Non-inspirational advice for heart patients

21 Jun

by Carolyn Thomas  @HeartSisters

I know I’m not the only one who wonders why famous inspirational speakers and writers are so often NOT inspiring.  Call me cynical, but maybe I’ve heard once too often:

  • Follow-your-dreams!
  • Reach-for-the-stars!
  • Eat-more-kale!

These pep talks are typically delivered with varying degrees of cheerleading conviction by speakers who invariably spend considerable time boasting about their own amazing dream-following, star-reaching and kale-eating accomplishments. 

For this reason alone, I agree completely with Shawn Callahan, the Australian who helped to launch anecdote.com, and whose expertise lies in the unique field of business storytelling. His beef with motivational speakers is this:

“There is too much of a gap between the sender and the listener.

“Winning Olympic gold, being a world-class dancer, or climbing Mount Blanc while blind are just too far from the understanding and realities of most of the people they will share their stories with.

“It is too easy for the audience to sit back and say: ‘That’s great, fantastic, but I’m not like them, and they don’t know what it’s like for me!’

“In some ways, it almost does the opposite because it doesn’t build a key element of personal behaviour change – self efficacy.

“Self efficacy is a term coined by renowned psychologist Albert Bandura. It relates to a person’s belief in their own competence and ability to undertake a task.

“But hearing one of these speakers does not build self-efficacy and belief that you can achieve something more. It may, in fact, do the opposite.”

That is how I too sometimes feel when listening to big-time inspirational speakers.

If anything, I find them de-motivating, particularly on a day when I’m worn down by the chest pain, shortness of breath or crushing fatigue associated with my diagnosis of coronary microvascular disease. On those days, although I can admire people who are able to reach their goals in the same way I can admire Mother Teresa’s impressive lifetime record of sacrificial service to Calcutta’s poor, or the way I can admire the tenacity of a triathlete based on the volume and velocity of all that the vomiting at the finish line, these “inspirational” role models can also leave me feeling exhausted and inadequate.

Not inspired.

I’m guessing that inspirational speakers start off sincerely trying to help their audience members by sharing what they genuinely believe will work for listeners in order to ______ (insert lofty goal).  

So here’s the trouble with those dreams-stars-kale inspirational talks.  As social scientists often point out, “inspirational” messages are simply about the intention to inspire, while truly “inspiring” messages show the effect of becoming inspired based on a person’s internal reactions.

Thus, inspirational happens to you, while inspiring happens within you.

Here’s a little example.  A few years ago, I happened to read about Mike and Edward Wimmer, the father-son duo who founded the medical I.D. company called Road ID. Mike had frequently urged his son to wear an identification wrist band or dog tags with him during his solo marathon training runs, but Edward dismissed his Dad’s concerns with a casual “What could possibly happen to me while I’m out running?”  One day, however, Edward (as usual, carrying no personal identification) was out running when he was nearly struck by a frightening “King Kong-sized pickup truck” that left him sliding into a roadside ditch.  Luckily, he was not seriously injured – but was left very shaken.

“What if that truck had hit me? I would have been rushed to the local hospital as ‘John Doe’. Without proper I.D, family members and friends could NOT be contacted. Likewise, my medical records could NOT be accessed at the hospital. How long would I lay there unidentified? This freaked me out!” 

For 19 years, I too had been a distance runner. Like Edward and most other runners I knew, I frequently left the house for training runs with only the front door key tucked into a little pocket in my shorts.  I could relate instantly to his ‘what if’ story. As a heart patient, why on earth wasn’t I wearing my own medical identification?

Something clicked inside me, and I went online that very day to order my own I.D. bracelet (a purchase I’d been meaning to make for a few years). The glossy medical I.D. brochures I saw at my local pharmacy were intended to be inspirational, but Edward’s reminder of the mistake so many runners commonly make was what actually inspired me to act.*

The reality is that people usually change behaviour not because they hear a celebrity on a stage saying “Get motivated!”, but because something clicks in their life – big or small – that actually does motivate them.

Before my heart attack, I gave virtually no thought whatsoever to my heart (except maybe while struggling up the killer Quadra Street hill with my running group).

But after I survived a heart attack that had been misdiagnosed as acid reflux, I was suddenly intensely focused on All Things Cardiac while trying to make sense of a senseless chronic and progressive condition. I’ve spoken to thousands of women since then about heart health – not to inspire them, but as a cautionary example: don’t end up like me!

Instead of being called “inspirational”, I like the way Vancouver Coastal Health Research Institute described me after a recent public panel discussion (with three cardiologists) as more of a “knowledge translator”.  For example:

“In Thomas, the audience could see themselves, their mother, or another loved one; her story made the day’s information more relatable, understandable, and impactful.”

Inspiration is a relevant topic for those of us living with heart disease, because our health care providers are always thinking up new ways to inspire the freshly-diagnosed patient:

Take these pills, eat this food, follow this daily exercise plan, avoid that stress, keep those medical appointments, stop doing that, start doing this (and order that medical I.D.)!

Yet the sad reality is that (as I’ve written about here and here) no matter how sound the advice or how slick the informational brochure, most have been remarkably unsuccessful in inspiring heart patients to be more compliant (a distasteful and patronizing word that sounds like it has punishment at the end of it).

In other words, I could listen politely to an inspirational speaker onstage talking about dreams and stars and kale, words intended to motivate me into doing or feeling something I’m not currently doing/feeling. I might even take a stab at adopting the inspirational content, at least for a short while. But unless something within me suddenly clicks, the speaker onstage might end up being just another entertaining after-dinner speech.

And we never know from one minute to the next when we will encounter something or somebody who inspires us to take action. We may not go looking for inspiration, but we will know it when it strikes.

Behavioural scientists generally consider that, to be truly inspired, the inspiration is not willed – it just happens. In fact, the most inspiring messages involve three  related qualities, as described by the University of Pennsylvania’s Dr. Scott Barry Kaufman:

1.  Inspiring happens spontaneously and without intention. This could be an idea that comes from within, an inspiring role model, or a divine revelation.

2.  Inspiring transcends any self-serving concerns and limitations, often involving a moment of clarity and awareness of new possibilities. This moment of clarity is often vivid, and can take the form of “seeing” something one has not seen before (but was probably always there).

3.  Finally, inspiring involves approach motivation, in which a person strives to experience a new idea or vision.

Here’s another example – in contrast to all that inspirational dream-stars-kale out there:  the late U.S. tennis legend Arthur Ashe once had this simple piece of advice that I found utterly inspiring. Best of all, it’s focused on other people, not on his own stellar accomplishments or those of other elite athletes.  And it makes sense for chronically ill patients seeking to enhance their own self-efficacy, one small step at a time, and applicable to almost any life challenge:

“Start where you are. Use what you have. Do what you can.”

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Q: What has helped to inspire you as a patient?

See also:

* Mentioning Road ID does not imply endorsement of the company or products.

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12 Responses to “Non-inspirational advice for heart patients”

  1. United Advocacy Australia August 15, 2015 at 6:08 am #

    Great Blog – you make some really good points here.

    Like

  2. The Accidental Amazon August 9, 2015 at 6:19 am #

    Hah! This made me laugh! Thank you!

    Gawd, I hate all the usual rah-rah crap you hear from motivational speakers. As if. The cancer ones are particularly noisome. I have to agree with some of the commenters, too, that I think our docs and clinicians too often have no clue how to accept where we are at as patients and help us figure out how to go from wherever that is.

    As a clinician myself, I will give my workplace credit for trying to teach us how to figure that out, how to ask patients to define for themselves what they would like to achieve. It might be as simple as a patient saying she’d like to be able to walk to the bathroom without using a cane or a walker. Which really isn’t simple. But once someone defines a concrete goal, at least I can break it down into smaller goals & help my patient figure out the steps it would take to get there. It’s a darn sight better than ‘encouraging’ my cancer patients, for instance, with some of the usual cancer rehab bromides, like telling them to get a FitBit or walk 10,000 steps a day, which is utterly pointless when my patient can hardly get out of bed. Oy.

    And, yes, that stuff is really and truly included in the cancer rehab certification training I did a few years ago. Who are these people who write this crap?

    I wrote a post recently about personal ID bracelets and personal alarms. It was eye-opening. Oy, the things we have to think about. Also, I love Hyperbole-and-a-Half. I printed out her pain scale to show my patients. Hee hee…

    xo,
    Kathi

    Liked by 1 person

    • Carolyn Thomas August 9, 2015 at 8:08 am #

      Hooo boy….

      Your question: “Who are the people who write this crap?”

      My answer: Clueless people who live with the luxury of “healthy privilege“.

      Or, as patient Erin Gilmer scolded an audience of high-fiving tech hypemeisters at Stanford’s Medicine X conference last year (via taped video – because like many “Patient B” types living with multiple chronic illnesses, she was too ill to present her talk in person): “I don’t need an app to tell me how to track my fitness goals. And digital medication reminders are not what I need when I’m poor and can’t afford medications.”

      PS Kathi, I too *love* Hyperbole-and-a-Half, whose hilarious “better pain scale” should permanently replace our current 1-10 faces pain scale. (e.g. #7: “I see Jesus coming for me and I’m scared!”

      Liked by 1 person

      • The Accidental Amazon August 9, 2015 at 11:20 am #

        You know what kills me about that cancer rehab certificate training is that the whole thing was the brainchild of a physiatrist who had had cancer herself. Shame on her! She must have been one of those Patient A types. And forget trying to offer her organization feedback to make things more realistic. You get nowhere. *eyeroll*

        One of my other favorite graphics from Hyperbole-and-a-Half is her drawing of herself surrounded by rainbows, joyously proclaiming, “I’m not dead!” Yep.

        Liked by 1 person

  3. Paved Silver Roads June 22, 2015 at 11:55 am #

    I really think diabetes educators need to read this as well.

    All too often the term “non-compliant” gets used to describe a diabetic who maybe just hasn’t been reached properly. I know that the traditional way of inspiration (“if you don’t get blood sugars in line you will lose your vision/leg/life” schpiels) didn’t work a lick for me, nor do people saying “I’m the best diabetic ever and here’s how I do it!”

    I’ll be honest though – what inspired me to become a “compliant” diabetic was the ability to become one of those annoying “this is how I do it” people. Irony defined, I know, but the point is that different things work for different people and I think it’s high time that medical professionals understood this and used personalized methods of helping patients take care of themselves.

    Like

    • Carolyn Thomas June 22, 2015 at 1:33 pm #

      You have hit the nail squarely upon the head, albeit ironically… 😉 “I’m the best ____ (insert any type of diagnosis here) patient ever and here’s how I do it!” can indeed be off-putting to many, especially for newbies still trying to get their heads around the relentlessness of all the behaviour changes needed to be suitably “compliant” (uggggh, the dreaded C-word…)

      I think I do understand your ironic opinion switcheroo here: anybody who’s ever lived with somebody who’s obsessed with endurance sports (triathlons, etc) might recognized how tempting it is to engage in bored eye-rolling when they go on and on about every workout, about setting each new PR, and about how WE should start training, too, blahblahblah – right up until the day we laced up our own shoes to go for a little run ourselves. My earliest runs were just for fun, just to lose a few pounds, just to have a great time outdoors with my girlfriends. “No pace too slow, no course too short!” was our light-hearted motto.

      Then one day, after years of being back-of-the pack social runners, we determined we’d never been this fit and this ready to sign up together for a half-marathon! Our elite-athlete hubbies were shocked to watch us all cross the finish line together holding hands! But we had done this on our own and ON OUR OWN TERMS (beating a PR was never even remotely motivational to my running group, despite one hubby’s observation one Sunday, “You know, you could cut a minute off your mile time if you just stopped talking during your runs…”)

      Personalized methods do work (for me!); generalized “reach for the stars like I did” talk does not.

      Liked by 1 person

  4. Eve Zavodnick June 22, 2015 at 5:12 am #

    Carolyn, This gives me a lot to think about. I’ve been asked to speak at an American Heart Association event tomorrow night and while I don’t look to be inspirational, I often hope that my story is. My intent is to educate and I usually start off by calling myself the “heart attack don’t” since I did everything wrong in response to my heart event. The Arthur Ashe quote will be on my mind as I address the group tomorrow night.

    Liked by 1 person

    • Carolyn Thomas June 22, 2015 at 6:12 am #

      Hi, Eve – I absolutely agree that telling stories (especially “heart attack don’t” examples) can be powerful because audiences relate to the content. In fact, it’s the opposite of those inspirational speaker brag-fests. I use this approach myself in my own presentations for the same reason – I have a ton of “don’t” examples! One of our Mayo heart sisters mentioned this week that she spoke at a luncheon event recently, and during dessert one of the women in the audience pulled out her phone and called her doctor to make an appointment because of some odd symptoms she’d been ignoring until she heard that speech. Now THAT’S an inspiring talk. Good luck at your AHA event!

      Like

  5. Curious to the Max June 21, 2015 at 7:22 pm #

    Amen! I disdain inspirational speakers, speeches and their messages. (Well, disdain is a bit strong but I tend toward hyperbole when it comes to expressing my feelings!)

    I know I’ve said this a trillion times (hyperbole raises its little head again). Pleasure gives me ideas, wishes and dreams, but my inspirations to ACTION always have been generated by pain and fear.

    Never saw the Arthur Ashe quote before but I’m inspired to have “Start where you are. Use what you have. Do what you can.” tattooed around my pacemaker scar.

    Brrrrrrrrrrravo Carolyn, great post!

    Liked by 1 person

    • Carolyn Thomas June 21, 2015 at 8:15 pm #

      Thanks Judy-Judith! Do you know the hilarious blog/book Hyperbole And A Half? Laughs and art, what could be better? Especially her Better Pain Scale.

      I’m of two minds about the ‘pain and fear’ motivation, personally: for example, I take long daily brisk walks because exercise usually helps reduce my coronary microvascular disease symptoms (that’s the fear-and-pain-motivation at work) BUT I also love my long walks so much now that the motivation has changed to one of pleasure! 🙂 The Arthur Ashe quotation really speaks to me, especially for those ‘bad’ days when all I can manage is a slow shuffle down to the corner and back. I figure we should get extra points for ‘do what you can’ on days like that…

      Liked by 1 person

  6. Isabella Quigley Moriarty June 21, 2015 at 11:34 am #

    Well said. Thank you. I feel inspired when I am in touch with my own ‘self-efficacy’ as you say.

    When I was watching the film ‘Touching the Void’ years ago, I became aware that this movie was made on a mountain top. Many of us climb our own inner mountaintops. That said — I was inspired by the film because I realised I used the same techniques he did, except it all occurred within me – it would be hard to make a film of our inner journeys.

    I am glad you write from your heart and speak as you do.

    Liked by 1 person

    • Carolyn Thomas June 21, 2015 at 12:09 pm #

      Hello Isabella and thanks for sharing your perspective. I love that “inner mountaintops” analogy! I haven’t seen Touching the Void, so I just went and read a review of it. But I can already tell this is a movie I’d find too disturbing to watch! “Crawling and hopping five miles back to base camp…” Yikes. It reminded me of the Doug Sanders post in the Globe and Mail recently in which he called mountaineering “the height of empty egotism…”

      You’re so right – we may not do any “crawling or hopping” these days like these adventurers do, but there’s a whole inner adventure going on just to put one foot in front of the other some days.

      Like

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