Whether we like it or not, we are now in a time of transition. This pandemic likely affects your work. For example, many more psychiatrists and other clinicians are taking up telemedicine, a technology that promises to change psychiatric practice forever. Also, some mental health clinicians are busier than ever, while others have fewer patient encounters and as a result, reduced income. For our patients, change, when it occurs, is even more likely to be negative. For everyone, there are new risks and losses, and they will continue to be with us for an extended time. Even when we go “back” to “normal”, that normal may be a 10% smaller economy. But that 10% represents an economic depression, with many more people unemployed, underemployed, and with lower pay. As Emile Durkheim, the French sociologist, noted in his 1897 study of suicide, suicide increases during times of economic hardship. This relationship has been noted many times throughout the 20th and 21st centuries, including the 2007-2008 great recession.

My goal today is not to dwell in the negative – although acknowledging it is crucial – but rather on considering the path forward, both for ourselves and for our patients. One thing I’ve learned as a psychiatrist and as an informal business coach is that change is hard for many and often abandoned. It is scary and unwelcome. There are many good reasons for this reserve towards change, but when change comes uninvited, it presents its own demands and will not be denied. Today I focus on one unwelcome aspect of change: the inescapability of confronting one’s ignorance and incompetence. Just giving voice to this fact can bring some relief.

When you attempt to learn something new, to acquire new knowledge or skill, you are engaging in an activity you don’t have the knowledge or skill for doing well. So, inevitably, you begin from a position of ignorance and incompetence. From this position, you will make rookie mistakes, waste time, misunderstand guiding concepts, and develop skills that do not align with what actual performance requires.

Also, you will be challenged, overwhelmed, and doubt your ability to accomplish the project at hand and, more broadly, any new project. You will feel the emotional weight of ignorance and incompetence, and because of your ignorance and incompetence, you will not know the way forward. Of course, in hindsight, it will be easy to look back to see the path you took, including all your missteps and dead ends. But we don’t have the benefit of hindsight until afterwards. We can make the most of foresight, but at its best, it is limited.

You likely will feel alone and, in front of others, feel embarrassed. You will wish to give up, and you may give up. Your giving up will be either temporary or permanent. If permanent, you will never fully know whether your giving up was the right thing to do. If you succeed at an alternative project that brings you remuneration and purpose, then it will be easier to decide that the giving up of your original project was acceptable. But you will never know for certain because you only live a single life, and your life is filled with paths not taken and paths taken but abandoned. Since these paths were never fully actualized, you’ll never know how they would have turned out if they had been taken. Thus, you – all of us – always live with a gnawing uncertainty and perhaps regret about what might have been.

So, although regret is unavoidable for people who exercise free choice from available options, most people end up having a greater sense of regret over activities that were desired and not taken rather than activities that were taken and that turned out poorly. Thus, regret is usually associated with having been too passive, not exploring and experimenting enough, not taking enough risk, and specifically not risking failure and embarrassment that arises from the unavoidable ignorance and incompetence that comes from trying something new.

To borrow Winston Churchill’s aphorism that “democracy is the worst form of government except for all the others,” so “leaning into ignorance and incompetence is the worst way to live, except for all the others.” Or, my other way of putting it is “you have to suck first, to be able to stop sucking.”

Thanks and take care.

Dr. Jack


“A ship is safe in harbor, but that’s not what ships are for.” ― John A. Shedd

“A bend in the road is not the end of the road…Unless you fail to make the turn.”― Helen Keller

“Far better it is to dare mighty things, to win glorious triumphs, even though checkered by failure, than to take rank with those poor spirits who neither enjoy much nor suffer much, because they live in the gray twilight that knows neither victory nor defeat.” ― Theodore Roosevelt

“Would you tell me, please, which way I ought to go from here?” 

“That depends a good deal on where you want to get to.”
“I don’t much care where –”
“Then it doesn’t matter which way you go.” ― Lewis Carroll, Alice in Wonderland

“I know not all that may be coming, but be it what it will, I’ll go to it laughing.” ― Herman Melville, Moby Dick