating for months, maybe even years.  I practiced prioritizing, selecting, and distilling those ideas into about 1000 words each day, more for my own benefit than anyone else’s.  That people read and related to them was definitely a happy bonus.

Besides NBPM, I attribute this turnaround to two books that Donna recommended to me earlier this fall:  Leadership and Self-Deception and The Anatomy of Peace, both by The Arbinger Institute.  I have wanted to write about them for the last several weeks, but I haven’t yet figured out how to prioritize, select, and distill the lessons coherently.  The foundational ideas are not necessarily new, but they are profound.  The books are written as modern allegories, and there is just something about the metaphors and analogies that has unlocked and integrated everything I have learned about inner work, communication, relationships, and leadership to date.  And that is saying a lot.  Because of these books, the daily writing, and all the conversations I’m having (with myself and with others) as a result of both, the two most challenging relationships in my life right now have fundamentally improved—mostly because I have been able to shift my own attitude.  As with all things, this new ‘way of being’ will take practice.  I need to keep the training wheels on for a while yet.  But now that I have made this turn, the path looks straight, and I see light.

The manure has piled on all year.  So much fertilizer, oh my gosh.  It’s done its job, though, because I have definitely grown.  I feel strong, healthy shoots of green popping out through the thick, dark carpet of poop.