Category Archives: Psychology

Standing Up to Authority

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Unknown-1In 1978, as United Airlines flight 173 was approaching the airport in Portland, Oregon, the captain noticed an abnormally loud thumping sound, along with an unexpected vibration and a yawing motion to the right.   The captain aborted the approach and began to circle the airport while trying to solve the problem.   Steeped in thought, he circled the airport for an hour, just long enough for all the fuel on board to be exhausted.   The first officer casually mentioned the low-fuel condition to the captain, but the captain was too entrenched in problem-solving mode to heed the warning.

The “good news” was that only 10 of the 189 people aboard died from the resulting crash because the lack of fuel on board prevented a fire on impact.   And as a result of the accident new recommendations were put into place that led to what is now called crew resource management.   This is a set of procedures pertaining to how members of the crew are to relate to one another in order to prevent confusion.   One of these procedures has come to be called the “sterile cockpit rule,” in which no idle chatting is permitted below 10,000 feet (i.e., on takeoff and landing).  Another pertains to the importance of speaking up assertively in the face of authority until a problem is resolved.

When I ran my own company I encouraged my employees to reveal to me any inadequacies they saw in the company.   One of my supervisors sent me an email in which she outlined, in detail, all the things she thought was wrong with the company.   When I received the email, I called to thank her and ask her permission to share her email with the other supervisors.   I heard her take a deep breath, after which she said that she thought my phone call was going to be her termination notice.  I told her that I admired her courage, and that I wanted to not only address her concerns, but to encourage other supervisors to emulate her.

Before I ran my own company, I worked for two non-profit mental health centers.  In both places, I climbed the executive ladder quickly, moving from therapist to assistant clinical director at one agency in a matter of two years, “climbing” over others who were in some cases twice my age.   Even in those days, I knew the “trick” was to meet with the people running the show, and respectfully tell them how they could do their jobs better.   Though I knew I could be fired because they thought I was an egotistical upstart or gunning for their job, I had the good fortune of working for leaders who were not intimidated and did what James Collins (in the classic management tome “Good to Great”) saw as a hallmark of a great company– actively breed and nurture leaders who would ultimately take their pace.

In my private pilot checkride,–the crucible that determines whether or not you earn your ticket to fly, there were three instances in which the examiner raised his eyebrows because I made decisions that were contrary to his expectations, but proved to be in the best interest of safety.   Technically, the student on a checkride is acting as “pilot in command,” but most students emphasize the “acting” and will defer decisions to the examiner, who has the authority to determine your future ability to fly.   It turns out that I made a lot of mistakes during my checkride, and was fully expecting to fail, but when the examiner told me I had passed I looked at him nonplussed, and he said to me, “You earned it.”   I suspect it had a lot to do with the decisions I made to unabashedly yet humbly defy his preferences.

Several major aviation catastrophes later, a lack of standing up to authority has been cited as a potentially critical link in the accident chain.   Without a doubt, leaders need followers in order to lead, but the best leaders know that the best followers are the ones who can be counted on to speak up, even at the risk of being punished for doing so.

 

The Golden Rule: Leave Yourself an Out

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images-4Most of us were taught that doing unto others what you would have them do unto you was the “golden rule.”     The well-known aerobatic pilot Patty Wagstaff once said that for pilots the golden rule was these simple four words:  leave yourself an out.

Pilots get into deep trouble when they forget that rule.   They fly into canyons not knowing what might greet them around the corner (such as a transverse mountain boxing them in).    Or they fly into bad weather because they failed to locate an alternate airport.   Or they fly through a hole in the clouds not knowing what will greet them on the other side of the hole.  Failing to leave oneself an escape route, an alternate way out, can end in disaster.

I used to think of it as slightly awkward when behavior therapists define the goal of therapy as increasing one’s access to reinforcers.   It sounded superficial, but as is often the case, it turned out to be more profound than it sounded.   (A reinforcer, for the uninitiated, is something that will increase or decrease the likelihood of engaging in the behavior that came before it.) Increasing one’s access to reinforcers can be thought of as simply being able to make more effective choices in life.   It means giving yourself as many “outs” as you can.

Andrew Solomon once wrote that every person who suffers from deep depression has one thing in common:  they feel trapped in one way or another.    Whatever their situation, they believe they have no choices left, no “outs.”  When I work with depressed clients, I often try to uncover the source of the trapped feeling, if it isn’t readily apparent.  Helping someone to find an “out” by exploring possibilities that may not have been considered can be a great relief.

Leaving yourself an out works in business negotiations as well.   Every negotiator knows that the first step in negotiating is to not allow oneself to “need” the deal.   One must always be able to visualize and get comfortable with the idea of rejecting the deal altogether. Leave yourself an out.

It may be sheer insecurity or claustrophobia that causes me to check where the exits are every time I go into a movie theater or crowded place.  I even look at the ceiling in elevators and try to discern how to unlatch the top in order to access the roof in the event of getting caught between floors.  Maybe I take aviation’s golden rule too seriously, but then again, experienced aviators have decided to take this idea and plate it with gold.

I have, in my time, met a few pilots who seemed to have merged the two goldens, devolving into the attitude represented by “Do unto others, then run like hell!”  Perhaps it works better to keep them separate but equal:  Do unto others as you would have them do unto you, and always leave yourself an out.  Works for me.

 

If You Can’t Get to Heaven: Leo Sandron and Ward 407

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images-2The food that was served to the staff in the cafeteria at Metropolitan State Hospital in Norwalk was just as bad as the food served to the patients.   That’s why many staff members walked across the street to the cafeteria at the modern headquarters of Bechtel, where we could sit and dine among the white shirts and ties of the engineers who were designing nuclear reactors and cities in Saudi Arabia.

I was sitting at a table with my supervisor, Leo Sandron, when a loud, corpulent psychiatrist walked over to us.   After Leo introduced me as his psychology intern, the psychiatrist remarked, “Oh, so you’re on ward 407.   You know what they say?  If you can’t get to heaven, go to 407!”

Attempting to enter the modern era, a few years earlier the hospital started calling the wards “units,” in order to sound less like what they were, psychiatric wards for the patients no one else wanted or could handle.   The hospital in Norwalk, still functioning to this day, was the dumping ground for patients who were involuntarily committed throughout Southern California.

I was lucky to have been assigned to unit 407, because it was the only enlightened unit in the hospital.  That was due primarily to one remarkable individual, my supervisor, “Dr, Leo.”   Leo was one of  a dying breed; a humanistic psychologist in a hospital that was one of the most inhumane places I had ever seen.   His unit had the reputation of being the only one on the hospital from which patients were ever discharged.  That’s because it was arguably the only unit in the hospital where the patients weren’t trapped in a medical nightmare.

Leo had a “secret sauce,” a therapeutic ingredient that no one else in the hospital had.   That sauce was work.   On his off hours he would go to businesses in the area and convince the owners to hire his patients.   He would then give his patients “passes” to go to work in the community for part of their day.   At work, patients who had been hospitalized in some cases for decades would shed their engrained identities as patients and gain dignity for a few hours a day at a job “on the outside.”  On the inside Leo had a motto that he would recite to patients whenever he saw evidence to the contrary: “There are three things you aren’t allowed to do here: you can’t be sick, crazy or lazy.”

Leo had the glass windows removed that separated the nursing station from the day room, so the nurses and psychiatric technicians couldn’t hide and separate themselves from the patients.   No other unit did that, mostly out of fear for the staff’s safety.  He would smile broadly when he saw you and rub your shoulders; he believed in touching both staff and patients, and we loved it!   He held psychodrama groups daily, with the staff members participating alongside the patients, and although he was a rather funny looking, overweight fellow himself, he led daily exercise groups as well.  He not only gave me permission to run poetry writing groups with the patients, but he connected me with the foremost poetry therapy proponent in LA, who at the time was teaching at LA City College.   And he scolded me for submitting a patient to psychological testing, because he believed that testing should only be done therapeutically and the projective tests I was giving only led to patient regression.

When I worked with Leo it was close to the end of his career, and he appeared to be fighting off his own depression.   When I talked to him about it, it was clear that he was struggling with the medicalization of the hospital (and his beloved wife Frances’ declining health).   The new medical director put psychiatrists in charge of each unit, when previously the staff member who earned the most respect, regardless of their position, had led each unit.   And a renewed push was placed on medication as the only legitimate treatment method; the humanistic changes that Leo made on his unit were being pushed to the side.

Leo has long left us, and while I am not a big believer in heaven or hell being anywhere other than on earth, if there is a heaven outside of 407, Leo is there rubbing everyone’s shoulders.

 

 

KISS Me You Fool

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checklistSheila got out of bed on a bright, CAVU morning, checked her METARS via DUAT, saw that  there were no TFRs or noteworthy NOTAMS that might discourage her, dressed and made her way to the FBO.   Once in her airplane, she checked the ATIS, dialed up ATC, and was on her way.   Once in the air, she asked for VFR flight following, and navigated with her GPS from one VOR to another on a VICTOR airway, just for old times sake.  On her way to her destination, she kept her eyes glued to the PAPI as she gently descended to earth, but not before going through her final GUMPS.   And by the way, did I ever tell you the (true) story of the time I went NORDO on my way to SMX?

If you are a pilot, you understood every word I didn’t say.   Every trade has its shorthand.  Flying is replete with them.   Pilots live or die by them. The idea behind mnemonics– be they abbreviations, acronyms, or short phrases, is to make complex things simple.

One acronym everyone knows is KISS, which, in case you’re not one of the every, is short for “Keep it simple, stupid.”   That isn’t particularly aviation-related, although I have heard it more than a few times in that context.   KISS is what it is all about; if cleanliness is next to Godliness, then simplicity is next to cleanliness.

Complexity, of course, is merely a lot of simplicity all tangled up.   Understanding complex interactions is merely a matter of disentangling, disambiguating, or to use the popular word, deconstructing interactions so that we understand each component and how it builds on the previous one.   I could not have gotten through graduate school without a host of mnemonics– some of which were taught to me and some of which I made up myself.  Whenever anything seemed difficult to remember, I would construct some sort of abbreviation that made sense to me.  Ask me Freud’s psychosexual stages or the four subtypes of schizophrenia and I will tell you in a flash.   Go ahead, try me.

One form of mnemonic is the checklist.   Checklists are used religiously in aviation, and some believe that it is the procedure that has contributed most to the increase in aviation safety. (Atul Gawande writes about the importance of using checklists in surgery in “The Checklist Manifesto.”)   I have yet to need the checklist I have committed to memory for a major emergency, but it is designed to make sure that I not only do what I need to do, but that I do them in the right order.    The mnemonic is ABCDE, and it applies to all airplanes at all times.  If you are a pilot, you probably know it.   If not, you don’t need to.   If I had to remember to trim to the best airspeed (A), look for the best field (B), run through my systems to try to solve the problem (C for checklist), declare an emergency (D), and then, finally, grab the emergency landing checklist (E), all in exactly that order, I might get flustered.   But simply remembering ABCDE and applying each item in order makes it all simple, and perhaps with a little bit of luck or Divine intervention, that is one KISS that might save my life.

 

 

Annie Hall meets Alexis Hymen

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images-5The prize for best article-title-of-the-month goes to an article I found perusing the Journal of Family Psychology.  The title was simply “Alexithymia and Marital Quality:  The Mediating Roles of Loneliness and Intimate Communication.”   Makes a psychologist proud.

Woody Allen said that the inspiration for the name “Annie Hall” came from the word “anhedonia,” which is psych-speak for the inability to feel emotions.    Alexithymia, which very literally means “without words for emotion” and less literally means the inability to express your feelings, has a similar ring.  So what should we name the lead character in our new verbally inspired film?   “Alexis Hymen” comes to mind, although if I didn’t know a few people with that last name in Brooklyn I would think it had a distinct Ian Fleming ring to it.

Many people have improbable names.   I knew a Peggy Beach who had a sister named Sandy.   No kidding.   And just the other day I was listening to CNBC and heard a political commentator being referred to as “Crystal Ball.”  I thought it was a joke but by the third time she was announced that way I realized that was indeed her name.

My last name is improbable just because it is one of those names that is so rare.  As a kid I was told that if I ever went traveling throughout the U.S. and needed a place to stay I should pick up a local phone book and look up my last name.   If anyone had that name, they were related.   Apparently, the Heilveils would do a lot to save a few dollars on a motel room if they could find someone to bum a room off of.

One of the key findings of the above-mentioned research was that “…higher alexithymia was associated with greater loneliness, which predicted lower intimate communication, which was related to lower marital quality.”   The amount of data crunching that went into reaching that conclusion was enormous, and the research methodology was impressive, so now there is empirical support for what we already think we know.

Yes, dear, I know it’s important to tell you how I’m feeling, because that will make us more intimate, and then our marriage will be much better off.  So, for the sake of our marriage, I want you to know that I am feeling sad that I am so inadequate at expressing my feelings, and guilty that because I am so lousy at this I am probably destroying our marriage, and really angry at those researchers for agreeing with you and making me look like the bad guy again. 

That’s what Alex would say to Alexis, if only he could.

 

 

 

 

Pilot in Command, or Directing the Dream

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demonsI had a recurrent dream when I was a child that I was being chased by faceless, flying demons wearing black capes.  I frantically flew away (without benefit of airplane or wings, Superman-style) trying to escape them, and managed to wake up just before they destroyed me.  I woke up sweating in fear nearly every night of my childhood.

A psychoanalytic dream interpretation book I bought at a supermarket checkout stand diagnosed the dreams as symbolic of a sense of impotence, a helplessness and hopelessness to have an impact on the frightening world around me. And later, when I heard a late night talk show psychologist say that one could control one’s dreams just like a director directs movies, at about age 18, I turned around and faced the demons, daring them to expose their faces, and they all at once disappeared.  I never had that nightmare again.

We each fight our own unique demons throughout our lives, and learning to fly was for me a symbolic way to overcome a life rooted in fear.  I don’t know how many other pilots share that motivation, but I do know that nearly every pilot with whom I have ever spoken shares the quickening of the heartbeat and chill down the spine that comes the moment one loses the chains of gravity and launches into sky, leaving the earth and its accompanying worries below and behind.

Flying, like directing my teenage dreams of being chased, is one way some of us attempt to manage fear.   The term that every pilot learns immediately when taking flying lessons is that he or she is the “pilot in command,” a way of drilling deeply into one’s psyche that the ultimate responsibility for making the decisions and taking the actions that will keep you and your passengers alive is yours, and it is a responsibility that doesn’t cease until all occupants are safely off the airplane.

Being pilot in command means that you are in ultimate command even when a controller tells you what to do, that no matter what anomaly or distraction threatens you, you are where the buck always stops.   It means, ultimately, that no matter how frightening the demons are that are chasing you, you must turn toward them and face them.   And that is the only thing that will make them go away.

Dreaming appears to be a fairly ubiquitous phenomenon, shared by most animal species on earth.  (New book title: Do Plants Dream?)  Whether dreams are simply the “residues of the day,” whether dreaming is a form of catharsis or working through of conflicts, most dreams probably don’t need a conscious director.   To beg the aviation metaphors a bit, they probably do just fine on auto-pilot.   But when the content of our dreams become disturbing to us, whether those dreams occur during sleep or wakefulness, it is time to find the pilot in command within us.