Module 4. The habit of judging ourselves and others
Welcome back! How’s it going? Are you beginning to see that it is possible to work with your mind, instead of getting lost, having that thought train take you for a ride? Have you experienced a taste of being able to be with your thoughts and feelings, have you seen how it is indeed possible that you don’t always have to struggle with your mind? Yes, you can turn this struggle into a dance, and once you know how your mind works you may find that you have more energy. You can put your mind to work for you instead of fighting against it. If at this point you feel like your mind is already full with facts and concepts, don’t worry. You can go back and review these modules as many times as you need to. I think of these lessons as concepts in the service of wisdom. Concepts are like brain candy. They’re sweet but pretty much empty calories for your brain. The more you fill up on concepts, the less room or attention you have for developing your own wisdom. Wisdom is the real nourishment. That’s where experience comes in. You can read a meal or cake recipe that looks delicious, but you have to make it and taste it for yourself to know how good it actually is. By putting these concepts into practice in your real life, you develop your owm wisdom. And that’s the only way to become wise. Not from books. Not from podcasts. Not from listening to a million mini-courses on mindfulness.
And believe me I know what it is like to feel like we never have enough time to do all of the things we should be doing to truly fulfill our mission as healthcare providers. Wisdom is not necessarily recognized or rewarded. To my clinic, I’m a unit. To be clear, I don’t run a unit at the hospital or in my clinic. I’m the unit. I’m measured by my RVUs, my relative value units. My relative value equals how many units I can bill for in a given day. Can you relate? If you are treated like a RVU robot or measured and or evaluated in some other way, the end result is all the same: it feels like there is never enough time to meet the goals that are set by others for us. Let alone our own goals. With that in mind, I created this course to fit into your already overbooked schedule. Notice how all of these practices are designed to be used on-the-go. That 3 steps 3 breaths practice. Or taking just a moment to note a thought and return to the present moment.
So if this challenge-opportunity to prevent yourself from burning out is feeling like yet another thing that you should, but don’t have time to be doing, don’t worry, I’ll help you get the hang of it so that you can put these concepts into practice in your own life. And when you can use them regularly, you are likely to feel better yourself and to be more efficient at work. Perhaps you will even improve your patient evaluation performance scores. And by doing these short practices over and over, you’ll develop your own wisdom. It will become easier to maintain connection with yourself and your patients, and develop the habit of compassionate action itself. Here’s my habit mantra: short moments, many times. Any new habit is formed by repeating short moments, many times throughout the day. Each time you take a deep breath and pause instead of habitually reacting, you’re building that habit. Each time you take a moment to noting an intrusive thought, you’re building that habit. Each time you ground yourself in the present moment, you’re building that habit. Short moments, many times.
Let’s build on what you’ve already learned and bring in another mental habit that gets in the way of being grounded and open: self-judgment. To be clear, we have to use our judgment all of the time when we’re making decisions. That's not the type of judgments I am talking about. And as you’re probably seeing from your own experience, when we’re caught up in some empathy habit loop, or our mind is full of intrusive thoughts, it is really hard to have good judgment. Perhaps you’re already also getting a sense of how groundedness can help you step out of these habit modes and into compassionate action. That’s when we can be most in flow in the workplace and most efficient. That’s when we make the best decisions. Isn’t it ironic that we have the best judgment when we’re not being judgmental or feeling judged? In other words, we can discern the best course of action when we don’t feel like someone critical is standing over our shoulder editorializing or giving a running critique every time we’re about to make a decision. Our minds function best when they feel free and open.
Let's dive into this a little bit more. What does it feel like when someone judges you or tells you you made a “bad” decision? I don’t know about you, but my defenses go up. Like a castle that is being attacked and pulls up its drawbridge so the invaders can’t get in, I armor up and close down to protect myself. I’m that turtle sensing threat–immediately withdrawing into my protective shell. We don’t have to wait for other people to attack or judge us because we’re pretty good at judging ourselves. Think of the last time you didn’t get the right diagnosis in the first visit, made a mistake, we didn’t handle something well, or were short with a patient? Do you hear a voice in your head that has that all too familiar tone of voice saying you can’t do this, you are not good enough, what’s wrong with you? You don’t know what you’re doing, or something else? Just like other intrusive thoughts, self-judgment gets in the way of well, just about everything. Self-judgment makes it harder to think. Self-judgment makes us second guess our decisions. Self-judgment makes us close down. Self-judgment slows us down and depletes us of energy, adding to our exhaustion and burnout.
So why do we judge ourselves? From a neuroscience perspective, self-judgment (and being judgmental in general) follows the same rules as any other learned behavior. Cue–we do something or make a decision that doesn’t go as well as we hoped. Behavior–we judge ourselves. Result. Let’s hit the pause button here and unpack exactly what the result is. From a brain perspective, a behavior only gets reinforced if there is something rewarding about it. Self-judgment falls into the negative reinforcement category because the cue or trigger is something unpleasant. What is rewarding about judging ourselves? Well, self-judgment is typically triggered by something we’ve done in the past. We can’t change the past, but we can learn from it for the future. Our minds are really good at adding a value judgment–this is good, that is bad–to actions. And here is the thikker. We think that this will help us learn to be better in the future or motivate us to do things differently next time. So to our brain self-judgment is rewarding: I’m judging myself not because it feels good, but because that punishing feeling is going to help me learn for next time. What is rewarding is the feeling we are doing something about the problem by judging ourselves. Voila! We get in the habit of judging ourselves.
Here’s the ironic part. We only learn when we’re open to learning. Think of Carol Dweck, the pioneering Stanford researcher that studied growth vs fixed mindset: growth mindset is all about being open to new possibilities. That’s when we learn and grow. When we’re feeling attacked or judging ourselves, we armor up and close down. We disconnect. We can’t learn in those situations! Our brains have been duped into thinking that judging ourselves is doing something helpful and thus it is a good thing. To be fair, there is some perverse make-me-feel-better quality when we’re in the position to look at other people’s actions and say to ourselves–or to them–well, I wouldn’t have done it that way. From the safety of not being in their shoes, we can have a different perspective or a wider view,and it is much easier to discern the best course of action, when we can stand back and watch the replay of someone else’s decision and pick it apart moment by moment. It is much easier than being in their shoes, having to make the call in real time. Now to be clear, having someone give us feedback is one of the best ways to learn.
Yet, how that feedback is delivered makes all the difference. So, imagine a coach, a mentor or a colleague who is bringing in a curious tone, they are asking questions, and are trying to understand your perspective before they give you feedback and suggestions. How does that compare to when they make a snap judgment, or deliver feedback with a tone or look that says, “I can’t believe you did that.” Those are worlds apart in how they are received by our minds. The open curious tone invites us to be open to constructive feedback. The judgmental tone closes us down, makes us want to defend ourselves or run away to protect ourselves.
So there are two things to learn from this: (1) Self-judgment gets in the way of being grounded in the present moment, being connected with ourselves or our patients, (2) Self-judgment is learned like any other habit, which means that it can be unlearned.
Remember, when given a choice, our brains will pick the behavior that is more rewarding. You know what it feels like to be judged, whether by someone else or by yourself. You also know what it is like when someone is kind to you. You might even know what it is like when you are genuinely kind to yourself. Which one feels better? Yes, another no-brainer. Kindness wins. Every Time. Or putting it kindly, kindness tastes sweeter, it feels, well, kinder, than being mean.
You savvy diagnosticians out there might already be making some new connections in your brain. You might be thinking that self-judgment shares some signs and symptoms with some of those empathy habit loops that we talkes about before. Yes, that's correct! Getting caught up in self-judgment feels a lot like getting caught up in your patient’s story: it feels restless, it feels close down, it feels the need to protect yourself and so on. And yes, kindness shares characteristics with compassion: openness, connection, groundedness to name a few. Recognizing these patterns is key!
If you need a little neuroscience brain candy to help your judgmental brain to swallow the kindness pill (as sweet as it is by itself), here you go. My lab has measured the brain activity of people practicing kindness. We found that the network of brain regions that gets all fired up when we judge ourselves or worry. It's called the default mode network, and my lab found that it gets really quiet when we are doing a kindness practice. Yes, note the irony of the network’s name: the default mode network. It was named this because it is what our brains default to when we aren’t focused on a particular task. We default to judging ourselves about past actions, worrying about the future and so on. Yet, my lab also found that with practice we can learn not to get caught up in all of this mental activity. Better yet, our brains will train themselves, as long as we give them carrots instead of hitting them with sticks.
Judging ourselves is like the stick. Being kind to ourselves is like the carrot: a sweet and healthy treat that gets us coming back for more. Judgment closes us down so that we can’t learn. Kindness opens us up so that we’re in our growth mindset.
If kindness still seems like a bit of a bitter pill to swallow–perhaps you don’t like carrots–and you’re finding this module difficult to swallow, you are not alone. Early on in our healthcare training, we learn to armor up, so that we can be ready to battle the diseases of the day. In the name of helping our patients, we fall into habit loops such as being hard on ourselves, sucking it up, martyrdom and other ways that we push down our emotions and put our own needs to the side. That short term reward of getting a little extra work done instead of exercising, eating your vegetables or getting enough sleep, connecting with family and friends, or doing something fun. Here, self-care takes a back seat until we are exhausted, burned out, or our physical or emotional health takes such a turn for the worse that we are forced to take some time to care for ourselves.
A lot of my patients have to hit rock bottom with their addictions before they seek my help. It may be worth checking in with any of your habits such as overworking yourself, martyrdom, self-judgment or any other related habit to see if they meet the simple definition of addiction that I learned in residency: continued use despite adverse consequences. Are you nearing rock bottom?
Consider the tools you are learning in this course as a way to find moderation. A way to work with your brain so that it doesn’t work you into a pulp. Awareness is like the antialcohol meditation that we take when we feel nauseated. When you look closely at moments when you beat yourself you feel a bit nauseated and get some good old fashioned negative reinforcement as a result. Kindness is your at-home detox. It helps soothe you and heal the mental wounds that you’ve inflicted on yourself so that you don’t seize up and go back to that bottle of judgment, just because it was comforting or gave you some brief relief in the past. When you really get a taste of kindness, you might even want more and more. Trust me, unlike benzodiazepins, this habit-forming behavior is more than safe–it will help keep you safe from inadvertently harming yourself. You can even practice it while operating heavy machinery.
Ready for some practice for today? See if you can notice self-judgmental habit loops. Cue - Behavior - Result When you are judging yourself, feel into the result. What does it feel like to judge yourself? Can you feel that closed-down armoring up feeling? In those moments, If you can, right after you notice you are judging yourself, take a moment to remember what it was like the last time someone was kind to you or you were kind to yourself. Feel into that. How does that feel? Does it feel a bit more open? Is kindness sweeter than self-judgment, without that bad aftertaste? Taking a moment to reflect on the difference between the two will help your brain see more clearly which one is more rewarding, and start to shift on its own.
Here’s an example that a physician gave us when testing out this program:
Cue: Being criticized by a friend after offering help but was met by a negative attitude due to a misunderstanding.
Behavior: I went into the Habit Loop of self-judgment. My mind started racing, thinking of all sorts of negative consequences of my action.
Result: Through the technique of awareness and by being kind to myself, I paused before giving a defensive response. Instead I apologized. This made the friend respond in a calm manner because I had not escalated the tension and the situation went back to normal.
So, iIf you want a bonus exercise, when you notice the self-judgment, see what happens when you take a moment to be kind to yourself. Maybe reminding yourself that you’re doing the best that you can and that’s ok. Some of the clinicians using the program highlighted how something as simple as a reminder phrase of “It’s ok, you’re good, you’ve got this'' helps them step out of self-judgment habit loops and into kindness.
If you need a note from your doctor to make kindness a priority, here you go. When symptoms of judging others arise, take a moment to be kind. When symptoms of self-judgment arise, take two: two moments to be kind to yourself. Repeat as needed. Number of refills: infinite.
Onward! We'll see you in the next module.