Scene 1: I’m working on my lectures for the Suicide Course. I’m reviewing responses from a survey that I took at last year’s MasterPsych Conference. I asked participants to rate their level of work-related stress. Results are below.

I had also asked what their stress was associated with. Results are below.

Scene 2: I take a break from my lecture writing and review recent emails I’ve received. I come upon one from a reader that says, “Jack, thanks for offering this free suicide course. I’m always impressed how you make things happen… It seems like you just go and do the things you want to do.”

The juxtaposition of these two scenes, occurring minutes apart, struck me. I’m certainly glad to know that someone I know thinks well of me. It’s certainly better to be well-thought of rather than thought poorly of.

But I wouldn’t be writing about this if there wasn’t more to it than that. What struck me was this doctor’s being impressed with my “doing what I want” contrasted to the large proportion of stressed psychiatrists, so many of whom feel beset by uncertainty and function with a sense of lack of control. Notice that one in five endorsed being so stressed that they’re ready to quit their job, and 84% of respondents experiencing at least moderate stress.

So, I thought, perhaps if I share my belief system or mindset, I can help at least a few of the psychiatrists who feel so stressed – and stuck – into beginning to make some positive changes in their lives. Here are some of my thoughts.

Change Is a Habit … And a Skill

A person need not be born a risk-taking, thrill-seeking daredevil in order to become comfortable with and good at making life changes. I believe that the more you engage in change the easier it becomes. It’s like working a muscle – your change muscle. Here are some ways this occurs:

  • As you make changes, you begin to experience the benefits of change and thereby increase your willingness to engage in more change.
  • You proceed through the change process and realize you survived it; nothing horrible occurred as a result and, often, some benefit accrued. You become comfortable taking on bigger changes.
  • As you initiate and implement changes in your life you develop skills. Quite simply, you get better at it. You begin to notice the pitfalls – that you avoid in the future – and the effective interventions – which you further refine and make greater use of.

You might notice that becoming more comfortable with, and successful at, making changes is based on well-established CBT techniques. The three bullets above correspond to 1) behavioral activation that leads to reinforcing outcomes, 2) exposure that leads to desensitization to the discomfort that change can provoke, and 3) skill acquisition.

So, no, you can be meek as a mouse AND become an awesome change artist.

I myself was quite change-averse for most of my life. For example, when at age 40 I started my psychiatry oral board review course, I lost 15 lbs in the two and a half months preceding it. I was so anxious I couldn’t eat. I would wake up every morning as dawn was breaking with a distinct thought in my head, “Who the hell do you think you are holding this course?!” I was particularly agitated by the thought that the psychiatrists who signed up had to actually get on airplanes to come to the course. That I had my fellow psychiatrists take such a big and definitive step to attend felt like the height of hubris. The only reason I went ahead with that first course is because I thought it would be more damaging to the chances of those first 12 participants to pass their board exam if I canceled than if I proceeded.

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After that first course, I went on to hold about 100 more of those oral board courses from 2002 until now. (Our very last one for Child and Adolescent Psychiatrists is taking place in the fall. I expect about 5 participants, the same as attended the last oral board course for the adult boards last year.) With each course I became slightly less anxious but by no means NOT anxious. Many times the evening before a course, I had to go jogging – and I don’t like jogging at all – to help dissipate my anxiety.

And so it goes.

Start Small

Many entrepreneurs, such as myself, are actually risk averse. We don’t bet the store on some new product or services. Rather we start out small, taking a series of incremental steps. If our product-in-development doesn’t take off, we have time to adjust it or kill it, and move on to another initiative.

I advise the same when making personal changes. I don’t recommend telling the boss the shove it, selling your house and, moving to Madagascar.

For most people, making a small meaningful change is best. Try it, learn from it, take a deep breath, and take the next small step.

I had a great little book I bought many years ago – I misplaced it so at the moment I can’t share the name with you. The author writes that change often triggers anxiety; it awakens your amygdalae. He recommends making changes so small they get in under the amygdalar “radar.” One example he gives is of a woman, suffering from obesity and the medical consequences that often accompany it, whose doctor nagged her to change her diet and to exercise. She didn’t do any of it although she agreed with her doctor it was the right thing to do. She finally got some traction when the doctor told her to tear up her health club membership and just stand up and walk in place during commercial breaks as she watched TV. That was her first successful step in a series of steps that led to her eventual loss of weight and improved health.

Meaningful Change

If you’re embarking on a process of change, it helps if you know what it is you want. This sounds obvious, but most people, our patients and we too, often may not be fully clear what it is we are striving for.

I’ve written about the “5 Why?” approach. If you start with the desire to “not work so hard,” for example, ask yourself “Why?” After each response, ask yourself “Why?” four more times. Only then might you come upon your real motivation and desired outcome. Try it. It may blow your mind!

I’ll stop here. Please share with me of your struggles with change, your failures and successes. I’d love to share your thoughts with the other 2000 psychiatrists who regularly read these articles. I am happy to give you your byline or keep it anonymous. Your call.

Until next time,

Dr. Jack


Today’s Quotes

A quote about the game “Go” that was recently won for the first time by a computer running a program called AlphaGo.

Perhaps what’s even more important is that Go is a fixed game: The rules, possible moves and observable information about the game are all prespecified. AlphaGo is not allowed to invent a new move, nor gain new insight by quizzing its opponent. Fortunately the real world is not like this. From the Hubble telescope to vaccinations, people constantly invent new ideas that allow us to transform how we monitor and shape the universe and achieve previously unimaginable outcomes.

A hallmark of human intelligence is our ability to redefine the game and think out of the box, and this remains a significant frontier for artificial intelligence.
– Emma Brunskill, assistant computer science professor, and affiliate in the machine learning department, at Carnegie Mellon University. Quoted from the New York Times, March 9, 2016