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Book Review-Helping the Suicidal Person: Tips and Techniques for Professionals

Robert Bogue February 13, 2023 No Comments

They want to help; they just don’t know what to do.  It’s a tragic fact that most psychology and sociology programs don’t have a single class regarding suicide in their entire academic career.  So therapists and social workers encounter a suicidal person and they feel – as they are – completely unprepared for what to do next.  Helping the Suicidal Person: Tips and Techniques for Professionals is a way of addressing the gap in knowledge –and coming to a better place of nurturing and support to help people move away from suicide as the only option.

Note: Throughout this post, I’ll be using “client” as shorthand so as not to distract from the readability.  I don’t intend to imply that everyone with whom you’ll encounter is a client, nor that you can’t use these techniques if you’re not a therapist.

Research Power

While the tips are research-informed, they are often offered with limited support in research.  There’s a simple reason for this.  The research is hard to come by.  Sometimes, research can show a reduction in attempted suicides but not in completed ones.  In fact, to show a 15% difference in suicide rates (with an appropriate confidence interval), researchers would need to enroll 13 million people.  That’s a relatively impossible challenge.  As a result, we have to accept the research that we do have and attempt to make the best of it.

Sometimes, the problem isn’t scale.  Sometimes, the problem is the ethics of the situation.  Consider that there is no randomly-controlled trial about the use of parachutes reducing death when jumping from an airplane.  Obviously, they work.  So obviously that no one would subject someone to the control condition of death to demonstrate that people without parachutes jumping from planes die.

This is a case where even though there is no research supporting the efficacy of the approach, it doesn’t mean the approach isn’t (or can’t be) effective.  It just means that the research hasn’t been done for a myriad of reasons, including time, money, and ethics.

Disclosure of Suicidal Thoughts

In some ways, it’s as if clinicians are practicing “Don’t Ask, Don’t Tell” as an approach toward suicide prevention.  Many clinicians don’t ask – and, particularly, don’t ask directly – if someone is considering suicide.  There was a historic concern that this might “plant” the idea of suicide in the client’s mind, but research has proved this to be incorrect.  Even without this defense, it’s still a hard thing for most clinicians to ask, so it’s frequently swept aside and forgotten about.

On the other side, the probability that a client will volunteer their thoughts of suicide are very low.  Despite somewhere between 1:5 to 1:6 people having thought about death by suicide, it’s unlikely that they’ll bring it up.  Instead, they’re more likely to believe that if the therapist doesn’t ask them, it’s not important – secretly knowing that it is.

The Loaded Question

Some questions cause people to become defensive, because they’re not sure how the person asking the question will respond.  The underlying challenge is that the question is related to something you think is – or may be – related just to you.  The Kinsey Institute found that asking the question “How old were you when you first started masturbating?” got a much better response than “Do you masturbate?”  Embedded inside the first question is the assumption that it’s something everyone does, and therefore the question of “when” isn’t particularly disturbing.  Of course, the small percentage of people who don’t – or won’t admit it – will respond that they can’t answer the question.  In working with people who are thinking about suicide, questions like “What are some of the ways that you’ve thought about killing yourself?” gets better answers than “Have you thought of ways to kill yourself?”  The presumption embedded into the question makes a difference to the way that people respond.

Similarly, you can intentionally stay ahead of where the person is likely to be by asking the question leading to an overly extreme – but not absurd – level.  For instance, you could ask “Do you think of killing yourself 20 times a day?”  The answer may be 15 – but the person will start by telling you “not that much” and giving you an answer that’s more likely to be accurate. 

Fear of Commitment

One of the barriers that clinicians must overcome is the client’s fear that if they say the word “suicide” or admit to suicidal thoughts, they’ll be involuntarily committed.  Involuntary commitment is a sometimes necessary but always troubling challenge.  People who are involuntarily committed experience a loss of freedom and control that can further exacerbate their reasons for wanting to die and simultaneously can destroy and therapeutic alliance and trust that might have been created.  (See The Heart and Soul of Change for more about the importance of therapeutic alliance.)

One of the challenges is that the client’s goals and the professional’s goals may be different.  The professional wants the person to stay alive, and the client wants the pain to stop.  As a result, there can be a gap through which clients become concerned about how their therapist will react.  They’ve likely heard stories about an involuntary hold – and they don’t want to experience it themselves.

Neither Lecture nor Pep Talk

Motivational Interviewing calls it the “righting reflex.”  It’s the tendency to directly correct a person’s perspective by telling them how they’re wrong – and it’s powerful.  It was Carl Rogers who insisted that client was the expert – in their lives.  We may, from a few minutes of conversation and some notes provided by others, believe their pain is manageable and their problems are all solvable, but from their perspective, they’re not.  Until they believe you truly understand, they won’t listen to suggestions; even after they believe you understand, they’ll not listen unless you tread gently by asking careful, somewhat leading, questions.

Lectures about how someone’s behavior, feelings, or perspective isn’t right has never worked – even when you were a child.  It induces guilt, shame, and invalidation, which further pushes them away.  It also causes them to become more entrenched in their positions.  They start looking for ways to defend their position and they find them.  They ultimately have invested more in their perspective and become less likely to change it.  (See Influence for more on these effects.)

Pep talks don’t work because they’re hollow.  Letting people experience joy and happiness is a good strategy to fight depression that seeks to convince them they can’t find joy or happiness.  However, these must be experiences they want.  One useful technique that I’ve used is to intentionally set a positive event out several weeks out so that anticipation can build.  The actual amount of time that you set the event in the future is dependent upon the client, but the point is to build an idea in the future.  Do be prepared that depression will try to convince them they won’t have fun.  The response is “Didn’t you have fun in the past?”

Rank and File

One strategy for assessing the importance of various reasons for dying is to ask the client to list them, and then rank them in order of importance.  This has a focusing effect that allows you to focus your energies on the most important items.  Sometimes, it’s possible to carefully walk them through strategies that break down the barriers preventing them from overcoming their reasons for dying.

For instance, if they’re struggling because they can’t find a job, you can work with them on ideas to get a job.  Care must be exercised here, because you’re likely going to move quicker than the client. You’ve seen these problems and solutions before and so you know the landscape and you’re likely to rush ahead. However, helping people work through problems is directly addressing the problem-solving challenge and cognitive constriction that seems to be found with most suicidal people.  It’s worth the time.

Reasons for Living

It’s an awkward conversation to ask people why they want to be alive.  It’s awkward when suicide isn’t a consideration and can be even more awkward when it is.  Often, you’ll need to start with the reasons why people want to die before getting to their reasons for living.  It’s important to recognize that people who are struggling with thoughts of wanting to die may have trouble enumerating their reasons for living.

You may need to prompt them to explain who would miss them when they’re gone or what they do to support others.  You might suggest they go through their recent calls and texts and make a list of those people who would miss them or their support.

They Can Move On

A somewhat typical response to reasons for dying may be that so their loved ones can “move on with their lives.”  This is the quintessential comment of burdensomeness.  (See Myths About Suicide for more on burdensomeness and its relationship to suicide.)  In many cases, however, the others that the client believes will “move on with their lives” are the recipient of the pain that the client is trying to displace.  Suicide and Its Aftermath says it plainly.  Suicide transfers the pain from the person who dies to those who survive.

Certainly, there are some situations where a person’s health is such that they are, in some sense, a burden to others.  However, one of the things that all people tend to misunderstand is that burdensomeness should be measured by the person who is (perceivably) burdened.  It’s possible that the other person doesn’t perceive it as a burden and may even believe it’s an opportunity to replay the kindness and support they’ve received.  Encouraging a more realistic perspective of the degree of burden is a good idea.

No Warning Sign Is Particularly Meaningful

One of the problems that exists in suicidology is that we believe things that aren’t true.  Thomas Joiner wrote a whole book about Myths About Suicide.  Craig Bryan in Rethinking Suicide challenges us to realize that the screening tools that we use don’t work.  Some still insist that most (or all) people who die by suicide sent warning signs.  Joiner addressed this directly and Bryan indirectly, but the myth persists.

The simple fact of the matter is that we have no way of knowing who will die by suicide or not.  We know statistics and probabilities – but not people.  There are lists of warning signs that cause concern, but it takes judgement to decide who is at the most risk of immediate harm to themselves and who isn’t.  It’s recommended that clinicians record the reasons for their assessments in their notes so, if there is any question in the future, there’s a record of why they assessed the risk the way that they did.

All that to say that while there are key indicators – like directly stating that they want to die – none of those indicators in isolation is a direct prediction of short-term risk.  It’s only by looking at all the factors in the situation that someone could assess risk.

The Tips and Techniques

The listing of tips and techniques are:

  1. Reflect on Your Biases about Suicide
  2. Take Stock of Your Experiences with Suicide (or Lack Thereof)
  3. Confront “Suicide Anxiety”
  4. Be Alert to Negative Feelings Toward the Suicidal Person
  5. Reject the Savior Role
  6. Maintain Hope
  7. Face Your Fears
  8. Directly Ask about Suicidal Thoughts
  9. Turn to Techniques for Eliciting Sensitive Information
  10. Embrace a Narrative Approach: “Suicidal Storytelling”
  11. Ask about Suicidal Imagery, Too
  12. Uncover Fears of Hospitalization and Other Obstacles to Disclosure
  13. Recognize that, for Some People, You are an Enemy
  14. Avoid Coercion and Control Whenever Possible
  15. Resist the Urge to Persuade or Offer Advice
  16. Understand the Person’s Reasons for Dying
  17. Validate the Wish to Die
  18. Acknowledge that Suicide is an Option
  19. Gather Remaining Essentials about Suicidal Thoughts and Behavior
  20. Learn about Prior Suicidal Crises: The CASE Approach
  21. Cautiously Use Standardized Questionnaires
  22. Privilege Warning Signs Over Risk Factors
  23. Screen for Access to Firearms
  24. Inquire about Internet Use
  25. Probe for Homicidal Ideation
  26. Collect Information from Family, Professionals, and Others
  27. Examine Reasons for Living
  28. Identify Other Protective Factors
  29. Pay Attention to Culture
  30. Investigate Religious and Spiritual Views of Suicide
  31. Solicit the Person’s Own Assessment of Suicide Risk
  32. Estimate Acute Risk for Suicide
  33. Estimate Chronic Risk for Suicide
  34. Document Generously
  35. Know When and Why to Pursue Hospitalization
  36. Know When and Why Not to Pursue Hospitalization
  37. Do Not Use a No-Suicide Contract
  38. Collaboratively Develop a Safety Plan
  39. Encourage Delay
  40. Problem-Solve Around Access to Firearms
  41. Discuss Access to Other Means for Suicide, Too
  42. In Case of Terminal Illness, Proceed Differently (Perhaps)
  43. Seek Consultation
  44. Make Suicidality the Focus
  45. As Needed, Increase Frequency of Contact
  46. Treat Chronic Suicidality Differently
  47. Involve Loved Ones
  48. Suggest a Physical Exam
  49. Recommend an Evaluation for Medication
  50. Continue to Monitor Suicidal Ideation
  51. After Safety, Address Suffering
  52. Look for Unmet Needs
  53. Target Social Isolation
  54. Use Grounding Exercises
  55. Assume Nothing: Does the Person Want to Give Up Suicide?
  56. Tap into Ambivalence
  57. Compare Reasons for Living and Dying
  58. Invite the Person to Look for the “Catch”
  59. Search for Exceptions
  60. Frame Suicide as a Problem-Solving Behavior
  61. Help Brainstorm an “Options List”
  62. Teach the Problem-Solving Method
  63. Nourish Future Plans and Goals
  64. Incorporate a Hope Kit
  65. Highlight Strengths
  66. Connect Suicidal Thoughts to Other Thinking
  67. Educate about Cognitive Distortions
  68. Help Challenge Negative Thoughts
  69. Elicit Coping Statements
  70. Rescript Suicidal Imagery
  71. Discourage Thought Suppression
  72. Foster Acceptance of Suicidal Thoughts
  73. Enhance Coping Skills
  74. Cultivate Mindfulness
  75. “Broaden and Build” Positive Emotions
  76. Pair Behavioral Activation with Values
  77. Differentiate Between Suicidal and Non-Suicidal Self-Injury
  78. Determine the Person’s Reaction to Having Survived
  79. Conduct a Chain Analysis
  80. Evaluate Where the Safety Plan Fell Short
  81. Take Advantage of the “Teachable Moment”
  82. Attend to the Therapeutic Relationship
  83. Address the Trauma of the Suicide Attempt
  84. Explore Shame and Stigma
  85. Warn about the Possibility of Relapse
  86. Review Lessons Learned
  87. Complete a Relapse Prevention Protocol
  88. Propose a Letter to the Suicidal Self
  89. Follow Up

Maybe it’s time for you to learn the tips and techniques that you can use to start Helping the Suicidal Person.

Small Group Safety Rules – Before, During, and After

Robert Bogue February 7, 2023 No Comments

There are many cases where groups can be powerful tools for healing.  Whether these groups are in a religious context, a mental-health recovery context, or simply a community context, they need to remain psychologically safe for everyone.  This guide is designed to address what should be done before you meet, while you meet, and after you meet to ensure the psychological safety of everyone involved.

Before

Before anyone gets together, they need to understand what the rules will be and what is expected of them.  Setting expectations prevents people from arriving at an event unprepared for the rules of the event.  Here are some suggestions for rules that every group should have:

  1. Confidentiality – Except as expressed in the organization of our group or explicitly agreed to by the participants of the group, everything shared in the group will remain in the group. No one will disclose what was discussed except through the rules the group has agreed to.
  2. Privacy – If you are participating virtually, we ask that you take steps to ensure that the others in the group will not be heard to protect their rights to control who hears what they’re sharing.
  3. Safety – This group will respect both the physical safety and the psychological safety of every individual. No overtly threatening physical activities or verbal attacks will be tolerated.
  4. Power Dynamics – In every group, there are a set of power dynamics that are unavoidable. Our goal is to minimize them so that everyone feels free to share.
  5. Inclusivity – Everyone will be given the opportunity to speak and share. We will not dismiss or interrupt others when they’re sharing.
  6. Focus – Everyone in the group is present for a reason. We ask that you remove distractions that may prevent you from fully participating, including silencing phones and removing other potential distractions.
  7. Curiosity – Stay curious about what the other person is sharing, including their values and the perspectives that led to their beliefs.
  8. Judgement Free – This group will remain judgement free. Everyone is entitled to their own values and experiences.  We don’t have to agree with them.  Our goal is to understand them.

Further, for groups that are intended to create space for hurting individuals to share, it’s recommended that you add:

  1. No Commentary – Participants should not directly address other participants’ comments unless specifically requested and approved by the person who’s being responded to. Even positive comments may be interpreted negatively or reinforce the perception that they’re being judged.

In addition to the rules, it’s recommended that participants receive invitations to the behaviors that are desired.  Some desired behaviors are:

  1. Titles – Please introduce yourself without unnecessary titles, certifications, and credentials. Consistent with our stance on power dynamics, we don’t want to imply that anyone else’s perspective is less valuable.
  2. Preferred Pronouns – We encourage you to signal to other participants your preferred pronouns, if you desire. It’s expected that others will honor your preferences, though they may forget or stumble.  If other participants don’t use your preferred pronouns, we suggest that you model the pronouns you would like to have used.

These invitations and rules help participants prepare for their experience with the group.  However, in some cases, there may need to be a broader understanding of why the group is gathering and the expectations of behavior.  An introductory statement can set the tone for the gathering even when the tone can’t be translated into specific, defined behaviors.  For example, an introduction might look like:

We’re looking forward to everyone joining us for this event.  Our goal is to create a safe and inviting space for everyone to feel heard and listened to.  We expect to demonstrate our caring and compassion for one another.  To do that, we’ve established a set of expected ground rules, which are:

During

When the group meets, there are two big goals.  First is setting the tone for the group, and second is maintaining the integrity of the group.

Setting the Tone

The process of setting the tone has two parts.  First, participants should be reminded that they’ve seen the rules governing the meeting, and that their presence is a tacit agreement to those rules.  They’re further reminded of critical rules in summary.  For instance, a tone-setting statement might look something like:

You’ve all received the set of rules that we’ll be following here, and by your presence here, we accept that you agree to abide by them.  As stated, confidentiality about what we discuss here is paramount, and we remind you that what is said here will only be shared in the ways that we’ve all explicitly agreed to.

Second, the first person to share should model the behavior that’s expected from the group.  The facilitator or convener should call on someone to start the conversation who can demonstrate the expected approach.  This can be someone with whom the facilitator has prior conversation or someone who has experience with the group process and knows what behavior should be modeled.

Maintaining Integrity

Facilitators should be on the constant lookout for boundary-pushing or boundary-crossing of the rules that are established for the group.  Boundary pushing is when a participant makes a comment that’s inside the rules – but just barely.  It’s important for facilitators address participants who are intentionally or unintentionally boundary-pushing, because not every participant will see these as boundary-pushing – some will interpret the response as a boundary-crossing.  Boundary crossings refer to those cases when someone feels as if the rules of the group have been violated.

In all cases, the facilitator should start with gentle shaping remarks designed to steer the participant(s) back inside the boundaries for the group.  If this isn’t effective, the facilitator should directly remind the participant(s) of the rules that were agreed to.  In extreme cases, it may become necessary to provide a single warning that further boundary crossings will result in expulsion from the group.  Finally, if a warning is given, and the participant breaches the boundary again, they should be expelled immediately.

In our experience, almost never does the situation require the warning – and in decades of experience, we have only seen someone expelled from a group once.  While these are exceedingly rare events, everyone should believe that these measures can and will be enacted if necessary.

After

After the event, the need to protect the safety of the group isn’t over.  A follow up message should be sent, which includes a reminder of rules that persist beyond the meeting and is a summary (without details) of what was experienced.

Typically, the rule that is most necessary for post-meeting is confidentiality.  The communication should indicate whom information is authorized to be disclosed to – including restrictions on those not in the group – and, if appropriate, when disclosures will be made.  In some cases, the group will have agreed to share notes with those beyond the group.  In cases like this, it’s ideal to provide the notes to the members and invite them to review the notes for a short period of time prior to being shared more broadly using the terms and conditions previously agreed to.

In cases where no disclosure is authorized, the follow-up message should state this and provide a generic appreciation and summary of the event.  For instance:

Thank you for your participation.  We feel that it was enriching experience for everyone and hope that you feel the same way.  As you know, none of us will be sharing the details of what was discussed during the meeting, but we’re deeply appreciative of the stories and perspectives shared during our time together.  We respect the vulnerability and courage everyone displayed in creating the space of learning and caring.

Book Review-The Burnout Challenge: Managing People’s Relationships with Their Jobs

Robert Bogue February 6, 2023 No Comments

“Reheated in a microwave oven” is the best way to describe The Burnout Challenge: Managing People’s Relationships with Their Jobs.  It’s a rehash of Maslach and Leiter’s previous book, The Truth About Burnout.  I disagreed with their approach in 2018 when I read it, which was originally released in 2000.  I had hoped that their update would address the problems with the previous edition – and in some ways, it did.  However, it also doubled down on some of the problems of the previous work.  I’ll start with the criticisms and then move to finding some value in the work.

I do need to acknowledge that, because we’ve written a book, Extinguish Burnout, and have the corresponding website, we’ve got a competing interest of sorts.  Also, Maslach attempted to discredit an article that we wrote about the origins of burnout as a construct – for which we were able to quote page and paragraph from Freudenberger’s original work, Burn-Out.  In so much as it is possible, I’ve tried to not allow this to color this review of the book; but at some level, I’m sure it’s unavoidable.

In most situations when I read a book that I so strongly disagree with, I simply don’t write a review.  It’s not worth the effort just to dissuade people from reading the book – however, due to the degree to which the book leads people astray and the positive bias that people might have towards reading it because of Maslach’s name, I felt that it was important that I post this review.  My hope is that I can illuminate common misconceptions and pitfalls that exist in the burnout space as well as to clarify some of the difficult parts to understand.

Connecting the Research

My biggest disappointment is that the revision didn’t connect to the research that has been done since the previous work.  There weren’t internal research citations for burnout work; instead, there were vague references to “research supports” – which isn’t satisfying if you want to see what was really said.  Often, what people say research results mean aren’t what they do mean or are even in conflict with the research author’s own interpretation of the results.

It also didn’t connect to work outside of the direct burnout space.  Instead, in many cases, the statements in the book contradicted what research in adjacent areas has shown.  Let me provide some clear examples:

  • Stress – Some of the best work on stress comes from Why Zebras Don’t Get Ulcers. (I wrote three posts to review it.)  It explains how stress functions and how it’s a short-term/long-term balance that results in long-term inefficacy, but this is totally missed.  Also missed is the work that Lazarus covers in Emotion and Adaptation and Barrett’s work in How Emotions Are Made about the importance of the person’s interpretation.  These would have, of course, undermined the premise of the book.  If we acknowledge the way people respond to stressors in the environment, we can’t completely blame the environment.  Of course, the work on behavior being a function of both person and environment goes all the way back to Lewin’s early work.  (See A Dynamic Theory of Personality for more.)
  • Psychological Safety – In the space of creating psychological safety, Amy Edmondson’s book, The Fearless Organization, is the landmark. Edmondson and her work on creating psychologically safe workplaces doesn’t get a mention – even though the argument is that workplaces are the problem and that improving safety is at least part of the answer.
  • Incompetent Leadership – In numerous places, the book blames incompetent leadership despite having never defined what leadership is in the first place. Of course, many have tried to address this topic, including Burns in Leadership and Rost in Leadership for the Twenty-First Century.  The book further sidesteps the skills that would make leadership competent – like those described in The Leadership Machine.  Ignored was the work indicating that every layer of organizational hierarchies will struggle with the others, as explained in Seeing Systems.  It’s easy to blame the leadership when they’re in the “them” group.
  • Intrinsic Motivation – The idea of people’s motivations coming from themselves gets a single reference. Deci’s work in Why We Do What We Do received only cursory attention despite being an important mediating factor to the need for direct organizational/structural motivation.  Daniel Pink’s extension to this work in Drive was similarly ignored.
  • Teams – While The Burnout Challenge addresses the need for collaboration, there’s no mention of Hackman’s work (e.g., Collaborative Intelligence), Hansen’s work (e.g., Collaboration), or works like Group Genius that would operationalize the concept of collaboration.
  • One View of Organizations – The Burnout Challenge views organizations as machines, but that’s only one way to conceptualize them. Also ignored was the work in Images of Organization, which describes how our views of organizations can help us – and hurt us – in understanding and changing them.  Other works, like Reinventing Organizations, use the mechanical lens to show how the motivations of organizations and their operation can be different.  This allows greater clarity about the kinds of structures that seem to lead to better employee engagement – and therefore less burnout.  (Research demonstrates that engagement and burnout are largely overlapping concepts.)

The Errors

In addition to the omissions, there are some direct errors in the work.  For instance:

  • Equating Moral Injury and Compassion Fatigue – The former is the result of asking someone to do something that violates their moral/ethical standards, and the latter is the result of prolonged exposure to others’ negative emotions. Frameworks would have exposed this.  Jonathan Haidt in The Righteous Mind covers the foundations of morality – and the conflicts that can and do arise.  Likewise, teaching how to manage moral injury would be useful, as Kidder does in How Good People Make Tough Choices.  In Moral Disengagement, Bandura explains how systems are structured to disable our morality – which could address or mitigate moral injury.  (Admittedly, this is probably a bad thing.)
  • Extensive Research on Burnout – Here, the problem is they assert that the research supports the three-component model of burnout that Maslach uses – exhaustion, cynicism, and inefficacy. While there is research that supports this formulation, it’s also what people were looking for, so the results can be explained by many reasons.  As we learned with the Hawthorne effect, things aren’t always as they seem.  (See Management and the Worker.)  Second, the statements ignore the research that refutes not only the construction that Maslach uses but also that burnout is a separate concept from depression.  I do believe there are nuances that separate burnout from depression – but they’re very small.

There are, of course, other errors, but fundamental errors like these are harder to excuse.

Understanding the Criteria

As stated above, Maslach has proposed there are three categories that should be used as the defining characteristics of burnout: exhaustion, cynicism, and inefficacy.  However, it’s relatively simple to deconstruct this and realize why the formulation isn’t right.  (There are research articles that point to limitations as well, but a simple logical progression will be quicker.)  We’ve all been exhausted without being in burnout.  Cynicism is what happens when we don’t feel effective any longer – thus leaving us only with inefficacy at the core.

Understanding the relationship between these factors at a deeper level requires an understanding of systems.  Donella Meadows in Thinking in Systems explains the basic stocks and flows that drive all the work around systems.  In short, we have a reserve of willpower that we consume when we feel ineffective.  (See Baumeister’s excellent work, Willpower, for more on willpower.)  When that willpower is exhausted, we feel hopeless.  The work of Seligman and others on hopelessness indicates that hope is a powerful force.  (See The Hope Circuit.)  This hopelessness – our feelings of permanent inefficacy — triggers cynicism.

However, there are other dynamics at play.  Willpower is a consumable resource but one that recovers.  So, we oscillate between hopelessness and the resulting cynicism, and feeling as if there may be hope – and we don’t need to be cynical.  The exhaustion component of the equation has its cyclical nature, too.  Some of this is rejuvenated when we sleep, even if we’re less tired and more exhausted – feeling like we have no energy.  The Burnout Challenge is quick to point out that burnout requires being sustained – and exhausted requires that as well.  However, the dynamics of cyclical progression are ignored.

The challenge is teasing out the causal nature of one of the components to the other and the relationships of these cycles.  To my knowledge, no one has been able to show these relationships.  I am, however, aware that screening high for burnout often leads to screening high for depression.

The Match

Another major consideration is the match between the employer and the employee.  While the match itself isn’t explained, there are many dimensions on which one could base the degree of relatedness.  Before we get to that, imagine a “surfer dude” in swim trunks, with a long-board at his side, on a southern California beach where the waves are “righteous.”  Also consider the immaculate professional in a custom three piece suit, expensive shoes, an expensive briefcase, and a watch that costs more than some people’s homes walking into the board room of a financial services firm in London.  Both are precisely fitted for the environments that I described.  Reverse the scenarios, and they’re incredibly out of place.  That’s the match problem.

It doesn’t mean that the circumstances or the people are wrong.  It means that the match is wrong.  One of the challenges in The Burnout Challenge is that, though the framing is that there’s a bad fit, the book returns to the good vs. bad dichotomy, which isn’t real.  It speaks of six factors (explained shortly) that are about how the employers aren’t being good to their employees – regardless of the match.

It’s described as a match, when the reality is that it hides a negative view of employers, including both management and leadership.

The Six

The six mismatches are as follows:

  • Work Overload – Here, the focus is on overworked workers who can’t keep up with the demands being placed on them. See the section on measuring performance below for more on this topic.
  • Lack of Control – This is the autonomy that a person has to influence the work they do. (See Compelled to Control for why I hesitate to use the word “control” here.)  This is where Deci’s work on intrinsic motivation is briefly raised.
  • Insufficient Rewards – Here, the word “rewards” is used as a proxy for both direct rewards and recognition. (For tips on this, check out 365 Ways to Motivate and Reward Your Employees with Little or No Money.)
  • Breakdown of Community – Community is the relationships with supervisors, peers, and the broader organization. See the section, “Social Capital,” for more.
  • Absence of Fairness – The perception (or lack thereof) that decisions are made fairly – that is, impartially. See the section, “Equitable,” for more.
  • Values Conflicts – When things that the individual finds important aren’t important to the organization, burnout is likely to arise, because they see no progress on the things that are important to them.

Measuring Performance

Let’s take a quick look at retail performance.  It’s measured in inventory turns – that is, how fast merchandise is sold on average from the shelves.  Here’s the official numbers from a retailer that we all know:

  • 1994 – 3.45
  • 1995 – 3.75 (8.7%)
  • 1996 – 3.66 (-2.4%/6.1%)
  • 1997 – 3.85 (5.2%/2.7%)
  • 1998 – 3.98 (3.4%/8.7%)
  • 1999 – 4.01 (0.8%/4.2%)
  • 2000 – 4.22 (5.2%/6.0%)
  • 2001 – 4.75 (12.6%/18.5%)
  • 2002 – 4.56 (-4.0%/8.1%)

The first number is inventory turns, the second number is improvement, the third number is the two-year improvement.  Any guess at the retailer?  If you think that it’s Walmart, you’d be wrong.  It’s the competitor that Walmart crushed: K-Mart.  Home of the blue-light special improved its performance – but not enough.  Walmart’s performance for the same period was:

  • 1994 – 5.14
  • 1995 – 4.88 (-5.1%)
  • 1996 – 5.16 (5.7%/0.4%)
  • 1997 – 5.67 (9.9%/16.2%)
  • 1998 – 6.37 (12.4%/23.5%)
  • 1999 – 6.91 (8.5%/21.9%)
  • 2000 – 7.29 (5.5%/14.4%)
  • 2001 – 7.79 (6.9%/12.7%)
  • 2002 – 8.08 (3.7%/10.8%)

It wasn’t that K-Mart wasn’t improving – they were.  Just not fast enough.  The question of performance is always relative to some reference point, and in this case, the point of comparison is the competitor.  K-Mart simply couldn’t keep up with these numbers.

In the context of burnout, we have two forces working on us.  First is the force of the external expectations of the organization, and the second are our own expectations.  The external expectations can be out of sync with reality.  For all of the negatives of Fredrick Taylor’s Scientific Management, it did have the benefit of being able to identify standards and norms for individual activities – and thus set reasonable expectations.

The unfortunate reality of today is that most organizations have no idea what a normal level of performance should be for many of the tasks performed.  They simply accept the results that their current employees are achieving.  When employees are replaced, this can lead to massive disconnects, as the previous person may have had the temperament and skills that made them perform the task substantially better than average – or substantially poorer.  When working with external expectations, it’s important to evaluate what they’re based on – and why those results may need to be adjusted.  Dan Ariely explains in Predictably Irrational that we often fail to correct our initial assumptions sufficiently.

Internal expectations are often more challenging.  They’re based on a desire for maximization (see The Paradox of Choice), perfectionism (see Multipliers), or simply previous conditions that no longer apply.  They may be expectations that were once external by parents, coaches, or others that have become internalized and now feel like truth.  When we’re facing internal expectations, we often need to find ways to develop better acceptance of ourselves.  (see No Bad Parts and How to Be an Adult in Relationships for more on acceptance.)  That isn’t to say that we shouldn’t maintain a desire to get better.  Carol Dweck in Mindset explains how a growth mindset allows for growth while acknowledging the current conditions, and Anders Ericsson and Robert Pool in Peak explain how to take that to excellence.

It’s important to note that, clearly, internal expectations aren’t the responsibility of the organization; they’re something that each of us bring to the organizations we join.

Social Capital

Robert Putnam’s work in Bowling Alone is a classic as it relates to the concept of social capital – that is, our ability to get things done because of our relationships.  In his follow up book, Our Kids, Putnam explains how this social capital impacts our children.  In the organization, most HR professionals know that people join organizations, but they leave managers – and sometimes the group dysfunction that managers allow to continue.

As humans, we need relationships: to be expelled from our communities was a death sentence.  We need to depend on others to share the work and make the load lighter.  (See Healthy Dependency in Relationships for more.)  In the context of work, relationships are with our manager and our peers.  If they’re good, they’re a shield that will stop us from considering other offers or leaving when we’re upset.  If these key relationships aren’t right, then nothing will be right.

For the most part, these relationships can’t be directly controlled because of the variation in perspectives, experiences, and values, but there is one way that organizations can ensure they get better outcomes.  That is to insist on accountability.  (See The Four Disciplines of Execution for more.)  That’s no guarantee that there will be good relationships, but it makes it more likely.

Equitable

We need to understand why fairness is so important.  To do that, we can look at a game that economists use.  It involves two people and $10.  The first person picks the split between the two people, and the second person decides if either of them get the money.  From an economic point of view, any split between them should cause the second person to accept the deal, because they’re better off for it.  (See Drive, Choosing Civility, The Marketing of Evil, and Positive Psychotherapy for coverage of the ultimatum game – it’s very popular.)  However, the economist view isn’t the one that happens.  When the balance between the two gets shifted away from the second person by about 60-40 or 70-30, they start saying no.  By 80-20, it’s even more profound.  But why?

It appears that our evolution has necessarily involved the addition of anti-cheating responses.  Richard Dawkins in The Selfish Gene proposed that genes were exclusively selfish.  However, Robert Axelrod in The Evolution of Cooperation showed how collaboration could be adaptively evolved.  Jonathan Haidt in The Righteous Mind expressed a similar sentiment – with much less math.  The evolution of cooperation requires a way to identify cheaters and punish them.  Thus, when we detect people trying to cheat us – to not be fair – we have a natural reaction to try to punish the cheater.  That means we have to detect the problem, and some of that relies on the way we view the situation.

At first, it appears as if equitable and equal should be the same.  If two people receive the same amount, then it should be equitable.  Fair enough.  However, what happens when the amount is a percentage increase?  Someone making $1,000,000 getting a 10% increase gets an extra $100,000 while the person making $50,000 gets an extra $5,000.  Is that equitable?  Maybe, but maybe not.  It depends on your framing.

If you’re focused on the amount, then it appears unfair – even more unfair than in the ultimatum game.  If you are focused on the percentage, you recognize it as “fair” because it’s equal.  So, here, there’s an important message for organizations: make sure that what you’re doing appears as fair as you intend it to be.  The Righteous Mind considers fairness (and not cheating) a foundation of morality, and certainly this rings true.  It’s foundational to the way all people view things.  There are competing possibilities for the ultimate moral decision, but largely we all believe we should be fair.  Being effective at maintaining employee engagement (and thus avoiding burnout) includes emphasizing the ways in which the decisions are fair.

Collaborate Within, Complete with Outside

Morten Hansen in Collaboration makes the point the most clearly.  You must keep competition on the outside and collaboration inside.  He’s not alone: Group Genius, The Culture Puzzle, Bowling Alone, Collaborative Intelligence, and even The Hidden Brain express the same sentiment.  Competition inside of groups is bad.  However, the question becomes how large is the collaborative vs. competitive group?  For the most part, organizations have abandoned the review approach of stacked ranking, where members of a group are sorted from best to worst, and typically the worst are let go.  Clearly, this was bad, because it set up inherent competition in the group.  However, what about different divisions in the same organization?  Steve Balmer’s reign at Microsoft was filled with inter-group conflicts, which may have been part of the reason why the stock price was flat for such a long time.

The Burnout Challenge equates this competitive group aspect with a culture of fear.  In the context of losing a competition, that’s fair – however, it’s in many ways too broad a characterization of the safety (or fear) that someone feels at an organization.  This is just one aspect of the story.  If the organization utilizes competition internally, but even the losing group retains their jobs and gets other interesting assignments, it’s possible and probable that they’ll feel safe.

Self-Employed

One curious condition arises when one thinks that it’s the leadership’s fault that you’re burned out.  What happens if you’re self-employed?  Who do you blame for being overworked and under recognized?  The answer is yourself, obviously – but what do you do about it?  The challenge with the framework laid out in The Burnout Challenge is that there’s very little you can do.  Because the model doesn’t account for perceptions or our ability to change our perspectives on the same objective facts, we’re left stuck.

Mind the Gap

For us, the issue is really in the gap between expectations and the results that you believe you’re getting.  If you believe that you’re getting the results you expect, you will feel effective, and you’ll avoid burnout.  These expectations can either be internally driven – that is, what you expect – or externally driven – what the organization or your manager expects.

It’s entirely possible to be in a situation where expectations are misaligned – but they’re your expectations of yourself, not the expectations foisted upon you by others.  One of the key things we tell people is that most of the requirements for what we do aren’t the requirements of others but are instead the way that we believe we should behave.  It’s not about the boss that expects that there won’t be any typos – it’s the expectation we have for ourselves.

This has two implications.  First, it’s this gap that moves us towards burnout, and it takes a lot of support and self-care to avoid burnout.  Second, it means that burnout can be entirely internally driven and doesn’t necessarily require the influence of the organization at all.  (See The Paradox of Choice and Multipliers for the impacts of maximization and perfectionism.)

Band-Aids

One of the most useless things for burnout – in the long term – is a two-week vacation.  Many of the popular solutions to burnout is to offer people massages at work or encourage them to take a two-week vacation, but the truth is that this is just an opportunity to recover.  It doesn’t address any of the fundamentals of the situation that led to burnout in the first place.  As the old saying goes, if nothing changes, then nothing changes.  You can’t expect to stay out of burnout if you return to the same situation that led to burnout with the same tools.  You either need to change yourself, change the situation, or get new skills.

Is This Thing On?

Are you listening to the feedback you ask for?  If not, you’re contributing to the idea that their work and opinions don’t matter.  It’s the harsh reality for too many organizations.  They must execute an employee survey every year, because someone told them they had to.  They might even say that the items identified in the survey will be addressed – but far too often, the survey is done, and no one has any idea how to convert the feedback into a set of actionable steps to change the outcomes.

The bigger problem with this behavior is that it breaks the trust that you will pay attention, the result of which is that people stop telling you the truth about the situation, making it nearly impossible to recover.

Where the Lever Breaks

I’m all for leverage and scalability.  I love finding simple solutions that have great returns.  It’s magical when you see it happen.  One could easily accept The Burnout Challenge’s assertion, “Where major advances in workplace well-being occur, they come through better workplace design, not through supplying organizations with tougher employees,” if it were not for our knowledge that this rarely works.  It’s the strategy fallacy.  Sometimes, it’s called the “planning fallacy,” and it’s apparent in the way that we run projects differently today.

It used to be that we’d run waterfall-type projects with big, upfront planning of what we wanted and a large development cycle.  It worked well for hundreds of years, as engineers built bridge after bridge and building after building.  There were some notable failures, but they were always explained away as aberrations.  The Tacoma Narrows Bridge failed, because new materials in use elevated aerodynamics to a point of concern.  As long as the projects were the same, things worked relatively well, even if tragedy occurred when things did change.

Software development through the 1980s used this model with dismal results.  Projects didn’t work, they were late, and more over budget than the Sydney Opera House.  As a result, in the late 1980s, a shift started happening towards what is now called “agile development” or “agile approaches.”  Unlike big, upfront planning, it recognized that there were things that had to be learned along the way, because every project was essentially unique.

Agile approaches are iterative, emphasizing making small changes, learning, adapting, and trying again.  This allows teams to learn during the process and discover challenges that simply can’t be predicted.  That’s where the great level of strategy breaks – where it encounters an unanticipated problem.  When it comes to people and their perceptions, there are always unanticipated problems.  Consider The Coddling of the American Mind, which explains how we’ve attempted to warn people that they may be triggered by content only to discover that students continue to be triggered by content – just not the content that the instructor expects.

To be clear, I’m not opposing strategy.  We need a strategy.  However, we need to accept that strategy isn’t the only solution to the problem.  It’s not a case of whether we need better designed organizations or tougher employees.  The simple fact of the matter is that we need both – or rather, we need to accept that strategy isn’t enough.  We don’t need tougher employees – we need employees that are more equipped to handle the slings and arrows that life throws at them inside and outside the organization.

Match Matters

The major premise of The Burnout Challenge isn’t without merit.  Match does matter.  When you’re in an organization or a position that doesn’t match your skills or temperament, it can move you towards burnout.  However, the key is understanding how that happens – so you can intervene and prevent it.

If burnout boils down to perceptions of efficacy, then how does a bad fit lead to less efficacy?  Physics has the answer.  When one object collides with another, and there’s no energy converted to friction, the entire energy is transferred to the second object.  (In practical terms, there’s some deformation and therefore energy conversion to heat, but it doesn’t matter for this example.)  Perfect alignment means almost perfect energy transfer.

Consider that we’re measuring efficacy based on how far to the North an object travels, but instead of being hit square, our object is hit at a 60 degree off-axis angle.  The energy is still imparted to the second object, but the yield from that energy is literally half of what it would have been had it been an aligned transfer of energy.

If we’re still expecting our full efficacy – and we are – then we’ll feel like we’re coming up short, because we are.  When we mismatch with an organization, we struggle, because there is so much effort spent adapting to the mismatch, and that friction and misdirection makes us feel less effective.  That lack of efficacy, in turn, leads us to burnout.

So, while there are many things with The Burnout Challenge that are wrong, we can recognize that match between person and environment does matter.

The Grand Illusion

Robert Bogue January 31, 2023 No Comments

It’s the title of a Styx song, but it’s also the inability to see what should be so patently obvious that we could scarcely miss it.  The movie, The Matrix, would say, “… the world that has been pulled over your eyes to blind you from the truth.”  Unlike the Matrix, where once we’ve seen it we can’t go back, we often fall into the lure of predictability and clarity.

Other People’s World

Pick your favorite social media platform and do a random scrolling or swiping through posts and stories.  You’re likely to see two things.  First, other people are doing stuff that seems cooler than the stuff you’re currently doing.  (After all, you’re just scrolling.)  Second, their lives seem more ordered and directed than your own.  For the first, the important part is that one need only recognize that posts on social media are, for most people, a highlight reel.  They post things that are positive.  They don’t (often) post the picture of the coffee they spilled all over themselves, the dog vomit they had to clean up, or the million other small insults or frustrations that comes with daily life.

For the second, the perception of an ordered life is the grand illusion.  While you may see a consistent or at least thematic element to their posts, you’re likely ignoring the time they did something slightly out of character.  The social media view obscures the struggle that they had to figure out which way to go with their lives.

In fact, marketing people are quick to point out that people who are trying to generate a persona should not share these distractions from their core identity – even if they’re real.  I violate these principles regularly and on principle.  I’m a whole person, and I want people to see the random connections I make – even if the consequence is that people can’t really understand my identity and therefore my personal brand.

A Researcher in Another Field

When you’re reading, and you encounter piercing insights into humanity by another human author or researcher, it’s natural to assume that they’ve spent their entire career looking for that one insight, and once it came to them, they carefully wrote it down to be elevated to the status of essential wisdom.  The truth is, however, much messier.  In my own journey, I’ve wandered across topic areas.  Burnout, conflict resolution, mental health, and suicide are a wide variety of topics.  What has started happening without warning is that people whose work I admired in one area has surfaced in another.  For instance, Roy Baumeister’s work on Willpower is great.  But his work spans into the suicide prevention space as well.  Carol Dweck’s work on Mindset is another classic.  Her work in burnout is less well known.

These powerful researchers toiled in relative obscurity in fields before – or sometimes after – the ones they became known in.  This is a place where the grand illusion starts to break down.  When we encounter these great works, we can become pigeonholed into believing that the researcher is focused on that area.  However, when we discover that they haven’t always focused on what they’re known for, we’ve got to ask, at some level, how that can be.  One can’t have spent their whole life trying to solve one problem if we discover other, less successful, areas of their career.

We’re faced with the reality that they’re not as singularly focused and successful as we believed.  We’ve heard stories about how the great artists weren’t “discovered” until after their death.  They toiled in relative obscurity while they were with us.  However, somehow that perception that people could not be known has been relegated to a memory of distant times in the past.  After all, with the factors we have today, shouldn’t the great professionals in every industry be identified quickly and rewarded?

The One Stand to Rule Them All

People are fickle.  Bell bottoms are in.  Bell bottoms are out.  Bell bottoms come back.  In our world of rapidly changing desires and near ubiquitous availability of the internet, one might believe that people who have developed expertise or insight might naturally be elevated to the position of influencer, sage, or master.  However, the same problems we had in a pre-internet era plague us today.  Do a search for burnout on the internet and see how many hits you have to wade through.  Too many people become “experts” because they spend an hour “researching” burnout on Google, then feel competent enough to write about it –whether they’re right or not.  (The book review listing has 16 books that I’ve read specifically on burnout – and that doesn’t include related topics.  We take research seriously.)

This creates a sea of noise that both content creators and content consumers must contend with when they try to connect, to transmit the true insight to the world.  For the most part, people settle for the more mundane.  Minor influencers admit that they’re not being fairly compensated, as individuals who are paying for the services wonder where have the good guys and gals gone.  AI-based content creation tools, like ChatGPT, have all the markings of making this problem worse and not better.

It’s far more common for me to find people who have changed their focus than it is for me to find folks who have had a consistent connection to a single topic for the course of their career.  The truth is that they didn’t know – and couldn’t know – what aspect of their interest and works might be picked up and identified as interesting to others.  It’s a constant stab in the dark that all sorts of artists face every day.  They don’t know when they’ll be discovered – or for what.  As a specific reference, look at the work of Joan Borysenko, who wrote the book Fried.  The last blog post on her site related to burnout was 2018.  Her work has focused more recently on spirituality.

Best Work

Sometimes, people leave an area for decades.  In my own work, I wrote about burnout first in 2003 – and it took until 2019 to write the Extinguish Burnout book with my wife.  For about 15 of those years, I didn’t give burnout much thought.  It took the gap of 16 years to come back to it and spend time with it again.  However, it’s not held my focus for the last four years.  It’s another thing we do – but not the only thing we do.

The illusion created is that other people lock on to their best work, and it’s what they become known for.  However, the truth seems to be that people work on something, leave it, come back to it, and leave it again.  There’s not one topic to take a stand on that they’ll never leave.

Creating the Illusion

Two decades ago, I got to see Siegfried and Roy at The Mirage.  Their tiger show was amazing.  However, I was literally sitting inside the stage, where you could see how some of the illusions were performed.  They forced the audience’s perspective, which hid black cages and paths the tigers would use to get themselves off stage.  The illusion was great for most of the audience.

It’s that forced perspective that transforms the winding pathway of life into the perception of a linear projection from the start of life to the end.  When we only see those messages aligned with what people have done in their area of recognition, we see the illusion that they choose to create – and that we choose to accept.

If you want to create the illusion of consistency, the brand marketers would say that you only communicate on your primary point and silence all the rest.  It means that your true gift to the world may be stifled or never recognized – but it will create the illusion that your world has been exclusively focused around one thing.  If you’re going to do this, I encourage you to try to choose wisely.  Too many have had to retool after years of sending the wrong message to the world.

Book Review-The Selfish Gene

Robert Bogue January 30, 2023 No Comments

It all started with memes.  I wanted to know the origin.  I wanted to understand how they start, how they function, and how to generate them.  I discovered that the root was The Selfish Gene – and memes were conceived as the ideological counterpart to genes.  The book is long in the tooth yet as important to understanding evolution today as it ever was.  It explains not just the simplicity of selfishness but also how altruism can appear as a complex solution to the simple replication problem.

The Replicators

The most basic start of life, it is presumed, began with molecules that could convert raw materials into copies of themselves.  Ultimately, they’d consume all of the molecules that existed in their environment, and they’d have to evolve to more and more complexity to continue to replicate themselves.  In the process of competing to be able to replicate themselves, these mini-factories developed into the sequences that we today call genes.

The language throughout most of The Selfish Gene is intentionally open.  Dawkins is clear that his perspective is that a gene is a minimally sufficient unit to replicate.  It ignores the number of molecular sequences necessary to constitute a gene and instead focuses on the replication behavior.  This is convenient, since it allows for combinations of molecules in ways that say a gene can be of arbitrary length if it’s capable of replication.

Selfishness

Those that win in the replication game are those that can replicate the most – and beat out competitors of the raw materials.  There’s not intent or complexity, it’s just whatever can make the most copies wins.  The complexity only arrives when we discover the methods that the genes use to ensure their success – particularly in competition with others.

The Evolution of Cooperation

In The Evolution of Cooperation, Robert Axelrod explains the results of the game theory simulation work that he did.  He pitted programs against one another in a game of “The Prisoner’s Dilemma.”  The short of the game is that two robbers are caught by the police.  If both stay silent, they’ll each get three years.  If one defects, they’ll get only one year, while the other person gets five.  If they both defect and sell out the other, then they’ll both get five years.  The best selfish strategy is to always defect – if the other person doesn’t.  The best strategy for both parties is to not defect.  This simple setup allows for several strategies for determining whether the other person will defect and therefore what your best strategy should be.

This is the rise of complexity: predicting what others will do – or, more simply, adapting to the environment in which you find yourself.  The better you can detect what your competitor replicators are doing, the greater your probability of beating them out for precious resources.

Sexual Reproduction

Our sexual reproduction is just one of many strategies that have evolved by the genes that are cheating by offering a little less to the combination than they should.  Sexual reproduction involves the shuffling of genes through two parents.  Each provides half of the genes, and this constant shuffling leads to a lot of variation of gene combinations, so that genes can work together to ensure their replication.  Research on bees has shown that genes do, in fact, work together for their replication, with two separate genes being required to uncap and throw out infected grubs which collectively benefits the hive.

While it seems like there would be disadvantages to mixing genes through sexual reproduction, the benefits of being able to work with other genes quite obviously has some advantages too.

The Cheats

When it comes to sexual reproduction, there are cheaters – and they’re called males.  In my review of Anatomy of Love, I explained that men chase and women choose.  Dawkins lays out why that may have happened.  Assume that that the replication started with two replicators contributing equally to the offspring using sexual cells – gametes.  It would be beneficial for one to skimp a bit on resources while seeking out other gametes that were slightly larger, thus allowing the other parent to invest more in the reproductive process.  This could progress to the point where one produced many small gametes – sperm – and the other to produce fewer, larger, gametes that we’d call eggs.

From the moment of conception, then, females have invested more in the reproductive process than the males, and therefore they need to be choosier about with whom they mate.  It’s wise for a female to pick a male who she believes will be supportive through raising an offspring even if they didn’t invest as much initially.

Cheating evolves at a second level, when females pair with dependable males, making them believe that the offspring are theirs while secretly copulating with other males, who may have other desirable characteristics.  Similarly, males who can convince females that they’ll support the offspring but instead abandon them for another will have an evolutionary advantage.  For every action, there’s a counter action.

The Ultimatum Game

Perhaps that’s why we’ve evolved to detect and punish cheaters.  One of the classic tests that sociologists have used to test this is called the Ultimatum Game.  In it, there are two people.  The first gets to decide how a prize – typically $10 – is split.  The second person gets to decide whether either person gets the split.  In other words, if the second person doesn’t like the split neither person gets anything.

From an economic standpoint, the second person should never say no.  After all, even if the split is 9:1, the second person is a dollar richer for the experience.  However, that’s not what happens.  What happens in most tests is that when the split exceeds about 7:3, the second person starts disproportionately saying no.  They’ve decided that the first person isn’t fair, and they will punish them even at their own expense.

It’s an odd response until you realize that it would be necessary to prevent cheaters from taking over the replication game.

The Value of Groups

The Righteous Mind suggested that we became the dominant biomass on the planet due to our ability to have a theory of mind for other humans.  (See also Mindreading.)  This allowed us to work together and conveyed an advantage over animals that had to work on their own – or at least those with less ability to anticipate or predict the other animals’ movements.  Humans as a race are relatively frail.  However, our ability to cooperate conveyed more advantage than fur or tooth.  We live in groups because it is better for us to depend upon one another.

Social insects are a bit different in their composition.  They essentially divide into the bearers (of genes) and the carriers (of those who transmit the genes).  In other words, very few of the insects replicate genes, with most of the population running the factory that cranks out copies of these genes.  In effect, they’ve got their own slave labor built in, with workers blindly working towards the goal of replicating the genes of the queen.  This group arrangement serves all in the context of replicating their genes.

Imitation

Memes are a thought or idea that replicates.  They replicate from one brain to another through imitation.  Memes survive in the same way that genes do: competing against rivals, their longevity, the ability to replicate, and the fidelity with which they are imitated.  Much like the early proteins that replicated in the primordial soup, there’s little indication of which ideas will replicate and which ones will not – and even more than that, which ones will remain over the course of years or decades.  Repetition and other factors increase the chances of a meme remaining.  (See The Hidden Persuaders for more.)

Many boomers and Gen-X remember the jingles and tag lines from the commercials of their youth.  Simple sayings like, “When it rains it pours,” (Morton Salt) and “Where’s the beef?” (Wendy’s) are stuck in our minds and periodically find themselves being reused and adapted.

In our social media world, we find memes that quickly come and go.  Very few memes have staying power, though some resurface from time to time.

Immortality Through Genes and Memes

Let’s face it.  Our bodies will die.  No one will live forever.  What we leave behind in this world are our genes – through our offspring – and our memes – that is, our ideas.  While genes have been the dominant replicators on the planet, they eventually seem to die out.  They may die out faster than ideas.  After four generations, someone has only 1/32nd of the genes from one of their ancestors (on average).  After a few more generations, the genes will be diluted even further, eventually potentially extinguishing all the genes from a particular ancestor.

Conversely, some ideas seem to persist.  Consider Socrates, Aristotle, and Plato from Greece.  What about Shakespeare and Yeats from England?  Some ideas greatly outlive the people who create them – and that’s why memes may ultimately become the dominant replicator on the planet. 

Parasitic Replication

We tend to think that our genes are pure representations of one animal – even the human animal.  What we rarely consider is how virus may be a separation of a gene or that a virus might integrate new genetic material into our genes.  We tend to think in terms of purity, but what if the actual combinations include parasites and viruses as a part of the evolutionary process?  If a parasite replicates as a part of the normal reproductive cycle of the host, how long will it be before the parasitic genes eventually become incorporated into the host?  There’s no definitive answer to this question, but it seems like eventually the two will become one.

Maybe one day our memes will be able to regenerate our genes, and it will come full circle.  Maybe we’ll realize the true power of The Selfish Gene.

Book Review-Guns and Suicide

Robert Bogue January 23, 2023 No Comments

Very few things could have a greater immediate and visceral impact on people than talking about Guns and Suicide.  Few topics are more sensitized in America than guns.  Few topics are more emotional than suicide.  No matter where you fall on guns, you likely have a strong opinion.  Some are heavily for, and some are heavily against.  Suicide is something that will likely impact each of us indirectly through our network of friends and their friends, and once it has, the world is different.

In Guns and Suicide, Michael Anestis walks through the issues and the opportunities to save lives – not by removing guns but rather by helping people store them more safely.

Number 2

Yes, the right to bear arms is the Second Amendment, but I relate the position on gun ownership based on my home state of Indiana.  I believe we have some of the least restrictive gun laws in the US – second only after Texas.  We’ve been for a long time an “open carry” state, which means that your side arm, if you choose to wear one, can be openly visible.  We recently moved to what the NRA calls a “constitutional carry” state – that is a permit is no longer required to carry a handgun.

I personally own several guns and keep guns in both my office and home for protection – despite knowing that the odds I’ll need them are heavily against me.  The guns that are for home protection are all stored safely – they’re in a box or they have a trigger lock on them.

I make these points not because I want to convince you guns are good but rather to share that I don’t have any problems with guns – either for hunting or home protection.

Lost Two

I’ve lost two beloved members of my family to suicide – both completed with a firearm.  Several years ago, now my grandfather chose to end his life rather than face declining health.  While I disagree with his decision, I respect his right to make it.  In August of 2021, we lost our son, Alex, to suicide.  This more tragic, because Alex had his life in front of him, and his decision was not well-considered.

Two men in my life and two different situations both using firearms – and neither the same.  Both impactful.

Safe Storage

Before getting to the impact of safe storage, it’s important to define what it means.  The answer is somewhat situationally dependent.  The short answer is that there’s some barrier to being able to use the weapon.  This could be that the ammunition is stored separately from the guns, or it could mean the use of a locking device.  Locking devices come in three major categories:

  • Cable Locks – A cable is placed through the gun in a way that prohibits it from being loaded. These locks are the most common kind of lock available, largely because they come with every gun when purchased new.
  • Trigger Locks – These locks go around the trigger and prevent the trigger from being pulled. These locks can be used while the gun is loaded.
  • Vault Storage – Vaults or safes are used to store the gun. This prevents immediate access to the gun.

The Impact of Safe Storage

Research varies, as it always does, but some studies place the risk of suicide death from a gun that is stored loaded and easily accessible at nine times the rate of a gun that’s stored safely.  Pause for a second and ponder how a simple lock or vault can be enough to change an outcome so powerfully.  While the answer to the question of “how” the mechanisms work to create an impact, there’s no doubt that having guns stored safely has an impact.

It’s important to say that safe gun storage also impacts unintended discharge by a child as well as theft.  Certainly, the numbers are about suicide, but children discharging guns they find is a different kind of tragedy that also needs prevented.

Home Protection

One of the key barriers to people wanting to store guns safely is the concern that they’ll not be available during a home intrusion.  The truth is that guns are used to defend homes in just 0.9% of all home intrusions (data is from 2007-2011) – so, an incredibly small percentage.  The data showed that there was injury in 4.2% of the intrusion cases overall, and 4.1% when a gun was used for self-defense.  The net of all this is that gun use for self defense seems to make a negligible – if any – difference in the likelihood of injury from an attack.  (The data comes from the journal article, “The epidemiology of self-defense gun use: Evidence from the National Crime Victimization Surveys 2007–2011,” not from this book.)

There’s no statistical evidence for safe storage vs. unsafe storage, which isn’t surprising given the incredibly low incidence rate.  It’s hard to study things when the overall rate is so low.  They’re so low, that it’s difficult to believe that it will be an event that will impact most people.

Gun Purchases

Statistics can show you odd relationships – sometimes that make little sense.  There’s pretty good research that says if you add a barrier to a chosen form of suicide, people rarely will switch to a different method.  If they want to jump from a bridge, and you add a fence, they’re likely to not die by suicide.  That’s why, when you read that a gun purchase is an indicator of higher rates – even excluding suicides that involve a gun – it makes you tilt your head.

Reporting the Thought

Admitting you have a problem is hard for all of us.  Trying to explain to someone that you’re feeling trauma because of something that you’ve seen or been through is difficult – particularly if the situation wasn’t traumatizing to them or is perceived as “normal.”  Soldiers underreporting of suicidal thoughts should not be surprising.  The culture of macho-toughness and the general need to not be seen as weak don’t make it easy to admit you’re struggling.

The problem is that you can’t help someone that you don’t know is struggling – and the very act of sharing your suicidal thoughts with someone makes them less intense and painful.  (For the mechanics of this, see White Bears and Other Unwanted Thoughts.)

Background Checks

Background checks have been a part of gun purchases for some time.  Initially installed with a waiting period, this waiting period has all but been resolved thanks to technology.  However, not all background checks are the same.  Some operate solely at a federal level, some at a state level, and others operate all the way down to the local level.  It turns out the level at which the background check is done matters to the outcomes.  Federal level checks were associated with an 11.64 per 100,000 suicide rate, and local level checks with a 5.74 per 100,000 rate.  Clearly, the more locally you evaluate gun ownership, the more probable it is that you’ll catch concerns.

You don’t need a background check to check out the background in Guns and Suicide.

Moving from How to What: Website Relaunch

Robert Bogue January 19, 2023 No Comments

Thor Projects is entering into its 18th year of business.  Throughout our history, we’ve focused on communicating “how” we get things done.  We’ve focused on our software development, courseware development, and other specific things that we’d do.  However, over time, we’ve realized that the executives that we were working with didn’t really care.  They care about the results that we can deliver for them.

We just recently rebuilt the entire website.  Instead of focusing on industries we serve or the “how,” we shifted to communicating the outcomes.  Businesses today are having trouble retaining employees and, importantly, engaging employees.  We’ve been addressing this issue for years by fixing burnout, improving conflict resolution, and, more recently, enabling empathetic conversations.  Organizations want to achieve better outcomes.  Most don’t know what’s wrong and need someone to evaluate their programs, get support for their success, and plan for performance.  It’s not just that there’s not enough time, there’s a need to better understand what has worked for other organizations.

We live in a world of constant change and that demands organizations be agile and to continuously transform themselves.  We’ve been helping organizations be more confident in their changes, modernize their technology infrastructure and operationalize change throughout the organization.

What’s rather intentionally missing is the power of the Microsoft 365 platform, including Viva, Teams, and SharePoint, as well as the most widely-used client applications on the planet.  We don’t cover the ability to develop custom software, leverage the Power Platform, or help manage multi-cloud solutions.  These are the “how” of “what” we do.  They’re the details we can discuss when customers are ready to engage.

You’ll also notice that we’re not enumerating the industries that we’ve served.  There’s not a mention of the powerful solutions that we’ve implemented in healthcare, financial services, government, and manufacturing – to name a few.  Every industry is different, and we know that through the work we’ve done.  If we can’t communicate that we can help you and your organization get the “what” they want, then the industry doesn’t matter.

The Connection

One of the challenges of our previous messaging is it was too complex.  People didn’t understand what we stood for.  They could see all of the activity, but a clear picture wasn’t emerging.  There’s a reason.  We were talking about the various “hows” but the message isn’t clear until you look at what we were doing.  We have and will continue to help organizations be successful.  Sometimes, that leads us down paths that seem odd, but the destination is always the same.

We’re proud of the results our clients have seen.  One client reduced their rework from 92% to less than 20% in a single year.  That’s about changing the process – and implementing the technology to support it.  Clients have processed millions of documents through the document pipelines we’ve engineered.  The results are more reliable delivery of responses and faster answers. Dozens of clients have seen how we can take a languishing division or product line and revitalize it.  Finally, we have a website that starts to explain how we help organizations be better.

The Complex Made Simple

The new website features an explosion of a watch in the header.  It’s a subtle message.  If you look at the inner workings of a watch, it seems chaotic.  However, it’s not.  It’s just complicated.  Someone needs to understand how to put it together and how the pieces fit.  However, for most people, using a watch is simple – you simply need to know how to read the time.  This is an analog for what we do.  (Pun intended.)  We take apart the back end, the internal components, so that we can make things work simply enough that our customers can tell time by looking at the face.  No one must know “how” we make it work – they only need to know that we will make it work.

We’d love your feedback about the new site – and the focus on what we can do for you rather than how we do things.  If you still want to know the how, we frequently publish white papers that explain this.

WingingIT Launch

Robert Bogue January 17, 2023 No Comments

The first person I ever co-led a workshop with was Eric Shupps.  We have so many memories, including the time that I got told that I was hard to listen to.  We both thought that Eric would be the one that got flagged for difficult to listen to first.  (I took out a $20 and told him that he won.)  Over a decade ago, Eric was one of my co-conspirators on the Microsoft ECM Implementers Course that was available for partners.

We’ve started a new video podcast where we talk about some of the things that we’ve encountered along the way.  We’re starting with the state of enterprise content management in SharePoint and Microsoft 365 – as well as why we call it “content services” occasionally.

It’s a fun time and a great way to understand the real story about Microsoft technology – along with some interesting stories about how we ended up here.

Check it out the second Thursday of every month.

Book Review-Healing: Our Path from Mental Illness to Mental Health

Robert Bogue January 16, 2023 No Comments

Recovery is more than the abatement of symptoms.  Recovery from mental illness returns us to a place where we can have a full and meaningful life.  That’s what Healing: Our Path from Mental Illness to Mental Health is about.  It’s changing our definitions of what is – and isn’t – okay, and what it does and doesn’t mean to have mental fitness.  It’s going to take a lot of work to change our way of thinking of mental health.  Robert Pearl shares in Uncaring and Mistreated how messed up our medical healthcare system is.  Mental health in America is generally regarded as worse – substantially worse.

Two Kinds of Families

There are, they say, two kinds of families in America.  There are families who have already experienced mental illness, and those who will.  There’s no escaping mental illness more than one degree of separation from you.  It’s too prevalent.  There is too much suffering to go around.

The truth is that most of our medical problems are actually the outcomes of poor mental health – as was shared in Change or Die.  If we just modify a few behaviors, we get much better health outcomes.  Less smoking, drinking, eating, and stress coupled with more exercise might stop 80% of our healthcare costs.  Not that we know how to do these things – but they draw the connection between our mental health and our medical tragedies.

We may not diagnose the mental health issues any more than we diagnose not enough exercise, but that doesn’t make the reality change.  The fact of the matter is that mental health issues are the largest category of disability recognized for disability support in the US – and yet we’re doing very little to resolve it.

Said differently, about 5% of adults meet criteria for a serious mental illness – as do about 6% of youth.  Sitting in a room with 20 people, one is likely to have a mental health concern that could be diagnosed as a mental health illness.  It’s everywhere, and we pretend that it’s not.

Murder and Suicide

There are a lot of deaths related to serious mental illness.  Many people are concerned that the people who are struggling with mental illness may become harmful to others or even commit murder.  While this does happen, a much greater concern is the elevated risk of suicide for those with a diagnosed mental illness.  It has been said that as much as 90% of suicides could have been diagnosed with a mental illness.  I disagree with this – unless you include non-serious mental illnesses.  The number of people who have been prescribed selective serotonin reuptake inhibitors (SSRIs) is startling – and scary.

Blame Where There Should Be None

It used to be that we blamed mental illness on poor families either from the experiences that they inflict on their children or genetics.  (See No Two Alike for more.)  Today, we recognize that mental illness doesn’t have a cause in bad people.  It’s a tragic but somewhat random outcome of life.  There are some things that we know will lead to complications, tracing all the way back to prenatal stress (fetal onset of adult disease, or FOAD) and adverse childhood experiences (ACE).  (See Why Zebras Don’t Get Ulcers for more on FOAD and How Children Succeed for ACE.)  These complications aren’t caused by the person themselves or even their families.  They’re just a tragedy of life.

Rose Kennedy

One could easily believe that Rose Kennedy’s deepest heartbreak would be the assassination of two of her sons.  However, she said, “deeply hurt by what happened to my boys, but I feel more heartbroken by what happened to Rosemary.”  Rosemary was mentally challenged from birth, but it was a botched lobotomy that sent her to a care facility.  Before then, Rose Kennedy supported Rosemary in their home.  It’s no wonder that John F. Kennedy was concerned about mental illness and mental health.  His 1963 special message to Congress was the last time a U.S. President focused so extensively and exclusively on mental health care.  The Community Mental Health Act that it spawned was the last bill that he signed before his assassination.

The act had the effect of breaking up state-run hospitals with the intention of redirecting those with mental illness towards community mental health centers.  However, by and large, these community-based resources never materialized, and many with serious mental illness found themselves thrown out on the streets.

Save Me, San Francisco

The band Train released an album and title song, Save Me, San Francisco, in 2009.  The band, from San Francisco, recounts their journeys and desire to return to their home.  However, not everything in San Francisco is so rosy.  During my many visits to San Francisco, I realized that whatever I thought I knew about a homeless problem paled in comparison to the challenges the city was facing.  The truth is that homelessness as a problem didn’t really exist prior to the 1970s – as the state-run mental health institutions were being dismantled.

People who had adapted to a life of institutionalization were thrown on the streets – unemployed, destitute, and homeless.  They were completely unskilled for the world that they would have to navigate, and the resulting homelessness showed it.

Step Back

While Carter tried to resolve the problems by signing the Mental Health Systems Act in 1980, it was too little, too late.  He’d be out of office soon, and Ronald Reagan immediately slashed federal spending – starting with the framework established by Carter.  More than that, he removed the first mental health team at the White House – the team that Carter had built.

The disaster inflicted on mental health wasn’t just contained to Ronald.  Nancy Reagan’s disastrous public campaign, “Just Say No to Drugs,” had laughable and negative outcomes.  (See The Globalization of Addiction and Dreamland for more.)  What’s the connection, you might ask?  The answer lies in the fact that substance use disorder – drug addiction – is a solution as well as a problem.  It’s a solution to numb some sort of emotional pain.  That emotional pain is the lack of mental wellness.

Growing up in the era of Regan and listening to his impassioned speeches, I can still respect him and accept that both Ronald and Nancy completely missed it on this one.  (See Great Speeches for Better Speaking for an example of Reagan’s address after the Challenger Disaster as an example.)

A Stitch in Time…

…saves nine.  The problem is that the mental health care system we have – if you’re willing to be generous and call it a “system” – isn’t geared towards prevention or health.  It’s a system for dealing with crisis.  It’s a catch system designed to contain the mess after the train is already off the rails.  In most cases, the system can’t restore a person to health.  The best it can do is keep the person from escalating.  That’s in part why we have an epidemic of prescription psychoactive drugs.  In Warning: Psychiatry Can Be Hazardous to Your Mental Health, there’s solid push-back on deploying medications – including SSRIs – like they’re from a PEZ dispenser.  Please don’t misunderstand.  SSRIs and other psychoactive drugs are a necessary part of the care continuum – but they’re overused, and the related work to remove their necessity is rarely done.  We leave people on medications that have long-term implications, and no one seems to be noticing.

We’re starting to see the emergence of proactive programs for socio-emotional learning (SEL) – but the programs are challenging at best.  As they’re new, there’s no research supporting their efficacy.  However, more critically, many of these programs don’t use best practices for teaching.  (See Efficiency in Learning for some hints.)

Involuntary Commitment

Many people who seek help find themselves caught in a system that doesn’t work.  They voluntarily go to seek help and find that the providers they contact are too afraid for their safety – or the safety of others – and they involuntarily put in an evaluation hold.  They start with their freedom – and they can’t leave, because they can’t have it.  It’s a part of a problem that we’re facing where those with mental health issues are held in a hospital emergency room – and the people are sometimes placed in jail to spare them the painful mental health process.

What most people don’t realize is that many mental health situations require that a person be mentally cleared before they get their care.  This places them first in an emergency room.  After that, they can be moved to a mental health facility for an inpatient stay – except, in many situations, a place isn’t available for them.  So, they’ve been deemed a hazard to themselves or others, and they’ve been medically cleared, but there is no place for them to go, so they’re detained in an emergency room.

When they’re finally cleared to go to mental health services because space is available, they are deprived of many things.  Some of which make sense.  Nothing that could be used to hang oneself – no matter how remote the chance.  However, they’re also deprived of most of their contact to the world.  Mostly, in today’s world, it’s their cellular phone.  The reasoning is to control external stimulation with the idea that this stimulation is creating part of the problem – as it often is.  However, it has the secondary effect of making people feel hopeless and out-of-touch.  Neither are good for mental health.

Exit from these involuntary situations seems to be based in part on the degree to which someone can act or lie their way out of it.  Research seems to show that many people have neither more nor less psychic disturbance than when they entered – they just get better at hiding it from the clinicians so they can go home.

The problem this sets up is that it breaks down the very foundation of the therapist-patient relationship by forcing the patient to lie to get the freedom they need.  It’s no wonder that one of the highest risk of suicides is immediately after a discharge.

No Room at the Inn

Sometimes, the process of holding a person fails.  The order to hold someone expires before they can even get to treatment.  The result is that friends, siblings, and parents are sent home with mentally ill and potentially suicidal loved ones.  Instead of the relative immediacy of the inpatient commitment, they’re placed into the queue of outpatients that spans months.  Finding a mental health professional at any quality takes months – and finding a provider that uses evidence-based practices in a skillful way takes longer.

The result is a gap between the time that a patient is identified with a problem and the moment when they first start to receive treatment.  That gap is a critical period where far too many people suffer and die.

What’s Wrong?

To fix what’s wrong with the mental health system, we must first diagnose what’s wrong, and then come up with solutions to fix those things.  The list of problems is long.  Some are addressed plainly in Science and Pseudoscience in Clinical Psychology.  Others are addressed in The Heart and Soul of Change.  What neither book addresses are the larger issues like payment that drive the system.

Mental health beds are reimbursed at a lower rate in hospitals than other kinds of beds – making them less profitable.  Mental health services are reimbursed at a lower rate than other hospital and ambulatory (walk-in) services.  Despite the laws regarding parity of mental health coverage, too many people find their mental health coverage allows for only a few visits – not enough to support even the quickest and most effective therapy.  Complicating this is that many providers, frustrated by the low rates from insurance providers, have moved to a private-pay only model.  If you can’t pay the provider directly, you can’t see them.

The ripple effect is that providers have no requirement nor incentive to record their outcomes and measure their success – or failure.  They’re free to operate without oversight and in ways that may not help patients –and, in some cases, may even harm their patients.

If we want a system that encourages the best people to work in the field, they need to know they can earn enough to pay off their student loans.  We also need to bring mental health the same quality outcomes measurement that is starting to take hold in traditional medicine.

Mental Health Killers

Amy Edmondson in The Fearless Organization lays out her views on psychological safety.  It’s the idea that you can feel safe expressing who you are, including your beliefs and thoughts.  That ability to feel safe is predicated on our ability to predict the future.  As I explained in my review of Mindreading, it’s not the science-fiction, deepest-and-innermost-thoughts mind-reading, but rather our ability to have a theory of mind for what’s going on inside someone else at the level of allowing us to predict their actions.  Certainly, we’ll be surprised as we unintentionally step on or run into a competing value that we’ve never seen before, but for the most part, we can expect how someone will respond.  (See Who Am I? for competing values.)

This leads us to our fear of people with mental illness.  We expect that we can’t model the thought patterns of those with mental illness, and therefore their behavior is – to us – unpredictable.  (See Sources of Power for more on our need and ability to create models.)  Without prediction, we experience fear and anxiety.  We are afraid that the mentally ill person is homicidal.

The truth is that, across the population, suicide is substantially more probable than homicide.  It’s also true that people with serious mental illness more are often the recipients of violence than the purveyors of it.  This doesn’t help us when we’re face-to-face with someone we don’t know who is shouting at people who don’t exist – and they don’t have a wireless headset on.

A Rope of Three Cords

The more that we lean into complexity and recognize that simple, one-dimensional fixes aren’t going to cut it, the more we realize that we need to approach people from a wholistic perspective.  We can’t rely on any one form of treatment alone in every case.  The best approaches are layered.  Medication, though research on efficacy is weak, can be helpful to bring people to the table to do the hard work that talk therapy requires – talk therapy being any of the proven techniques for improving mental health outcomes.  Other medical therapies, like transcranial magnetic stimulation (TMS), are added when appropriate.  Ruling out any of these three paths – or cords – of treatment isn’t helpful.

To echo the warning from above, medications shouldn’t be used as the long-term approach to mental health.  They have long-term complications.

Long-Term Care

For some, there’s no short-term cure.  Neither inpatient nor outpatient can address what decades of trauma and emptiness has wrought on a person.  Long term institutionalization is out – but residency programs and halfway houses may be that critical bridge between short-term crisis care and being integrated into the community.

These approaches often gather a small number of leaders who may or may not be clinicians to provide support for several transitioning patients – almost universally fewer than 16.  The patients live together in a single house that has rules.  A curfew, interpersonal interactions, and other rules are necessary to maintain order but far fewer in number than an inpatient facility.

These facilities are often incredibly successful at helping people avoid the service cliff that happens when people run out of money or primary coverage.  These halfway houses are often low-cost, subsidized by communities or community organizations to make it possible for people to work and stay in the house.  (Work is often an important component of long-term stabilization.)

Another aspect of these houses that is often under-acknowledged is the small communities of people that form and how these small communities combat loneliness – or, said differently, build social connections.  (See Loneliness for more on the impact of loneliness.)

They’ve Done Nothing Wrong

It was 1841 when Abraham Lincoln counseled that melancholia, what we’d today call depression, “is a misfortune, not a fault.”  Despite Lincoln’s admonishment not to treat those with mental illness as the victim, it’s hard to shake the centuries of the Christian church’s insistence on demons or sin having caused mental health issues.

The historic Christian burial for someone who died by suicide was at a crossroads under a cart load of stones or stakes.  By law, suicides were criminals, and the state could seize any property belonging to the person.  The result is that the victim – of mental illness or otherwise – was further victimized.  Caring individuals often failed to report accidents as suicides to prevent the consequences and the stigma associated with suicide for the families.  The result has made it very difficult to get accurate data.

Hopelessness

Don Berwick, one of the nation’s experts on quality healthcare, explains how hopelessness can kill more than leukemia.  His patient, Isiah, survived leukemia treatment only to die because of the helplessness he felt.  We need more than physical healing.  We need mental Healing.

Practical Complexity

Robert Bogue January 10, 2023 No Comments

It was a great, spirited conversation about the concept of complexity that led me to wonder what we really know.  Specifically, the conversation was about the idea that we love linear problem solving.  Proverbially, it’s the simplicity of A+B=C.  It’s a simple math equation that anyone who has learned algebra gets.  However, it’s a simplification of the world around us – and one that sometimes gets us into trouble.

Chemical Reactions and Probabilities

Given perfect understanding and infinite time, A+B does, in fact, equal C.  However, the problem is that we rarely understand things perfectly – and we rarely have enough time to allow all of the A+B to happen.  Let’s take a chemistry example in an attempt to make this clear.

We now know that different kinds of atoms have different kinds of properties and propensities to cluster together.  For instance, water is H2O: two hydrogen atoms with one oxygen atom.  If we placed twice as much hydrogen as oxygen in a sealed container, we’d end up with water.  The reaction time is dependent on many things, principally temperature and pressure.

Both of these factors lead to the probability that the correct combination of atoms will collide into one another in a range that causes them to enter the relatively stable relationship we call water.  Too slow, and they’ll bounce off; too fast and they’ll plow through each other without enough magnetic pull to stay together.  Temperature and pressure increase the overall motion of the atoms and their proximity to one another and therefore make the conditions more likely to occur where the factors are just right.

There are a few important aspects here.  First, the reaction isn’t immediate.  It may appear immediate, but it’s not.  Second, we simplify the billions of individual molecule formations of a much larger quantity – say, a cup of water – into a single reaction when it’s not.  Finally, the introduction of other factors may increase or inhibit the reaction.  We call items that accelerate a reaction, but are not consumed by it, “catalysts.”

Reinforcing Loops

Einstein called compounding interest the 8th Wonder of the World.  Even small changes over time create big results.  Consider, for a moment, the idea that you get better by 1% each month.  It’s a tiny change – barely noticeable.  After 10 years of this, how much better would you expect to be?  Mathematically, you’d be 3.3 times as good as when you started.  This is because even at very low rates of increase, these increases compound over time.  The previous result – the increase – is fed back in for the next cycle, so the second month you’re better from the first by not just two percent but slightly more than that (2.01%).

Extended out over long periods of time, this makes some sense.  However, the problem becomes that we rarely think about short periods of time.  Returning to the world of chemistry for a moment, an explosion is a rapid increase in a chemical reaction.  Fire results from heat (energy), oxygen, and fuel.  In an explosion, the cycle time from one set of molecules to the next is very, very quick.  There’s enough heat in the presence of oxygen and fuel that the reaction expands quite quickly.  The output of the prior reaction – fire or explosion – is available for the next cycle.  The result can be catastrophic very quickly.

Balancing Loops

Most of the time, we don’t find explosions, because there are balancing loops that reduce or dampen the impact of the forces that tend to reinforce themselves.  In the case of explosions, the consumption of the fuel eventually depletes it and deprives the reinforcing loop of the conditions of its action.  In the simple example, the results are relatively predictable.  The explosion continues until the conditions of heat, fuel, and oxygen are somehow removed.  Often, the fuel component is exhausted, but sometimes the expansion created by the explosion occurs more rapidly, and the heat (energy) dissipates too quickly.

In many cases, the reinforcing loops are stopped automatically because they reach some limit.

Initial Conditions

Imagine that you’re standing at the Continental Divide in the United States.  On one side of a spot, water rolls down into the Pacific Ocean; on the other side, water will roll down into the Atlantic Ocean.  At the very top of a peak, a very tiny difference in position leads to a very large difference in the water’s final resting place.  (If you’re a teenage boy, you’ll stand at the top and urinate in a sweeping motion to pee in both oceans at the same time.)

A very small difference in initial conditions leads to a very radical difference in the outcomes.  While it’s easy to determine that when we’re at the Continental Divide, it’s much more challenging to determine the places in life where a very small change in initial conditions can have a large impact.  Whether we identify them or not, they’re present everywhere in our everyday life.

Perfect Understanding

Of course, it would be great to have perfect understanding.  If we knew all the places where initial conditions mattered, we could adapt, adjust, and engage in ways that allow us to take advantage of the situation – but we don’t.  In fact, we simplify our world to pretend as if we have a perfect understanding when we often do not.  Let’s come back to water.

You get a glass of water from your faucet and wonder, is it 100% pure water, or are there other things in there as well?  There are, of course, other things in trace amounts.  There’s some chlorine that was used in the treatment process that hasn’t fully broken down yet.  There’s a bit of limestone that was dissolved in the water.  There are probably very tiny amounts of all sorts of things.

You dump the water, turn around, and get some from the refrigerator, thinking that it will be colder anyway.  The filter in the refrigerator has removed some more of the impurities from the water – but it’s still not 100% H2O molecules.  Trace amounts of other stuff still hitch a ride.

Even in our examples here, we’re intentionally ignored the impurities that don’t make much of a difference – at least most of the time.

Applying Probabilities, Time, and Loops

Now, combine these concepts and recognize that there’s a probability of something happening in a given time, that loops drive the continued expansion until a point of collapse or stability, and that our initial conditions that we can’t fully understand can make a big difference in outcomes, and we’ve arrived at complexity.  It’s a place where we can’t predict the outcomes with high degrees of certainty, because there are too many variables and too many components of the situation that we cannot know.  This is what led Lorenz to realize that a butterfly flapping its wings could create a tornado in Texas.  This doesn’t occur in the linear cause-and-effect type way.  Rather, given loops, time, and initial conditions, it’s possible that a small change can lead to a very, very large outcome.

Some would describe this as a non-linear model or a non-proportional result, but I do not.  Ultimately, it is a set of equations and reactions that are all quite linear in nature.  The results of a linear equation need not be proportional – exponents are allowed.  Further, the emergence of the perception of non-linearity is because we fail to recognize both the simplification of many to one – and we fail to recognize the challenges of multiple iterations and the impact of initial conditions.

Perception

What we perceive as complexity is often just something complicated that we’ve over-simplified and failed to take into account the components and speed at which the system loops and therefore feeds back on itself.

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