The Intuition Network, A Thinking Allowed Television Underwriter, presents the following transcript from the series Thinking Allowed, Conversations On the Leading Edge of Knowledge and Discovery, with Dr. Jeffrey Mishlove.


JEFFREY MISHLOVE, Ph.D.: Hello and welcome. I'm Jeffrey Mishlove. Our topic today is "Self-Renewal." How do we move from burnout to balance in our lives? How do we move from a space of pain to one of a higher equilibrium, a higher level of functioning? With me today is Dr. Cynthia Scott, a research associate at the Department of Family and Community Medicine at the University of California School of Medicine in San Francisco. Dr. Scott is the president of the Heart Work Group in San Francisco, and she's the co-author of numerous books, including Heal Thyself, Self-Renewal, and StressMap. Welcome, Cynthia.

CYNTHIA SCOTT, Ph.D.: I'm glad be here.

MISHLOVE: It's a pleasure to be with you. When we think about self-renewal, I get the feeling that it has to begin with a recognition of injury, of pain, of stress, or some kind of damaged state. One doesn't normally go through self-renewal when everything seems to be just rosy.

SCOTT: That's too often true. I wish it was more preventable. I wish people saw it and did it sooner. But actually, it really doesn't matter how you get there, it's just that you get there. I think one of the things about self-renewal is that it can happen any time in your life, and it will not maybe only happen once; it may be several times. So to believe that you will only get into this position once is a false idea.

MISHLOVE: Typically we hear of the midlife crisis as a time of self-renewal, but I think what you're saying is that self-renewal can become a way of life.

SCOTT: Well, I think that we're needing to do that. We looked at the number of careers that people have, and most people are going to have four or five different careers -- not just jobs, different careers. And each one of them, if you look at it in a self-renewal way, is a developmental process of getting more of what you want, finding more balance, finding more ease with yourself. And that comes in different ways at different times in the life cycle.

MISHLOVE: Well, oftentimes people are thrown into a phase of self-renewal out of necessity. They realize that they just can't continue the way they are -- for example, people who have had heart attacks. But the skills that are learned in that process are skills that can carry one forward and become literally a way of life.

SCOTT: I think illness is wonderful. I mean, in the people that I see who have had heart attack or life-threatening illness, they get to learn very fast. And often they get to learn and that becomes the teachable moment. When I go to visit somebody in the hospital and they're just coming out of being very sick, I say, "So, are you ready to learn now? Is it time? Is this the moment when you're ready to embrace a different way of living?" Because their body is signaling that something is really off and it's time to learn.

MISHLOVE: In primitive tribal cultures the shaman or the healer of these cultures is sometimes called the wounded healer -- a person who has healed themselves of a great illness. It's sort of an initiatory sickness, as it's described in the literature.

SCOTT: Well, it's the same way in business as well, because in some organizations you have to have had your heart attack to be ready for management material. It's a rite of passage in some places. And so I think we would like to look at ways that people can be healthy in their organizations, rather than need to come right up against the wall of self-renewal. It's a difficult process, but it's not one that has to end in tragedy.

MISHLOVE: It would seem that the first step of this process is really sort of self-examination -- taking an inventory of oneself, looking to see, how am I doing right now? Am I functioning as well as I might be?

SCOTT: Well, there's pieces that you need to look at. One is, what are you dealing with in the environment? How much change are you going through? What are your personal changes, pressures, and satisfactions? What are your work changes, pressures, and satisfactions? Then there's a whole area of looking at the kinds of coping skills you have. What are you currently doing to address those kinds of pressures, changes, and satisfactions? And then thirdly, what are your thoughts and feelings? What kind of buffers do you have in your mind? What do you say to yourself during this process? And the last area is, how do you signal your distress? Do you have physical symptoms that speak to you? Do you have other ways of talking to yourself, or do you emotionally become upset? So I always say that people do better if they're tuned up to those three ways of signaling. Do you listen to what your body is saying? Do you listen to what your heart is saying? Do you listen to what your emotions are saying?

MISHLOVE: Because oftentimes we may go through life and tell other people, as we typically do when someone says, "Well, hi, how are you?" we say, "I'm fine." And we tell ourselves, "I'm fine," and then we don't look at the details; what does this mean?

SCOTT: I find people spend more time, frankly, planning their vacation than they do looking at their lives. And so I recommend kind of a yearly tune-up process, and StressMap or different kinds of tools you could use. It's a way of looking inside to see how you're doing -- getting an EKG, if you will, a readout, on twenty-one different indices of how you're doing. I think that it's the kind of thing where people don't check in, and if you don't check in, then your body gets to tell you. Like heart attack -- the heart palpitations are very small. If you don't listen, then your heart attacks you, and then you have to listen to the stronger signal. So I always encourage people to check in before they have to hear the big noise.

MISHLOVE: And I suppose one of the very clear signals is how we hold ourselves in our mind, our level of self-esteem -- how much control do we feel that we have over things? It's like if we say, "I'm fine," does that mean "I'm fine under these circumstances, which are really getting me down?" What are the thought patterns? The literature seems to suggest that optimally functioning people, even in difficult situations, feel that they have a measure of self-control, a creative ability to maneuver, even in the tightest of situations.

SCOTT: Well, if you look at who stays well under stressful situations, it's people who operate with what I call the four C's. They work with a sense of commitment; they understand the bigger picture of why they're doing what they're doing. And then they work with a sense of challenge; they just feel like they are being stretched but not broken. They're the people who see the glass as half full instead of half empty. Then they do what you mentioned before, is they work with a sense of control; they take the piece that they can do something about and they go for it, and they focus on that and they stay right with it. And the fourth C has to do with connection -- they do it with other people around them; they reach out, they ask for help. If they feel overwhelmed, they get somebody to help them. They have thick Rolodexes. They don't mind asking for help. Those are the things that Suzanne Kobasa found in her research on hardiness, and it's in the social support literature. It's basic things that have been shown to be very indicative of longevity and other kinds of hardiness in high-stress environments.

MISHLOVE: In other words, two different people under identical circumstances may function very, very differently, depending on the attitude that they bring to the situation.

SCOTT: Your biggest buffer is in your mind. And it's the one thing you can control in all situations.

MISHLOVE: It's the one thing you can control, so if you're having thoughts of, "This situation is hopeless; this situation is out of my control completely," that's an indicator that maybe you should begin to take stock of yourself, not simply point fingers. Because the pointing of fingers at the external circumstances of one's life is already a symptom.

SCOTT: Well, it leaves you out of power. It leaves you feeling more powerless than you usually are. And sometimes when you talk with a coach, you've got someone else to say, "No, it's really not that way. Have you considered this?" And then all of a sudden, it shifts. So I find that it's very helpful, when I work with people who are in those situations, to help them really map out what is it that they can control, what is it that they can't. And often that's the real big discussion, because there's a range of influence in the middle, because what you may think you can control, I may have differences of opinion about that. But in the coaching situation, we get to broaden the range of control, the possibilities for you. You may not choose to do it, but at least you know it's there.

MISHLOVE: Well, I think one of the key things here is to really look ultimately at the way that we reason about our life. Some methods of logic or reasoning are just more productive than others, and there's a great deal to be said for the process of self-renewal to straighten out your thinking, so to speak.

SCOTT: But that's one of those hard things, Jeffrey, because it happens inside your head. I mean, having studied linguistics, it's a construction of reality, it's how you really see things happening. It's as if we both watch the same movie and you would say, "Great movie," and I would say, "What a terrible show." We saw the same piece of celluloid, but we chose to construct our reality differently. And so that's often the hardest thing, to help a person understand that they can change their mind. They think that they have to change their circumstances. If you want to take a behaviorist approach to it, you can change your mind and then maybe your behavior follows. So it's kind of an experiment; it's a series of ways of thinking.

MISHLOVE: Well, I should think the trick is to realize that it is in fact your mind, because many people when they go to a movie and say it's a bad movie, they think it really was the movie.

SCOTT: Yes, yes. It's always the bad movie keeps occurring in their whole life. They keep living the bad movie. But when you push against that, the person often becomes very defensive, because you're questioning the way that they see reality. And that's precisely what the work is usually about, is helping people make that shift. Nobody likes to change from being confronted, so if you kind of go around the side, or make experiments -- I usually like the person to discover that for themselves; then they really understand it.

MISHLOVE: Well, self-renewal implies just that; it's something that we choose to do. It reminds me of the legend of Mohammed going up to the mountain to find God, and often that's how it's done. People say, take a vacation, or go somewhere into solitude, find it within yourself, and then come out as the prophet.

SCOTT: But Mohammed had different skills, and I think there were more skills about that back then. I think that people today expect instantaneous kind of fixes. They expect to go away for a weekend and it gets better.

MISHLOVE: Take a Valium, right?

SCOTT: Yes, it doesn't get better. I think the real difference between burnout and stress is that with stress, when you and I have had a hard week and it's Friday, we do something nice for ourselves, spend time with people we care about -- the connection -- and then on Monday we feel better. Burnt-out people do all that and they don't feel better. That's the biggest signal.

MISHLOVE: In other words, it's as if the stress has become so chronic at that point that a hot tub or a massage is not going to do it.

SCOTT: And the vacation will not do it. All the books in the world won't do it at that point. You have to do something that changes the circumstances, and it can be the circumstances inside your mind, or the circumstances in your life. But that's the signal. You know when you're burnt out when you begin to feel a sense of depersonalization, when you just want to be away from all the people that you've been working with, and you just can't face another meeting with those people, or whatever. You also get a sense of emotional exhaustion. Those are the people that say, "I don't want to. I can't. I feel brown on the inside. I feel like I'm crisp." Those are the words that they say. It's a very different experience.

MISHLOVE: Kind of a feeling of hopelessness.

SCOTT: Hopelessness is sometimes associated with that if it goes on for a long time. Because the third thing that people spot when they're having burnout is they feel a reduced sense of personal accomplishment. They don't feel like they can do it anymore, whether they be a bank teller or a physician. They just don't feel like they're able anymore. And the burnt-out person, the most difficult part of it is that they don't recognize it themselves. They have it, but their friends see it. They are not kind, fun people to be around. They're kind of crispy critters on the outside, and so they're kind of going around wanting to be away, not feeling good about themselves, and feeling bad. But they don't recognize it sometimes.

MISHLOVE: How do you talk to a person who's in that space and is also in denial of it -- if a friend of yours were burnt out?

SCOTT: I'm trying to think -- a client I worked with recently. See, usually they have to feel, as you said, some pain to come in, and usually something begins to happen that says this is not working -- meaning their sales figures go down, they lose three cases in a row in court. Something begins to trigger that it is not OK. And sometimes it takes that pressure from the outside for them to feel it. I feel when people come and sit in my pink chairs, nobody wants to be there. They don't come there for nice, they come because something's wrong. And so the first question is, why now? What do you think is going on? Why is it different? You know -- why now, rather than ten days ago, or two weeks ago? What's happened? What has brought you here?

MISHLOVE: There's a certain resistance to admitting that anything is wrong, I suppose, in the first place.

SCOTT: Well, then the person just has to be in pain longer. See, again, the signaling system -- if you can listen sooner, you can get through it faster. But if you have to have your heart attack, or you have to find yourself, as one client I had, crying in the office uncontrollably, then it's a different signal. So if you can hear it sooner, you can do something about it more quickly.

MISHLOVE: You know, the metaphor almost sounds like an automobile. It's like you can take your car in for a tune-up on a regular basis, and some people even change the oil twice as often as the manufacturer recommends. But if you let it go, after a year or so your car's going to have funny noises.

SCOTT: And the block's going to seize up on you. You're going to lose your engine.

MISHLOVE: And unfortunately, we get manuals that come with the car saying that they need to be tuned up, but human beings don't come with a manual that suggests that one needs regular oil changes and tune-ups.

SCOTT: Well, that's what I try to do, is make ways that people can be self-renewing, that they don't have to get broken to get fixed. I'd much rather never see you in the pink chairs, and have you be tuning yourself up in the process. That's why self-renewal is about cycles and about feeling it before you get crispy on the outside.

MISHLOVE: One of the things that I find most fascinating is that behavioral science, the hard-core aspect of psychology, has come around to saying, yes, the relaxation response is a useful behavioral tool. To me it's as if they're borrowing from a very ancient tradition and they're saying, yes, now science confirms it's so.

SCOTT: Yes. I think biology has always shown us that. I mean, the body knows how to do that naturally. If you're on the freeway and all of a sudden you swerve and miss a car, your body goes, oohhhh, I'm glad about that. Your body knows what to do immediately. What happens is we don't let our bodies do what we know how to do. We push them and push them to the edge of collapse, and then we have to fix up; then we have to put the Band-Aids and the tourniquets on and kind of go backwards. But the body knows what to do.

MISHLOVE: So a natural part of self-renewal, for people who renew themselves daily, would be to use a relaxation technique, a meditation or visualization technique.

SCOTT: I try to tell people how to do that in thirty seconds. I could teach you how to do that in thirty seconds, because everybody says, "I have no time for this. I'm busy, busy, busy, busy." But if you can do it thirty seconds before you go into home after you get out of your car, thirty seconds when you come and sit at your desk, thirty seconds when you stand in the bathroom between meetings, you've got to do this for yourself, because it's a matter of physiological living. We are stressing ourselves to the point where we have new kinds of diseases that we haven't had before -- autoimmune problems, adrenal collapse; different kinds of things that we see now in the clinic that we didn't have before.

MISHLOVE: In fact it seems that the bulk of contemporary diseases are lifestyle related, rather than germ related. So in the middle of doing a television interview, I can --


MISHLOVE: Great. Let's do it.

SCOTT: Well, what I'd ask you to do is, it's physiologically impossible to be having a red alert in the middle of taking three deep breaths. You know that. So what you can do is to do that in thirty seconds, and you just put yourself underneath your desk, let your stomach go out underneath your desk -- see, below the camera level. With your eyes open, in your suit, under the lights. And without even making any sounds -- people can't even tell that you're doing it. You get very good at doing it with your eyes open. This is one of the executive techniques. You need to take little bits of time for yourself. See, people wait for their company to do this for them. If you wait for your company, you're going to rot out while waiting. And then if they rang the bell at ten-thirty every morning and said, "Stress break!" you wouldn't like that either. So this way you're under control. You take it when you need it, at your own pace. The way I teach it to people in business is you can learn to do it with your eyes open, in boring meetings, at times when you really need to get outside to come back and be inside.

MISHLOVE: Just as simple as breathing.

SCOTT: Um hm. So what you need to do re-Pavlov yourself, like Pavlov's dogs, so the signals of the things that used to give you pressure, like the telephone, or your beeper going off, every time that goes off you think, "Breathe." So that's your signal. You have to retrain yourself to pair the "stress bringer" with the relaxation response. Then you begin to plug it into your daily life.

MISHLOVE: In other words, we aren't breathing as well as we might.

SCOTT: Well, I usually say, we've got to be smarter than beyond breathing. I think a lot of stress management did nothing but teach us to breathe for years, and I think we have to both breathe and act differently, and think differently. It's a complex of things, it's not just breathing.

MISHLOVE: Well, the human being is a very sophisticated instrument. There are so many areas in which we have opportunities to improve our lives -- everything from our wardrobe, I suppose, to our breathing, to the way we cleanse ourselves, our diet, our nutrition, exercise. I suppose, though, at base it has to do with an attitude. If one considers that it's my responsibility to create an optimal life for myself in all of these many areas, from work to relationships to body, then there's an enormous amount of support out there in the culture for that.

SCOTT: But also I think we've done something a little on the dark side with that. I think we've created a way of thinking that we create everything that happens in our lives, and that if we just ate our sprouts and jogged and did our breathing and all those things, we would be OK. And there is a level of toxicity in organizations that people sometimes have been blaming the victim. They have been saying, with health promotion programs, that you should do all these things and then you would be OK. There are structural stressors that are inherent in the organization, when you have unclear roles and goals, of what it is you're supposed to be doing. And in organizations in change, you have two job descriptions, you're trying to combine two jobs. You're unclear on what it takes to do this job well, and your supervisor doesn't even know, because they don't know. So that's one of the things that are structurally very difficult for people to handle.

MISHLOVE: I suppose this is comparable to the toxins that are in the environment -- every year fifty thousand new chemicals.

SCOTT: Exactly. And not only just the toxins in the environment, it's the emotional toxicity that people have to deal with. Burnout comes from people having to deal with people all the time, and as I said it's bank tellers as well as nurses and physicians. It's people on the front firing line. Do you want to be the return clerk at the department store? You have to absorb a lot of emotional toxicity. And if you don't have the direct support of your supervisor, you can do everything else and still be at risk.

MISHLOVE: In other words, breathing at my desk isn't going to help me much if I've still got to deal with that same --

SCOTT: Yes, we find this a lot. The newer research on burnout says the thing that is most indicative of burnout is the relationship with your direct supervisor. We know this, that we can spot high-risk departments in hospitals now by the relationships that are created there. So there's nothing that says that one department has to inherently be more stressful than another. You can have a high-risk emergency room and a low-risk emergency room, based on the relationships.

MISHLOVE: How can I hope to renew a relationship if I don't feel that I can renew myself?

SCOTT: I think that sometimes it doesn't really matter where you start. I mean, you have to start where you feel most able. If you feel more control starting with yourself, start there. If you feel more able to start with the other person, start there. It all makes a circle.

MISHLOVE: In other words, I don't have to believe that I need to change my lifestyle if I've got a problem with my boss. That's a good place to start.

SCOTT: Having been in personnel, I've had people come in and say, "I have this problem." I say, "Well, have you talked to the person?" They say, "Oh, well, no, I can't talk to them." "Well, do you expect me to go talk to them? I'll teach you how to talk to them, I'll rehearse with you, but it's your . . . ." That's where people need to start, whether it be at work or in their families, because people can't change unless they know what's going on. When they say, "You have a bad attitude," what's a person supposed to do? They don't know where to start to change. But if you can talk about a behavior, something that you were doing -- "Every time I talk in a meeting, you interrupt me" -- then I can know what to do. But a bad attitude, I don't know what to change. So people feel helpless when they get that kind of feedback.

MISHLOVE: And what you're saying is that most burnout is related to an unsatisfactory relationship with the immediate supervisor.

SCOTT: That's what the new research seems to say.

MISHLOVE: That's quite serious.

SCOTT: Quite serious. So we have to look at the toxicity of the relationships. See, the managers used to think that if they just managed, planned, scheduled, and controlled, that they were in control, and they were being good and efficient. Now the new manager has to learn to create positive, nontoxic relationships at work.

MISHLOVE: And what if you're a manager and you've been successful, your bottom line is productive; well, you have a high employee turnover, and now this is coming back. It might mean changing years and years of a certain way of managing, of considering yourself in your role. And if you're an employee of such a person, that might be a tough nut to crack.

SCOTT: Well, what we're finding is that managers need to learn to do that because they're managing human capital. And if you are not being sensitive to those things in human capital, you're spending money. High turnover is not free; turnover on the average costs $27,000, to lose a first-line supervisor. It's not free to have people leave.

MISHLOVE: But if I'm an employee, I guess I have to make a decision either to confront this supervisor, or to leave.

SCOTT: But if you're in a climate in your organization where the confrontation is not one of hostility but of learning and openness to discovery, and it's backed up with skills so that people can have a climate where they learn how to do that together, then the risk is lower, and you have whole organizations that heal. You have whole groups that become less risk-producing, less burnout-producing.

MISHLOVE: Well, this seems to be essential. I gather that what you're saying is that self-renewal is really no longer enough; we have to do this together.

SCOTT: I think it's a 50-50 relationship. I think the person needs to do their part, and I think the organization needs to do their part as well.

MISHLOVE: What is an organization to do, if they may be in the same situation as the person? That is, a person with burnout, as you pointed out earlier, doesn't recognize that it may well be the case in an organization.

SCOTT: Well, the signal of burnout in an organization is when one person begins to signal and they send them to the psychologist; the psychologist is supposed to fix them, and they go back to the same thing and they don't get fixed, and it keeps going. So you have to begin to look at who is signaling the distress in the organization, and not punish those people but listen to them and find out what is happening -- where's the low cohesiveness? Where's the lack of support? Where's the poor supervisory relationship? Where are the unclear roles and goals? What is it that the organization can do to reduce that feeling on the part of the employee, and then what is the thing that the employees can do to be self-responsible for themselves?

MISHLOVE: Is it the case that burnout is just an inevitable consequence of being in the same job for too long, year after year after year?

SCOTT: If the structure stays the same. But if the relationship is good, what the work is, is less important than what the relationship is. And so you can have people who've been in a job for a long time and they don't burn out, because they understand the meaning. They feel a sense of challenge. It's the four things of hardiness. If you can create those in your organization, if you have a team that feels a sense of commitment, feels the challenge, feels the control, and has the support, they can be doing the same stuff and it's not as toxic.

MISHLOVE: Commitment, challenge, control --

SCOTT: And connection.

MISHLOVE: And connection, or community, I suppose. And this applies just as much to the individual self as to the corporate self.

SCOTT: See, what heals the person heals the organization. It's all the same thing. So that's what you look for. What creates hardiness in a person is the same thing that creates hardiness in the organization.

MISHLOVE: Well, that seems to be a good note to end on.

SCOTT: Good. Thank you.

MISHLOVE: Cynthia, it seems to me that you're raising a really crucial issue here in this discussion -- the need for people in considering their own self-renewal to look to the community, to look to the culture about them, I suppose, because it's not just our organizations, but our whole society. Cynthia Scott, thank you very much for being with me.

SCOTT: Thank you, Jeffrey.


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