Did you realise that rectify, rectangle, direction, correct, etc – are all related?
The penny dropped for me when as a first year medical student, in an anatomy lecture, I heard that the word rectum signifies the straight shape of that part of the bowel.
Had to be told about the origin of the word Ukraine as the borderlands – and not quite sure I buy it.
Words. Words can change how we feel in an instant, they can prime us to act in a certain way without us knowing – but they also can completely misfire.
It seems very obvious now, but it took me ages to figure this out: people don’t always mean what they say.It’s not necessarily because they are lying, but a lot of the time it is because they lack insight and communication skills.
What really hammered it home to me was when a consultant psychiatrist was explaining to me how to handle the “admit-me-or-I-will-kill-myself” kind of presentation. He asked me a very simple question: “If you wanted to kill yourself, would you go to a hospital to inform the doctor?” I’ve no intention of trying to simplify the complex issue of suicide, but there is certainly a type of patient who honestly believes they want to kill themselves and come to hospital, still. Why??? Because the words are misfiring. The words they are saying are: “I want to kill myself”. What (some of them) mean is that they are in so much emotional pain that they have no idea how to get out of it, but they would really like help. It can be, strangely, easier to identify the desire for suicide as the problem because it is a bit more external – at least compared to one’s coping skills.
The moral of the story was: people don’t always mean what they say – and they may not even know it.
This disconnect between words and insight is well known among international relations officials. Here what is said is just as important as what it is left unsaid. The people who answer questions at conferences (e.g. press conferences at the White House) aren’t the officials and military generals actually who know the most. The spokespeople are briefed in a very specific way and believe the things they say. It is too difficult to have insight into how you will be understood, so they get people who specifically understand the exact right stuff.
The significance of precise language is well known in Hollywood.
The production team of Gone with the Wind fought long and hard just to be allowed to have Rhett say “Frankly, my dear, I don’t give a damn.”
Damn was a vulgar word and the censors weren’t happy. However, “I don’t care” just doesn’t provoke the same emotions. Also, it is often said that the word frankly was an unscripted improvisation by Clark Gable – it wasn’t. It’s just different from the book, but that’s how it was in the script.
Nassim Nicholas Taleb said it well here:
when one of these [Salafi] fundamentalists talks to a Christian, he is convinced that the Christian is literal, while the Christian is convinced that the Salafi has the same oft-metaphorical concepts to be taken seriously but not literally –and, often, not very seriously.
What got me reminiscing about this was a post by FJ of The Pensives about critical thinking as an antidote to manipulation. FJ identifies reading people (and empathy) as a key part of examining one’s true intentions. FJ’s insight certainly resonates with my own – that there is meaning way beyond words. I think context needs to be examined. Incentives need to be looked at. FJ’s argument is that putting oneself in someone else’s shoes is important. Maybe he is saying the same thing in different words – no pun intended, but there’s also a potential caveat here. It’s best expressed by Nicholas Epley wrote in his fabulous book Mindwise:
Reading body language and trying to take on the other’s perspective doesn’t seem to help to understand the person better. What does help is creating situations where people can openly tell you what they think – and listen carefully.
Obviously, that’s not always possible. However, the point I am trying to make is that while empathy has become an increasingly popular concept, we shouldn’t envisage it as an antidote.
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My mother is in the throes of learning a foreign language – and I am doing my best to help. I am bilingual in English and Russian. There are definitely lots of people more talented at languages than I, but I am always surprised at how exceedingly rare people with near-perfect grammar and pronunciation in two languages actually are. Indeed, it is one of the things that stops me from wanting to learn another language – knowing how hard it is to get to proficiency.
In my attempt to help out with my mam’s progress, I found a lecture from this polyglot on the psychology of learning a language. He made a very interesting point:
in order to speak a different language you need to mentally switch wavelength and adopt a new persona. He argues that a language has a certain emotional state associated with it.
I don’t think it’s as literal as “happy vs sad”, but it’s more like a feeling you get when you speak a language. To be blunt about it, I imagine if I tried to speak Italian I would be more laid back and extroverted than if I tried to speak German. Indeed,
a few of my close friends remark that my mannerisms, tone and timbre all change when I switch between my two native languages. I had zero insight into this until I was told about it.
On reflection, I realised that a friend of mine who is fluent in German and English does something similar. He kind of seems to look at his shoes more when he speaks German – and seems generally less approachable.
I also feel quite different when I am speaking English vs Russian. This is going to sound like I’ve lost the plot, but I can think of no better way to describe it.
In English, things are slick – like an iPhone. In Russian, things are deep and meaningful – like Dostoevsky.
I like to listen to podcasts. I realised that listening to a good podcast in Russian made me see the speaker as being intelligent, whereas a good podcast in English made me feel that the speaker is competent. The difference is subtle and so cliché! It gets worse. The Russian speaker always seems a little too direct – though not aggressive – and the English speaker seems a little sales-pitchy. I mean that’s just caricature-worthy – but also true.
It looks like I am susceptible to the “national stereotype” biases even though I am well able to play for both sides and understand that these are just biases.
Much as I hate to admit it, I think I am also more polite when I speak English – and probably more tolerant. At the same time, I would also tend to oversimplify things more when speaking English.Perhaps having to speak English as a lingua franca has changed the world. The Financial Times has an interesting published an article portraying the ultimate beneficiaries of this arrangement as its victims here, arguing that China and Russia understand the USA and UK much better than they understand the rest of the world.
English is a language that doesn’t really allow for long sentences because there aren’t sufficiently complex noun and adjective endings, verb conjugations, etc to show what belongs where in a long sentence. For example, a typical German sentence is longer – because they do have the necessary grammatical framework.
In order to make sense in English, sentences have to be short and declarative – and by proxy, so do one’s thoughts.
All in all, there is definitely a persona-migration that happens in my head when I switch languages.
But that, as usual, got me thinking.
Adopting a persona to do any task at all is a thing. It’s not limited to languages. It’s a bit like having an implicit role model. It’s a dangerous game to play though.
On the one hand, it seems to make things easier. If one imagines themselves as a competent surgical trainee from Gray’s Anatomy, studying for medical finals get that little bit easier. However, isn’t this a departure from reality? I really like the point brought up in Steven Pressfield’s War of Art: imagining yourself as a poet/artist/programmer/whatever – is only a vanity project. The point isn’t to define oneself as a poet/artist/programmer/whatever, the point is to make poems/art/code/whatever. Acting in a role, faking it until you make it is well and good, but travelling too far out into the world of alter-egos, be they Italian or surgical, should be done with a lot of insight.
“I hesitate to give advice because every major single piece of advice I was given turned out to be wrong and I am glad I didn’t follow them.”
– Nassim Nicholas Taleb
Taking advice from anyone, be it Seneca, an aunt or an admired mentor is risky business. Almost everybody who gives advice means well – even those who make money by doing it. However, it is very easy to overgeneralise with advice. It’s also tempting to shift part of the responsibility for results onto the advice giver – without meaning to do so – just one reason we are drawn to good advice, hacks, secrets, tricks and shortcuts. It’s also not uncommon to receive conflicting advice from seemingly reputable sources. What to do then? Here are four questions to ask before deciding to take on advice.
Is it advice or is a fact?
Exercise is good for you is a fact; it’s not advice. It applies to everyone from recent ICU patients to pregnant women to the elderly to – basically everyone. Obviously, the application of this fact is different for all these people, but it is all based off the same fundamental principle. High-intensity interval training and a ketogentic diet would be good for you is advice. It doesn’t apply to everyone. People who say it assume that everyone is just like them, so it will work for everyone (or for a critical mass that makes the rest irrelevant). It won’t work for everyone – simply because the assumptions don’t hold for everyone. It’s not 100% clear what those assumptions are, perhaps it is genetics, microflora, etc, but it’s not a fact and as advice it needs to be refined, i.e. made contextual – I will explain further on.
How does one distinguish between facts and advice? It’s probably an intuitive judgement that relies on the universality of a statement. If it is a fact, great; a new gem for our wisdom collection. If it is advice, we shall continue to investigate.
Is it a sales pitch?
Watch an interview with Richard Branson. He always says it is very important to let go, not hold a grudge and other such merry stuff. He also always brings up this example: when he started his airline, British Airways tried to sabotage it through a series of illegal tricks like calling Virgin passengers, telling them their flight is cancelled and rebooking them with BA. Being the sound lad that he is, he made up with the management of BA after the dust settled on their conflict. Great story. There’s just one problem. If Mr Branson really took his advice seriously – he wouldn’t have gone around 20 and 30 years later dragging British Airways through the dirt. Yes, they arguably deserve it, but it certainly isn’t an example of letting go and being sound. What it is, is a sales pitch for people who lack insight. Branson is basically talking up the brand that centres so significantly around his persona. If he is sound, surely you will want to buy from him and his c. 400 companies.
There are, of course, less subtle examples of this. Is there a conflict of interest? The most obvious example comes from the glut of people online who sell X teaching others how to sell X. For example, people who sell courses on how to sell courses. Professional advice givers that aren’t really professional – the many life coaches out there – are in that same category. To be fair, even doctors and lawyers could be accused of this. The difference is that there is a greater degree of responsibility that the provider assumes for their client. So the difference isn’t qualitative, it is quantitative.
Taking advice from mentors is ridden with problems too. They have an ego and a reputation to defend. Before I went into medicine, Every. Single. Doctor. I met told me not to do it. They told me I would regret it. Once I was in it, it was a different game. They couldn’t talk to me earnestly like before because they had standards and facades to uphold – a vision to sell. Any complaint regarding the issues in medicine goes down like we’re in the Stanford prison experiment. Ok, it’s not a sales pitch, but it’s a perversely related beast based on a conflict of interest.
The reason advising in various shapes and forms is a whole industry, is that it sells. It sells just like Coke. Advice is a product, it’s the intangible magic pill – one that makes us feel good too.
Is this advice contextual?
Advice without context is meaningless. That part of the advice industry that is tailored is useful. So for example, a one-on-one consultation with a doctor or lawyer, an engagement with a management consultant would be contextual. They ask questions, in other words, they find out the context. All advice should really always carry the same disclaimers as medical advice. For example, Marcus Aurelius’ advice to live every day like it’s our last isn’t right for everyone. Similarly, just because Jimmy does better on the purple inhaler doesn’t mean that Bobby will too. It wouldn’t be right for Jimmy to tell Bobby to throw out his brown inhaler and buy a purple one. This logic should be applied to all advice.
This is one of the reasons why “secrets” often traded by people who did well in something are of limited value. They lack context. Furthermore, this is made worse by a certain cognitive bias: once one learns something, it is virtually impossible to imagine not knowing about it.
Daniel Kahneman, in his wonderful Thinking Fast and Slow, showed that we have 2 systems: one intuitive, stereotype-driven fast system, and the other logical slow system. The trick here is that everyone’s fast system is slightly different. The point of giving advice is to elicit an idiosyncrasy about this particular person’s fast system that is so far from reality that it is hurting them.
Do I want to swap places with this person?
It’s only a crude proxy, it doesn’t always apply, but generally, unless a person is living your dream at least in that aspect of their life on which they are advising – it’s probably not worth taking their advice. It still a valuable data point, but not good advice. This is why it is hard to take advice from overweight doctors and why reading the biographies of philosophers has me feeling shocked with their trail of pregnant land ladies and other hypocrisies. It is also the reason why role models are usually more beneficial than advice givers.
And yes, I know that someone out there will call this advice – or even meta-advice! However, I don’t think it is possible to give advice by asking questions. Questions direct people to narrower answers, but I do believe that this set of filters will lead to more thoughtful and relevant decisions.
Read all posts about being an ENTP
As a female ENTP, I am a reasonably uncommon breed. It’s not that I think that Myers-Briggs cracked some super important code – I don’t believe the “science” behind it, it’s a little horoscopy, but it is consistent – and they managed to describe certain things with impressive precision. It has been described elsewhere, but I will keep calling it ENTP for clarity.
Having millennial restlessness superimposed on ENTP-ness is tough. In a world where doing one thing really well gets rewarded exponentially well, it’s also scary. I remember being a medical student and shadowing teams in St. James’ Hospital. After a difficult thyroid surgery, I was waiting for the next case and observing the wonderful Professor T., a well-known Dublin Ear Nose and Throat (ENT) surgeon, reading the newspaper in between two surgeries. I was wondering what he was thinking.
I just imagined life as an ENT surgeon: day in and day out taking out tonsils, resecting thyroids and realigning nasal septa – by choice!
I don’t think I could do it. Thank God there are people who can. I respect it hugely and I fully understand we need it. Indeed, if he was even more specialised – and only ever did tonsils, let’s say, that would be even better for the patients. But what would it be like for him? How can one continue to find new facets to something like a standard surgery? He didn’t strike me as the type who couldn’t wait to go home. There must have been something there for him that was clearly missing for me.
As you know, I have a strong dislike for self-help books. However, one of my favourite social media personalities (she’s Russian, so she may not be super interesting to the reader), reads Barbara Sher and specifically recommended a book called I Could Do Anything If I Only Knew What It Was. The name did resonate with me. I never thought that a book like this would interest Maria. Maria left her job in – I think – publishing soon after she started to found her own beauty business. She’s married to a serial entrepreneur. Together they make an impressive couple: I think they started with quite little and now they’re running a few interesting ventures – and there’re babies everywhere. It would seem that she knows exactly what she wants. Apparently not.
Once again, it reminds me of how pointless it is making inferences about other people’s lives. Anyway, I am currently reading the book.
It’s not as cringy as I had expected. I skipped a few chapters that seem to bear no connection to me. However, Chapter 6 relates directly to ENTPs, without calling them that.
Sher describes people who want to try everything, to understand how everything works, who feel that by dedicating oneself to X, you are tragically missing out on Y.
Sher argues that our biggest problem here is the belief that there is very little time to do everything, hence, we hysterically push ourselves into a niche hoping that it will fit. I completely agree that that’s true. At the same time, while Mrs. Sher may have an interesting point, I wonder how it related to the exact opposite point made by the Stoics. They argued that one of the worst things you can do is assume that there’s lots of time.
I think the resolution of this dilemma is obvious. Advice is meaningless without context. It’s like those men who teach about business always say: Never underestimate your opponent. For this advice to be useful for me, I have to multiply it by -1. Never overestimate your opponent. [Obviously there are limitations here, but it is a more useful heuristic given my world view.] The bottom line is that it’s impossible to know the beliefs and assumptions of your readers. That’s why therapy works, but self-help books don’t. It’s all in the context.
If you’re reading this and you are an ENTP kind of person, don’t think that time is completely against you. I think we are prone to be hyperaware of some realities like the merciless passage of time – but we get stupefied by lists and all of these endless techniques on how to get organised. We’re already organised. We’re not distracted. We’re aware of the dangers of endless distraction. However, banning ourselves from pursuing them is just against our nature.
With this in mind, Sher recommends to write out the 10 lives that you will you could live. My list includes that of a retail investor, a philosopher, a psychiatrist, a blogger, a painter among others. Her argument is powerful: look at the list and see what can be done in 20 minutes a day – or just occasionally. I underlined this:
“Don’t dedicate yourself to poetry. Write poems.”
This thought was also brought up in a different context in Steven Pressfield’s War of Art and the less interesting Ego is the Enemy by Ryan Holiday. As it stands, I already feel a lot of pressure from society to be able to say “I am X.” A doctor, a management consultant, a journalist – whatever. It makes no sense to add to this pressure by imposing my own restrictions. Furthermore, most of the time, it’s just a way to romanticise what one’s doing. If I like it, I will do it. Labels just aren’t for ENTPs. Of course, it’s not just ENTPs. Richard Branson and Elon Musk don’t have to explain their meandering interests to anyone – because they’ve already won.
In a world that likes to label people, it takes courage – and yields tremendous benefit to remain unlabelled.
If you are an ENTP, or this feels like the story of your life – leave a comment – let’s be friends ❤
In all my time in medicine, psychiatry was certainly the steepest and most unexpected learning curve.
The truth is that I started off as a pro nerd who wanted to be a surgeon. When they said medicine is an art and a science, I was just waiting for them to stop. In medical practice, choosing an antihypertensive drug is not an art. Perhaps, looking for new mechanisms of action is more creative, but not the practice of prescribing. There are scientifically rigid algorithms on how it should be done as of today, and the rest is harmful heresy – not art.
When I was in first, second and third year of medicine, I was convinced I wanted to do general surgery. Possibly paediatric. I took serious steps to that effect. I found a family friend who was a surgeon, and aged 19, I was spending my summers doing 36 hour shifts of shadowing surgeons. Scrubbing in on critical abdominal aortic aneurism ruptures, appendectomies, cholecystectomies, you name it. I learnt much faster in those 3 months of summer than surgical trainees in their cursus honorum residency.
At that time, I was shaping up to become a pragmatic and practical surgeon. We all know the kind of culture that is prevalent among surgeons – especially 10 years ago. Needless to say, it rubbed off on me too and I was expecting psychiatry to be a wishy washy waste of time. There was no stigma, no prejudice, no resistance – just an expectation of something I will have no interest in.
Then my college experience of psych began. I recall being late to the first lecture and sitting down at the back with one purpose only: make sure I am signed it. I wasn’t expecting to learn anything other than a bunch of genetics concerning schizophrenia and Alzheimers and be lectured on good communication skills.
I was so wrong.
My attention was instantly captivated by the lecture. It had nothing to do with the lecturer: he was ok, but it’s not like he was ultra captivating, charismatic or whatever. It was the substance of what he was saying. The lecture was on something called phenomenology (the study of subjective experiences). So for example, I learnt what the difference is between an illusion and a hallucination. What knight’s move is. Perseveration. Running commentary.
It was fascinating. It was like a parallel universe just opened up to me. I was entirely unfamiliar with all of these things. No portrayal of these phenomena in films comes close to actually considering what it is like, never mind meeting a person who suffers from such a thing. Maybe A Beautiful Mind is a place to start. But still, it barely, I mean barely, scratches the surface. I was in the industry, I was top of my class and yet until I went and properly exposed myself to it – I was so so ignorant. It is important to realise that the general population, no matter how educated, has absolutely no idea what a person with a severe and enduring mental health problem goes through. Zero.
As a fervent advocate of the scientific method, I would like to point out the role of art in this. It’s not art in some kind of mystical, deeper meaning sense. It is art in the sense that it is creative. Surgery is creative – but in a practical sense. It’s just a more conservative field.
Psychiatry is cognitively creative. It’s not algorithmic like most of medicine. Much of it has never been done before. The DSM differs so much edition on edition, that it is clear that we haven’t even come close to understanding what’s really going on. Paradoxically, the actual practice of psychiatry is quite intuitive 90% of the time.
Ten percent of the time, though, psychiatry requires a doctor to think outside the box in another dimension. Because you cannot MRI someone’s brain and say – this is mercury poisoning, not dementia. This isn’t depression, this is catatonic schizophrenia. You really need to not just think, but rely on something less tangible – does it feel like this person is depressed or does it feel like it’s EUPD? Freud tried putting all kind of names on these intangible feelings. It’s just a first attempt. Is it possible that both of these diagnoses are missing the point of what’s really going on beneath the surface and in another 20 years the DSM will have neither of those in it? If House solves puzzles, this is solving puzzles when you have no idea what the resulting picture is going to be.
Following on from my recent thoughts of what schooling does to our brain, I wanted to reflect on what happened to my friends who showed themselves to be remarkably intelligent in school. I have a circle of friends made up of people with IQs at least over 140 (sounds rough, I know, but thankfully it’s not limited to that). Seriously though, it’s interesting to reflect what had happened to my most intelligent friends over the 10 years that have passed since leaving school.They all did incredibly well in their exams. They all come from different countries and backgrounds: some come from well off families, which cannot be said of others.
I have observed a few different paths:
Of note, none of them have children of their own at this point. Many of them have travelled a lot and even permanently immigrated, mostly to the United States.
All in all, I think all these superbly intelligent people have fallen into different categories driven by what they value most. In terms of their values the most important spectrum seems to be their appetite for risk. Is there success here? It all depends on how you define it. They are all doing well financially. They are all reasonably happy, it seems. There’s no one size fits all recipe for success here. They only one I can suggest is play to your strengths and go all in.
I often say on my blog for secondary school students that it’s all about balance. I feel wishy washy about it when I say it, so I wanted to tell this story to explain.
I recall spending some time with a dear friend of mine. She is a hugely successful physician now in one of the world’s top universities. This is way back when we were about 19 – in the throes of medical student life.
My friend, let’s call her Angela, is a particularly classy lady. She grew up in one of the finest neighbourhoods in a nice Irish city, educated privately, fancy extracurricular activities, the whole thing. She’s a gunner though, that girl. Being wealthy doesn’t automatically make you soft, and she’s the perfect example of that.
We were probably the only 19 year olds in Marks & Spencer’s buying things like dark chocolate and fresh linguini while our college classmates were out drinking 2 for 1 cocktails or Dutch Gold and eating frozen pizza. We spent our afternoons watching Gray’s Anatomy, The Other Boleyn Girl, Marie Antoinette, Coco Before Chanel, Gilmore Girls… And studying (her way more than me). You get the gist.
I never judge people for indulging. It would never occur to me to begrudge someone their luxuries or criticise them for being wasteful. So when I remarked on the fact that she has expensive taste, she was relaxed about it and said: If you can’t eat properly, what’s it all for?
This throwaway remark got etched on my brain. What’s it all for if you can’t be with your family? What’s it all for if you can’t sit and meditate for 10 minutes? What’s it all for if you can’t enjoy yourself for even a little part of the day? I don’t think she meant it that existentially. The way I took it was more in the stoic philosophy sense: live every day like it’s your last. As a true medical student workaholic fanatic, who was ready to give up everything for success, I never thought that living each day like it’s your last is about more than just achieving. I think if you work really hard, weirdly, sometimes it is easy to lose respect for yourself in a certain way. You become your own slave, the executive of your dreams, but not the person who actually gets to live them. That’s what I mean by balance.
This post came out recommending things that doctors should and shouldn’t do on social media.
So the article sites these 5 things you should never post as a doctor on social media:
1. Inaccurate Medical Information
2. Anything that Violates Patient Confidentiality
3. Your Personal Information
4. Opinions on Controversial Issues
5. Complaints or Rants
Point 1 is universal. It has to do with due diligence and integrity, not with being a doctor. Point 2 – about patient confidentiality – is sacred. 100% agreed.
My questions is:
Must a doctor always continue to be a doctor on social media?
A doctor isn’t a public figure – with a few notable exceptions. Doctors don’t have a responsibility to treat every interaction with another human being (including virtual interactions) like they are consultations with a doctor. Anybody who perceives it that way is misguided. The same way you don’t expect a lawyer who sat down beside you in a coffee shop to give you bulletproof advice or a professional investor sat next to you on an airplane to tell you the next big stock – you shouldn’t expect a doctor to remain a doctor in non-medical situations.
The rules above are coming from a place of fear. While the above is probably meant as a recipe for an easier life, it seems to put constricting expectations on doctors that will ultimately harm them and their patients.
As it stands, doctors aren’t outspoken enough about problems they face. They are the last to complain, the last to go on strike, the last to give their opinions on how their own system could be improved. What if they talk about their problems? Is it going to get controversial? Hell, yeah!
A propagation of fearful attitudes called for by the author of the linked article couldn’t possibly alleviate the global healthcare problems that we are all facing. Yes, information should be accurate and useless rants are… useless. However, given the extent to which doctors like to follow rules verbatim, it seems that the above rules (“don’t speak unless spoken to”) wouldn’t serve them well in the long run.
A millennial's musings 