116. Resistance | The inner anti-drive that keeps us stagnant and how to break inertia

We all have an internal drive that propels us forward, inspiring us to achieve and create. Yet, there’s also an innate anti-drive, a subtle yet powerful force that holds us back. This episode delves deeply into the nature of this anti-drive. We explore the foundations of resistance, drawing insights from Stephen Pressfield’s ‘The War of Art’ and linking it to entropy and the Second Law of Thermodynamics. We’ll examine why resistance occurs, how it manifests in both our personal and professional lives, and the various ways it can be hidden, even under the guise of positivity. We’ll discuss practical strategies to overcome this resistance, ranging from the psychological tools developed by Phil Stutz to Stephen Pressfield’s adopting a professional mindset.

Awake and Aware | Our 2024 Live Event

Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Focusing on interactive experiences, this event offers a unique opportunity to reset, reflect, and connect with like-minded individuals. Limited slots. 

Website: Awakeandawarebend.com

Early bird discount code: FULLYAWAKE24. $100 off registration. Expires Jan 31, 2024

CME: Yes! This is a CME event.

The Flameproof Course | Self mastery and anti-burnout

This course will make you so burnout-resistant that when they tell you to see 5 patients an hour with only a rusty spoon in your pocket and a unit clerk at your side, you will just smile (results not guaranteed).

The next cohort begins Feb 1, 2024. Learn more here.

Love medicine, but the job itself leaves a lot to be desired?

I work with many docs in your shoes. To learn more about 1-on-1 coaching, start here.

---

3 free resources specifically designed to address pain points in emergency medicine practice

• Scripting your least favorite conversations
• The quick and dirty guide to calling consults
• My 4 favorite documentation templates

We Discuss:

What is Resistance?

• The term resistance from the book, “The War of Art” by Stephen Pressfield. 
• Resistance is an internal, psychological force that opposes progress and creativity. It manifests as procrastination, self-doubt, fear, and other behaviors or thoughts that prevent us from achieving our goals or realizing our potential. 
• Resistance is the internal anti-drive the keeps you from learning that instrument, starting a spiritual practice, deepening your medical knowledge. 

The link between resistance and entropy

• Entropy is a measure of disorder or randomness. The second law of thermodynamics states that in an isolated system, entropy tends to increase over time, leading to a gradual decline into disorder.
• There is a Tendency Towards Disarray and Inactivity
  • Resistance leads to a state of inactivity or stagnation in personal endeavors. It’s an internal drift towards not doing, not creating, or not progressing.
  • Entropy is a  universal trend towards disorganization and chaos.
• They both take continuous effort and energy to overcome
  • Overcoming Resistance requires continuous effort and conscious action. It’s a daily battle
  • Combating Entropy demands energy input. External work must be applied to the system to maintain order and decrease entropy. 

• They’re universal
  • Resistance is an inevitable part of the creative process. 
  • Entropy is a fundamental principle of the universe. It is also inevitable. 

Resistance is always on patrol and ready to thwart creativity

• Resistance seeps into our professional AND personal lives. It could be neglecting self-care, missing family events, or not pursuing hobbies, all in the name of ‘dedication’ to a profession. Professionally, resistance can show up as procrastination of skill upgradation, fear of failure, reluctance to embrace a new role, imposter syndrome.
• The presence of resistance doesn’t label anyone as a ‘bad person’ or ‘failure’; quite the opposite, it is part of the human condition.
• There are myriad ways to go about tackling resistance. We discussed this briefly in Episode 110 on strategies to conquer mid-shift overwhelm

Where does resistance come from, and how does it work? The pain of leaving the comfort zone

• Where does resistance come from? We have resistance because there is some pain in getting to the other side. What is on the other side of pain and fear? Possibility. 
• What do we do when we meet up against pain? 
• We stay in our comfort zone and rather than working through the pain of getting to the other side… to possibility, we avoid. 
• We see possibility,  and think, “Yes, that looks incredible! Let’s do it.” We come out of the comfort zone a little bit, there’s some modicum of pain involved and then we retreat into our bubble.

Resistance can be hidden in positivity action

• Here’s where this gets tricky, Especially for that part of our brain that is so Adept at rationalizing. It’s natural to put some kind of positive label on being in and STAYING IN the comfort zone, to not venturing out or overcoming the resistance such as: being virtuous, not being a sellout, being brave, or idealistic. Those are all wonderful, But a question to ask is are they honest, are they being used as an excuse?

How to overcome resistance. Strategy 1 – Phil Stutz’s The Tools

• Acknowledging Fear and Pain: The first step involves recognizing and accepting the existence of fear or discomfort in a particular situation. This awareness is crucial because it sets the stage for a conscious and intentional response rather than an unconscious reaction. 
• You can visualize the fear or pain as a dense cloud before you. That cloud is made of pain. you can walk through it, but it’s going to hurt. what’s on the other side of the cloud? possibility.
• After there is awareness of the fear, of the cloud of pain before you, this is where Reversing the Desire happens: Instead of wanting to escape the discomfort, we mentally and emotionally turn towards it. Stutz suggests using a mental mantra like, “I want this fear, I welcome this pain”
• Then… you go. You move forward. Mentally and physically move forward into the challenge. This act symbolizes the acceptance and overcoming of the obstacle, transforming what was once a source of avoidance into a source of power.
• As you move through the pain, you can visualize what’s on the other side as the sun breaking through the clouds. This represents the experience of moving through pain and emerging on the other side.
• As you visualize the sun breaking through the clouds, repeat the mantra “I want the pain,  pain sets me free”. This helps in reprogramming your brain to tolerate and actively seek out the discomfort that comes with growth. Walk into the cloud and let it envelop you
• Once you’ve confronted the pain, recognize and celebrate the reward on the other side. It’s not just about seeking out pain for its own sake, but recognizing that on the other side of that pain is a reward. Is growth. 
• When we are stuck, there can be a ruminative cycle of negative self-talk or rationalization that leads to inaction. And that word, inaction is the key. We think we need to have it all figured out before acting, to have worked through all our fear. But when you look at the greats in history, they felt resistance too. Overcoming resistance is scary. It takes courage.  Courage is the ability to act in the face of fear

Even the best feel fear, it can almost never be overcome 

• Pressfield wrote, “The amateur believes they must first overcome their fear, then they can do their work. The professional knows that fear can never be overcome. They know there’s no such thing as a fearless warrior or a dread-free artist.

How to overcome resistance. Strategy 2 – Going Pro

1. A Pro Shows Up Every Day: they are consistent and disciplined, working on their craft regularly, regardless of whether they feel inspired or not.
2. Commitment Over the Long Haul:  Professionals dedicate significant time to their work, treating it as a full-time commitment.
3. Is Committed Over the Long Term: A professional is in it for the long game, understanding that mastery and success are the results of sustained effort over time.
4. Doesn’t Take Failure or Success Personally: Professionals are emotionally detached from the results of their work. They don’t let failure discourage them or success lead to complacency. This isn’t some modern pop psychology, this goes back to the Bhagavad Gita The awakened sages call a person wise when all his undertakings are free from anxiety about results.
5. Works from a Solid Base of Skills: Professionals continually develop and refine their skills. They invest in their education and training.
6. Accepts No Excuses: A professional takes full responsibility for their actions and does not blame external circumstances for failures or setbacks.
7. Plays It As It Lays: Professionals deal with reality. They work with what they have and adapt to situations as needed.
8. Is Dedicated to Mastering Technique: They understand that skill and technique are vital and constantly work to improve them.
9. Asks for Help: Recognizing their limits, professionals are not afraid to seek advice, mentorship, or collaboration.
10. Shows Courage: A professional faces challenges and fears but doesn’t let them hinder their progress. They are willing to take risks for their work.

Why being process vs goal-oriented is a key to overcoming resistance but nearly impossible to execute fully 

How criticism can be a manifestation of resistance

• A professional owns their actions and outcomes, not attributing failures to external factors.
• Criticism of others may reflect one’s own fears, insecurities, or frustrations.
• Critiquing others can be a way to deflect from facing personal challenges or creative work.
• This type of criticism is often a defensive mechanism to resist personal growth.
• In some cases, criticism serves as a manifestation of internal resistance.
• Overcoming resistance can involve breaking down daunting tasks into smaller steps.
• Incremental progress helps to transition from the comfort zone to new possibilities.
• Henry Fonda’s story of overcoming stage fright illustrates taking major steps against resistance.
• Admiral William McRaven’s concept of making your bed represents starting with a small, manageable task.
• Small acts of discipline, like making your bed, symbolize taking control and instilling order, essential for combating resistance.

Overcoming resistance in documentation habits

• Contextual Challenge: Clinicians often face challenges in documentation, resulting in extended work hours and taking charts home, which seems insurmountable due to deeply ingrained habits.
• Psychological Resistance: The resistance to change in documentation habits stems not from a lack of desire for change, but from an internal psychological force that opposes progress, acting as an ‘inner anti-drive.’
• Incremental Approach: To combat this resistance, the strategy involves taking tiny, manageable steps, recognizing that trying to overhaul habits all at once can lead to system overload.
• Reinforced Habits: The documentation habits that need changing have likely been reinforced over years, forming a calcified part of the clinician’s shift workflow.
• First Small Step: Starting with a small step, even if it seems insignificant, is crucial. This step, though uncomfortable, is necessary to begin the process of change.
• Visualization and Granularity: Guiding clinicians through a visualization of performing the new habit in real time, focusing on granular specifics to identify and confront the points of resistance.
• Embracing Discomfort: Encouraging clinicians to embrace the discomfort associated with the change, recognizing that resistance and pain are invariably present in the process.
• Building New Habits: Focusing on how to develop new habits and professional structures that counteract the habitual resistance, ensuring that reliance isn’t solely on chance.
• Symbolism in Action: Likening the initial step in changing documentation habits to making a bed – a small act that instills a sense of accomplishment, builds momentum, and symbolizes taking charge.
• Process-Oriented Focus: Emphasizing the importance of focusing on the process rather than the outcome, aiming to instill new workflow habits that ultimately lead to the desired goal of improved time management and efficiency.

Making your bed and small acts that squeeze resistance out of the picture

• Admiral McRaven’s Simple Advice: advocating for the simple act of making your bed each morning as a foundation for discipline and structure.
• Starting with Small Tasks: McRaven emphasizes the importance of starting your day with a small, completed task like making your bed, which sets a tone of accomplishment and order for the entire day.
• Building Momentum: This act is not just about organization but also about creating a positive chain reaction, fostering a habit of completing tasks and gaining momentum from these small wins.
• Instilling a Sense of Pride: Completing this simple task daily instills a sense of pride, boosting confidence and encouraging the individual to take on more tasks and challenges.
• Preparation for Bigger Challenges: The discipline and order cultivated from this routine prepare individuals to face and manage more significant challenges in both their personal and professional lives.
• Discipline and Routine Against Resistance: Pressfield underscores the role of discipline and routine in overcoming Resistance, advocating for taking control of actions and environment in a disciplined manner.
• The Importance of Small, Consistent Steps: Pressfield advises adopting consistent, small steps to work against Resistance, acknowledging that overcoming these internal barriers is a continual struggle.
• Professionalism in Overcoming Resistance: Pressfield links overcoming Resistance to professionalism, which includes a dedication to orderly and disciplined work, mirroring the principles in McRaven’s advice.
• Synergy of Concepts: The intersection of McRaven’s and Pressfield’s concepts illustrates how small, disciplined actions, like making a bed, can significantly impact overcoming larger life challenges and internal resistances, aligning with the principles of professionalism and personal growth.