“People think of depression as being just sadness. It’s much, much too much sadness, much too much grief at far too slight a cause.
(…) what it is that causes some people to be more resilient than other people. What are the mechanisms that allow people to survive?
Depression is so exhausting. It takes up so much of your time and energy, and silence about it, it really does make the depression worse.
Shutting out the depression strengthens it. While you hide from it, it grows. And the people who do better are the ones who are able to tolerate the fact that they have this condition. Those who can tolerate their depression are the ones who achieve resilience.
Valuing one’s depression does not prevent a relapse, but it may make the prospect of relapse and even relapse itself easier to tolerate. The question is not so much of finding great meaning and deciding your depression has been very meaningful. It’s of seeking that meaning and thinking, when it comes again,“This will be hellish, but I will learn something from it.”
The opposite of depression is not happiness, but vitality, and these days, my life is vital, even on the days when I’m sad. I felt that funeral in my brain, and I sat next to the colossus at the edge of the world, and I have discovered something inside of myself that I would have to call a soul that I had never formulated until that day 20 years ago when hell came to pay me a surprise visit. I think that while I hated being depressed and would hate to be depressed again, I’ve found a way to love my depression. I love it because it has forced me to find and cling to joy. I love it because each day I decide, sometimes gamely, and sometimes against the moment’s reason, to cleave to the reasons for living. And that, I think, is a highly privileged rapture.”
“Your home is whatever in this world you love more than you love yourself. So that might be creativity, it might be family, it might be invention, adventure, faith, service, it might be raising corgis, I don’t know, your home is that thing to which you can dedicate your energies with such singular devotion that the ultimate results become inconsequential.“
“Look, I don’t know where you rightfully live, but I know that there’s something in this world that you love more than you love yourself. Something worthy, by the way, so addiction and infatuation don’t count, because we all know that those are not safe places to live. Right? The only trick is that you’ve got to identify the best, worthiest thing that you love most, and then build your house right on top of it and don’t budge from it. And if you should someday, somehow get vaulted out of your home by either great failure or great success, then your job is to fight your way back to that home the only way that it has ever been done, by putting your head down and performing with diligence and devotion and respect and reverence whatever the task is that love is calling forth from you next. You just do that, and keep doing that again and again and again, and I can absolutely promise you, from long personal experience in every direction, I can assure you that it’s all going to be okay. Thank you.”
- Elizabeth Gilbert.
“If I start by assuming the worst and work backwards, I can make sure that the protections we build work for both expected and unexpected use cases.”
“Given that I spend my days and nights imagining the worst that could happen, it wouldn’t be surprising if my worldview was gloomy. It’s not. The vast majority of interactions I see — and I see a lot, believe me — are positive, people reaching out to help or to connect or share information with each other. It’s just that for those of us dealing with scale, for those of us tasked with keeping people safe, we have to assume the worst will happen, because for us, a one-in-a-million chance is pretty good odds.”
You can’t help it; sometimes, you just get a bad feeling about someone that’s hard to shake. So, what’s happening in your brain when you make that critical (and often lasting) first judgment? Peter Mende-Siedlecki shares the social psychology of first impressions — and why they may indicate that, deep down, people are basically good.
I had to watch it a dozen times in order to get the essence of his talk. It is very dense. So, how do we all get good at what we’re trying to do?
“I got my start in writing and research as a surgical trainee, as someone who was a long ways away from becoming any kind of an expert at anything. So the natural question you ask then at that point is, how do I get good at what I’m trying to do? And it became a question of, how do we all get good at what we’re trying to do?”
“In the last few years we realized we were in the deepest crisis of medicine’s existence due to something you don’t normally think about when you’re a doctor concerned with how you do good for people, which is the cost of health care. There’s not a country in the world that now is not asking whether we can afford what doctors do. The political fight that we’ve developed has become one around whether it’s the government that’s the problem or is it insurance companies that are the problem. And the answer is yes and no; it’s deeper than all of that.”
“The cause of our troubles is actually the complexity that science has given us.”
“We’re all specialists now, even the primary care physicians. Everyone just has a piece of the care. But holding onto that structure we built around the daring, independence, self-sufficiency of each of those people has become a disaster. We have trained, hired and rewarded people to be cowboys. But it’s pit crews that we need, pit crews for patients.“
“Our experience as people who get sick, need help from other people, is that we have amazing clinicians that we can turn to — hardworking, incredibly well-trained and very smart — that we have access to incredible technologies that give us great hope, but little sense that it consistently all comes together for you from start to finish in a successful way.”
“Having great components is not enough, and yet we’ve been obsessed in medicine with components. We want the best drugs, the best technologies, the best specialists, but we don’t think too much about how it all comes together. It’s a terrible design strategy actually.”
“Now a system, however, when things start to come together, you realize it has certain skills for acting and looking that way. Skill number one is the ability to recognize success and the ability to recognize failure. When you are a specialist, you can’t see the end result very well. You have to become really interested in data, unsexy as that sounds.”
“Which brings us to skill number two a system has. Skill one, find where your failures are. Skill two is devise solutions.”
“And so we looked at what other high-risk industries do. We looked at skyscraper construction, we looked at the aviation world, and we found that they have technology, they have training, and then they have one other thing: They have checklists.
Could we design a checklist for surgery? Not for the lowest people on the totem pole, but for the folks who were all the way around the chain, the entire team including the surgeons. And what they taught us was that designing a checklist to help people handle complexity actually involves more difficulty than I had understood. You have to think about things like pause points. You need to identify the moments in a process when you can actually catch a problem before it’s a danger and do something about it. You have to identify that this is a before-takeoff checklist. And then you need to focus on the killer items. An aviation checklist, like this one for a single-engine plane, isn’t a recipe for how to fly a plane, it’s a reminder of the key things that get forgotten or missed if they’re not checked.”
“And that brings us to skill number three, the ability to implement this, to get colleagues across the entire chain to actually do these things. And it’s been slow to spread. This is not yet our norm in surgery — let alone making checklists to go onto childbirth and other areas. There’s a deep resistance because using these tools forces us to confront that we’re not a system, forces us to behave with a different set of values. Just using a checklist requires you to embrace different values from the ones we’ve had, like humility, discipline, teamwork. This is the opposite of what we were built on: independence, self-sufficiency, autonomy.”
“Making systems work is the great task of my generation of physicians and scientists. But I would go further and say that making systems work, whether in health care, education, climate change, making a pathway out of poverty, is the great task of our generation as a whole. In every field, knowledge has exploded, but it has brought complexity, it has brought specialization. And we’ve come to a place where we have no choice but to recognize, as individualistic as we want to be, complexity requires group success. We all need to be pit crews now.”
How parasites turn our thinking sideways: Ed Yong at TED2014. A fascinating talk on behaviours and manipulations.