Episode 2: The Science of Flourishing

Love and belonging aren't things we talk about much in medicine.  But they're irreducible needs of humans.  Join Rebecca Lauderdale, MD, for an introduction to the burgeoning science of human flourishing, and why we as physicians can benefit from understanding it.

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Resources: 

The Gifts of Imperfection, by Brene Brown, PhD

The Meaning of Human Existence, by Edward O. Wilson, PhD

PERMA Theory of Well-being

Character Strengths and Virtues, A Handbook and Classification by Martin Seligman, PhD, and Christopher Peterson, PhD

Learned Optimism by Martin Seligman, PhD

"The Journey" in Dream Work by Mary Oliver

Music Used with Permission:
Intro "Death Dance" by Luftmensch
Outro: "Crossing the Rubicon" by Jakob Ahlbom

Transcript

Women Physicians Flourish.  Podcast Episode 2 

The Science of Flourishing

Hey there everybody! Thank you so much for coming back for episode 2 of the Women Physicians Flourish podcast. This episode is going to be some more foundational/theoretical material that I think is absolutely a requirement before we go further. If you don't process this part, at least start to turn it over in your head and consider the mountain of evidence that it’s true, you might still benefit from the practices I’ll talk about later on, but there will be a limit to how helpful that will be.  You might just need to ponder this self love and compassion stuff for a little while. I told you last episode that I am committed to giving you actionable, evidence-based things you can do to heal burnout and to flourish, but these first two episodes focus on some concepts that you really need to understand first. This process isn't a to-do list, but a lifelong practice of cultivating what we want and letting go of what we don’t. It’s not a race, though sometimes I know I’ve felt so in pain in my life that it felt quite urgent to “fix something.” 

So, last episode I introduced you to Brene Brown’s wholehearted people - those people in her study cohorts that were so different from the others because they were uninhibited by fears of rejection or shame, and instead lived in this freedom and openness, they were creative and innovative and had incredible relationships. They were flourishing.

Last episode we also talked about how the key difference between these wholehearted people and the other people in Dr. Brown’s data was that the wholehearted people had self-love. And I ended that episode with the hope that if you’re one of those people like I used to be, that I put a little crack in your shell and made you at least start considering that self-love is not some woo new age concept but its an imperative if you want to lead a fulfilling life.

I’ve said the word flourishing several times and I want to take a moment to make sure that I give a clear definition that is also in line with the current psychology literature, there’s been a development over time, particularly the past 10-15 years, in that definition. A lot of this research has been done by Martin Seligman, who is a doctor of psychology and founded the field of Positive Psychology and the department by that name at Penn State. I used to think that positive psychology was synonymous with pop psychology.  I thought it was just a bunch of bogus stuff that self help authors made up, but when I was looking for ways to be more happy, I looked at this research and realized it was quite rigorous, though still a relatively new field. 

Dr. Seligman first put forth Happiness theory, which he pretty quickly revised, he said that it was too one-dimensional, and not a full description of how we choose our best course in life.  He talks about this in his book Flourishing, which focuses on wellbeing theory and the research behind it. He says that happiness is not the be-all and end-all of well-being, and isn’t necessarily its best measure. So,  positive psychology is not “happyology.” Dr. Seligman talks about 3 types of lives - in ascending order of flourishing and life satisfaction. 

the pleasant life - with as many pleasures as possible and learning the skills that amplify them. The main drawback of this is that experience of positive emotion is 50% heritable, and pleasure habituates rapidly.

Then there’s the good life - having experiences of flow in your life, which he equates with engagement, knowing what your highest strengths are and then recrafting your life to use them as much as you can

And then the third one, the meaningful life, with the highest life satisfaction - which involves knowing your highest strengths and using them in the service of something larger than yourself.

In the 3 types of lives, rates of life satisfaction are almost not related at all to pursuit of pleasure. Where pleasure matters is if you have both engagement and meaning, pleasure is just the icing on the cake (and you get more than if it were experienced alone).

So, Seligman’s acronym for components of Wellbeing is PERMA: He talks about it like a dashboard.  The most important “gauges” on the dashboard will be different depending on your preferences, and different people will prioritize them differently and at different times in their lives. These elements are things that free people will choose to do for their own sake, and not in order to get more of the other stuff. The skills of wellbeing can be taught, learned, and are transformative. And when working with increasing wellbeing, the point is not to change what people value but to help them maximize the things they do value. 

Positive emotion (happiness and life satisfaction are aspects). - highly heritable (more than 50%). So if you set out to change people’s subjective feelings, how merry they are, you only have 5-15% leeway for changing it. 

Engagement/Flow - When time stops. People in flow don’t report much emotion or cognition. Complete involvement. The ability to be entirely immersed in the activity (with people, with work). Research has shown that this element can be improved by identifying our greatest strengths, and consciously engaging in work and activities that utilize those strengths. Relationships - like I mentioned earlier, we have a need for connection, love, physical and emotional contact with others. We enhance our own well-being by building strong networks of relationships around us. Research shows that happiness shared is happiness squared. When we share our joy with those we love, we feel even more joy. And when we love, we become more loveable. So there’s a positive feedback loop. We also depend on the people around us to help us maintain balance in our lives. When we are alone too much, we lose perspective on the world, but when we let other people into our lives, we keep better perspective, have a network of support

Meaning and Purpose -  your “why”. believing we serve a purpose larger than ourselves. Meaning is particularly important in group settings. Worker productivity and satisfaction rises with rising meaning. (Adam Grant research - to the extent that cold-callers could see the benefit of the money they brought in from calls, their productivity increased). From day to day, if we believe our work is worthwhile, we feel a general sense of well-being and confidence that we are using our time and our abilities for good. Second only to relationships in contributing to global wellbeing scores. 

Accomplishment/Achievement/Mastery - Creating and working toward goals helps us anticipate and build hope for the future. Past successes make us feel more confident and optimistic about future attempts. There is nothing bad or selfish about being proud of your accomplishments. When you feel good about yourself, you are more likely to share your skills and secrets with others. You will be motivated to work harder and achieve more next time. You may even inspire the people around you to achieve their own goals. 

So that’s the PERMA acronym for the components of wellness, of flourishing. There’s also some discussion in the literature about possibly adding Health, Freedom, Responsibility as components. There is definitely agreement that flourishing and wellbeing are not simply the absence of pathology.  It means something different and different skills are required to get there.  There’s also agreement that wellbeing can be built. People can improve their wellbeing tremendously. 

In Brene Brown’s work, the wholehearted people are people who are flourishing. Those people feel a deep sense of love and belonging in their lives.  And the only thing, again in the data, the only thing that differentiates these people from people who don't feel love and belonging in their lives is that they believe they are worthy of it. 

Let me repeat that, because it felt geological in magnitude the first time I really grasped this. The only difference between people who feel a deep sense of love and belonging in their lives and those who don't, is that they believe they are worthy of that love and belonging.  They don’t have some special set of pre-existing physical characteristics or innate personality traits, special childhoods or socioeconomic status or career success.  This isn't a belief that you’re better than other people, arrogance, but the simple belief that you deserve love and belonging just as much as anyone else on the planet. And when you can do that, you can move mountains.  

I know we don't talk about this a lot in medicine.  I can't recall any professors or attending physicians in my training directly addressing self-care or self love or even really about loving patients. I remember once talking about sleep deprivation in a noon conference but there wasn't really any support - it was just like “oh that really sucks that you scored the highest score on the sleep deprivation scale because you’ve been on 1:3 call in the ICU and you have an infant at home.”  I certainly had some who clearly demonstrated a love for patients, and those people made a big impact on me, but we didn't often directly address happiness or wellbeing in ourselves or our patients. It was just about fixing pathology. And maybe that’s partly because there wasn't a lot of data or science for them to refer to - they didn't know this stuff that I’m talking about today, so bringing it up as part of a curriculum may have felt to them like it was too “woo” or soft or anecdotal.  But who of us is willing to live our lives without including love and fulfillment as part of our goals? I’m certainly not, and I bet you aren't either. 

Love, belonging, and significance are irreducible needs of humans.  They are needs that have been built into us over millions of years and we aren't getting away from it anytime soon. Edward O. Wilson, the renowned biologist, whose work founded the field of evolutionary sociology and psychology, has written extensively about this social nature of humans for 50 years, and in some of his more recent works he has discussed the things learned in field in some really beautiful ways - speaking to our need for meaning and creative expression and connection to others, and how science and the humanities need each other. In Dr. Wilson’s book The Meaning of Human Existence, which was published in 2014, he lays out a case that does a good job of finishing off the “selfish gene” theory- humans did not become humans by only looking out for number one.  Actually, you could say we didn't even become human until we grew a brain big enough to allow us to become unselfish - to think beyond our own personal best interest and act for the good of a group. The whole reason we became as powerful as we are as a species is that we evolved to form groups where altruism was required from at least some members, and where meaningful relationships were formed.  Now, that’s not to say that we don’t need independence and autonomy as well, and that’s the million year old tension - this need for significance that we have, the desire to be something special to someone, to have a unique value, to create - but then also to have connection and be part of something larger than ourselves. Dr. Wilson says it may even be that the particular level of intelligence humans have may ONLY be achievable in social creatures that have not only the pressure of natural selection, but of group and cultural selection as well, that accelerates intelligence.  

So, back to our study cohort - people who flourish feel love, belonging, and significance - it's how they are free to take leaps and are able to be vulnerable enough to be creative and take calculated risks in order to grow.  Wholehearted people, who believe they are worthy of love and belonging, have courage to create, to innovate, to reimagine themselves, because they aren’t constantly afraid of losing their worthiness if they step out of line. To use Brene Brown’s term, they aren't Hustling for their Worthiness. Belonging is a huge part of innovation and creativity. You won't take risks if you don't feel safe with your tribe if you do so.  You’ll keep living within the little boundaries you draw for yourself.  The other part of this that was especially important to me as a parent, is that when you feel worthy, you can love other people in a completely different way, because you can truly believe that they deserve your love and belonging with you, just by being who they are, without needing them to change, which is nigh impossible if you don't believe it about your own self, you’re always managing your kids to make sure they’re worthy, that they meet “the standards” of the group, whatever those are, to keep the group happy.  

So if you are, instead of feeling worthy, in a state of not- enoughness, of feeling lacking, what happens when you start to venture out and just imagine believing that you are worthy of love and belonging. That you are enough? “enoughness” is really hard to do in our society.  We live in a culture that basically trains it out of us from childhood. It takes about thirty seconds flat of looking at social media or tv to see this plain as day. And if your parents or the adults in your life who raised you didn't do this internal work, didn't know how to, and didn't truly believe they deserved love and belonging, then they couldn't teach it to you, and even if they did you can still fall victim to the surrounding culture. Add insult to injury and go to medical school and residency where you’re taught the hidden curriculum,right?  and then have a practice! Not enough sleep, not enough money, not the right weight, not a good enough mother, not a good enough wife, notes aren’t thorough enough, not tough enough, you need too much sleep, you’re not fast enough, you’re not contributing enough, you're not a good enough doctor, not enough, not enough, not enough. If you’re in that space right now where these statements ring really true for you, you are not alone - you can get out from under this mountain of shame and not- enoughness, I promise. I am here on this podcast to help you get yourself out of this and into a joyful, meaningful life that might be hard to imagine right now. I've lived this and so have a lot of other people, and there is most definitely light at the end of the tunnel for you. 

When I was pregnant with my oldest, my daughter who is almost 20 now, she was breech presentation and wouldn’t turn and so we found out like two days before that I was gonna have to have a c-section, so we had a semi-planned surgical delivery but we only had a day or two notice.  So I remember that night two days before she was born, sitting with my husband in one of our favorite places to eat, a local mexican restaurant, and I vividly remember being gripped by a quiet, creeping panic, knowing that this child, our firstborn, was going to be in the world and I would be truly responsible for a human life, and I felt the urge to jump up and run. But I knew that would’ve been silly, right, because she would just be coming right along with me, and I didn't really want to run because the responsibility, though it was immense and sometimes overwhelming, was beautiful and wonderful and a million times worth it. I’m telling you this story because when I first read this stuff, these concepts in Brene Brown’s work, I literally had that same urge to jump up and run away. But I realized that all my problems would be just coming right along with me wherever I ran, wherever I tried to hide.  I was gonna have to learn to do this, and it was gonna be scary, and sometimes overwhelming, but I sensed the potential for a change so big, so meaningful, and so full of joy, that I knew I had to do it.  

So maybe the bravest thing I ever did was to ask 7 other people, people I considered friends and knew were safe people, asked as vulnerably as I knew how (which at the time I didn't have much practice with and probably just seemed really desperate), to please start meeting together with me and working through this.  Because I didn't know how to do it alone, and the truth is that this work cannot be done in isolation from other people, even though I wouldve preferred it that way, it just doesn't work like that. I felt like the whole ground had dropped out from underneath me and I needed support, but I didn't really have a support system of friends already. I had wanted it all my life but because of some really mean kids in school when I was young, I bought into the story that friendships of the kind I wanted, the deep meaningful ones, just weren't for people like me. They were for “other people”, people who were enough in ways I wasn't but I didn't really know why, I just accepted it unconsciously as a law of the universe. So my behavior up to that point just kept perpetuating that assumption. 

So these 7 absolute badasses all said yes. And that was in 2014. And we have been together, meeting regularly since then, a few have moved away and a few have joined us. We keep up a group chat in between meetings for sharing things like successes and wins, but also when we find ourselves in shame and need a safe place to vocalize it. We keep the group chat going during hurricanes and tornadoes at 2:00 in the morning to make sure everybody’s ok and through engagements and marriages and career changes (I think every one of us has had a dramatic job change during this time, and most of us credit this work in our group with feeling empowered to make those changes, I know that was true for me), and we’ve been together through the illnesses and deaths of people we love. Some of us even gave talks at a festival a couple years ago about our group and how we did it and how transformative it has been, to teach other people how to do it. 

These women in my group (one man in the beginning, but unfortunately he moved away so we don't get to see him as much as we would like) have helped me learn, in a safe place, what real friendship and belonging are, and Ive been able to take that out into all the other parts of my life. I am so eternally grateful to them for taking that leap with me.  And here’s the truth  - you can have this too. You are worthy of love and belonging. You need people in your life who you can say “I’m a mess” to and know that you’ll get empathy and encouragement and support, or who you can say “I’m a badass!” to and they say “yes, yes you are!” and have a spontaneous disco party. You deserve that. (I gotta be careful about the word “deserve” - I’ll save that for another podcast. Suffice to say that I think we mostly use it as a weapon and I am very careful about saying that word). But you are worthy right now of love and belonging and goodness in your life, just as you are, no changes necessary to deserve anything.  And the key here is learning to believe that you’re enough. And some of the work of eliminating that feeling of not-enoughness and introducing more of the idea that you are enough, will need to happen in relationship with other people.  Between now and next podcast, think about who you might be able to bravely ask for support from, to invite into a new and beautiful role in your life.  Simple, but maybe not easy. Proven in the data. It works. 

Next episode we are going to talk about the inner critic and some really exciting ways you can change your whole self through working with your inner dialogue. I am so glad you came back for this episode, and hope that you’ll tune in with me next time for Women Physicians Flourish podcast.  In the meanwhile, you can find me at dr.lauderdale on instagram, where Ive got links to my email list and some other things in my bio, or you can go directly to my website www.rebeccalauderdalemd.com and sign up for my email list, and I’ll send you a couple exercises for working with your inner critic.  

Until then, here’s a poem by Mary Oliver called The Journey, that I think speaks beautifully to this Journey we are all on:

One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice --
though the whole house
began to tremble
and you felt the old tug
at your ankles.
"Mend my life!"
each voice cried.
But you didn't stop.
You knew what you had to do,
though the wind pried
with its stiff fingers
at the very foundations,
though their melancholy
was terrible.
It was already late
enough, and a wild night,
and the road full of fallen
branches and stones.
But little by little,
as you left their voice behind,
the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do --
determined to save
the only life that you could save.

Much love, friends, until next time