S03E73 Exploring Mental Toughness versus Resilience

Have you ever thought about the role mental toughness plays in your life or your children's lives? Let's promise you an intriguing journey that revolves around cultivating mental toughness versus resilience, a subject that is often spoken about, yet seldom understood.

Let's take a look at personal experiences of fostering mental fortitude in our children, drawing from the suggestions of fitness coach Ben Bergeron. After that we will navigate through the tricky balance between comfort and challenge, all while challenging our preconceived notions about mental toughness.

What about high-stress situations, such as surgical residencies? What is the cost of developing mental toughness versus resilience? How did you develop your own mental toughness or resilience? Tune in and let's learn together.

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S03E73 Exploring Mental Toughness versus Resilience

Mental toughness. Young people today don't have it do they? Or do they? I was talking to two parents coaching their kids in grade school football, and they both lamented how soft they felt their kids were.

But when I asked them how they planned on trying to make their kids more mentally tough, one parent just shrugged and said, "I don't know. I think I'll just have a soft kid forever." And the other just said, "I wish I could just communicate what I know about being tough to my kid, but it's hopeless. Ugh." I thought about my own kids, and I think in some ways they are more mentally tough than I am, but in other ways, not so much.

They're teenagers now, and I would say I wish I did a better job teaching them mental toughness growing up. I think my kids would probably agree that the mental toughness they developed were through their own experiences, especially being kids going through the COVID pandemic.

Not necessarily from me guiding them as a parent, and as a result, their mental toughness is different than mine.

I do believe I am mentally tough, though, and not to brag, but most people I know who completed surgical residencies generally are. But the type of mental toughness I developed came about from a fair number of traumatizing experiences in childhood, and then as an adult.

These experiences are not those that I would ever wish on my kids. And therefore the mental toughness that I have is not the kind that I would want my kids to have. But so much of the success I've achieved, if any, I believe came in part because of the horrible experiences I have had.

So how can I reconcile my experiences with mental toughness with my children's?

Ben Bergeron, who's a well known fitness and CrossFit coach, has a very glib and ready answer on how to coach mental toughness to kids, which I read in a recent Morning Chalk Up article he wrote with Patrick Cummings based on his podcast, Chasing Excellence.

And the article's called, Coaching Mental Toughness with a Minimum Effective Dose.

So, does Ben Bergeron have the answer? Do you know how to coach mental toughness? Let's talk about it.

So let's take a look at Ben Bergeron's advice in this article. When he was asked, how can you teach a kid about mental toughness and handling challenges when they become more difficult? Ben provided an example of his own kid. He said when he would help his 11 year old son practice soccer, he first had his son shoot at the goal from about a medium distance, which was too hard. And that resulted in repeated missed shots and tears from his kid. So, to change things, Ben started his son's shooting with the ball right in front of the goal, where of course his son would be able to kick the ball right into the net.

After that, he moved the ball back about 5 yards, and then he repeated the drill. Then Ben moved the ball five yards back again, and then five yards back again until at some point his son started missing his shots.

Ben then moved the ball back a little bit closer where his son was able to make his shots again. Therefore, Ben said the goal was to find that spot between comfort and challenge, which allowed his son to continue to progress while avoiding the frustration of repeated failure. And Ben Bergeron called this the minimum effective dose, which is a popular concept in CrossFit.

So as I read this article, I felt like it was a good lesson in terms of how to coach both kids and adults. But I wasn't sure that this really applied to creating mental toughness. I suppose it really depends on what your definition of mental toughness is. For example, what if your kid doesn't want to practice kicking the ball and gets bored after 10 minutes, when you know he needs a lot more practice to be consistent. Will this drill encourage your kid to practice enough to make him make the game winning penalty shot when 50 people are yelling at him at the end of the game?

For me, mental toughness is the ability to perform consistently under stress and pressure. And I'm not sure that Ben Bergeron's minimum effective dose approach, while it is one great way to train your kids for sure, is designed to build this kind of mental toughness. I think that mental resilience, which is the ability to maintain mental fitness is a different concept.

While mental toughness is more of the ability to focus and complete a goal despite pressure and stress, mental resilience is the strength to cope well with difficulties, failures, and setbacks. And I think Ben Bergeron's strategy of finding the sweet spot between comfort and challenge has more to do with mental resilience than with mental toughness.

And my kids, while maybe not as mentally tough as I am. I think they have more mental resilience than I do in some ways. At least certainly more than when I was their age. And maybe being mentally resilient is healthier and better than being mentally tough.

I remember as an 8 year old kid playing chess. I was pretty good, but I wasn't gifted by any means. And one of my father's work friends came over, and he beat me pretty handily, twice in a row. And I ran away crying in frustration. And the crying was pretty normal for an eight year old kid, but the fact that my dad and his friend laughed at me and told me not to be such a baby, pretty much guaranteed that I was going to feel pretty horrible. And suffice it to say, I wasn't interested very much in chess after that.

Now there wasn't a whole lot of teaching about mental resilience back then and my parents probably could have benefited from a lesson from Ben Bergeron or honestly, maybe even Mr. Rogers.

And today, I don't think my kids would have even allowed me to act the way that my father did back then and in this day and age, they would have called me out on that type of behavior, so I guess there has been progress in terms of child raising at least in my family.

Now, in surgical residency, there was no shortage of experiences which were psychologically damaging. And many surgeons can tell you many more gut wrenching experiences than what I probably experienced. But I'll relate an early, small experience as an intern that comes to mind when it comes to developing mental toughness.

And maybe I'll talk more about some of the crazier stories that I have from residency in the future. This particular experience was when I was an intern fresh out of medical school. And at that time, our work schedules were grueling. While the 80 hour work week was just starting to be mandated for residents, that 80 hours was considered something you just reported officially, but did not follow.

All of us worked a hundred hours or more regularly a week, which on average comes out to 14 to 15 hours a day. And every third night was spent on call overnight in the hospital. And you generally wouldn't be able to leave until the next day, at least until early afternoon.

A few of us residents fell asleep and crashed their cars going home. The stress was extreme, and as our intern class went, I was about average in terms of performing under such difficult circumstances. There were definitely some residents who responded worse than I did to the heavy workload and the sleep deprivation.

But there were also a lot of fellow superstar residents who seemed to be able to do everything well on little or no sleep.

As the intern on the various surgical services, every night on call during sign out there was a list of tasks you needed to complete before you could go to bed. And there were a lot of tasks. Most of them was what you would consider grunt work, menial, labor intensive, thankless jobs that were generally unpleasant.

For example, on the Cardiothoracic Surgery Service, one task was to get a chest x ray in the chart of every patient who was about to go to surgery the next day. It didn't matter that that x ray was never needed. And we knew that because it didn't matter how old the actual x ray was. And we knew that this was an old fashioned practice from years gone by. But it was still required on the service, and that meant another menial task for the interns. We had to comb the X-ray file room to locate the images and hound the X-ray tech to come and shoot the chest X-ray. But the tech might have already left for the day.

The superstar interns, of which I was not one, actually learned how to operate the portable X-ray machines and take them bedside to shoot the X-rays and then go develop them in the X-ray lab. But I digress. So for me, one night I had completed all my tasks except for one.

I needed to get a fresh blood sample from a patient who was going for surgery the next day. It was needed for a type and screen in case the patient needed a blood transfusion during the case. Of course, it wasn't likely at all that the patient would really need blood, but it was a blanket policy for all patients on that particular service.

So at 1am I went to the patient's room and struggled mightily to draw blood from the poor patient. This patient had been in the hospital for weeks, and the patient was old and frail, the veins were completely shot from all the IVs and previous needle sticks, and I had just started my internship a month or two before.

And I was still not the most skilled at blood draws. But our senior residents had drilled into all of us interns over and over again like a mantra: "You can ask for help, but remember: asking for help is a sign of weakness." And I could only imagine what he would have said if I woke him up to ask for help for a blood draw.

So I stuck this poor patient and poked and poked and poked. And it took about five times before I was able to get the sample. And this poor patient suffered because of it. I then had to walk through the hospital across a long crosswalk across a block to another building where the blood bank was to drop off the specimen.

And when I handed the specimen to the tech at the window, he looked at it and he frowned and he said, I can't accept this. The label on the tube doesn't have the time and date written on it. So I said, no problem. Give it back and I'll write it. I just drew the specimen and he smirked at me and he said, I can't. You'll have to go get another specimen. And when I literally begged and pleaded to get that specimen back. He refused.

The anger and rage I felt at that moment was insane. I think if I had a knife I might have stabbed him. But instead, I walked across the corridor over to a phone hanging on the wall. I picked up the headset and I literally smashed it against the wall repeatedly as hard as I could before throwing it down and yelling at the tech that I would be back with another specimen.

I almost called my senior, but I knew, one, he wouldn't help me. And two, the verbal abuse and bullying I would get from him and the senior residents would be worse than the difficulty of just getting another blood specimen myself, even if the poor patient suffered even more.

So I had to go back. It took twice as long and twice as many sticks to finally get another specimen from the poor patient. And I finally came back with another specimen. Of course the tech was no longer at the window and it was someone else who took the tube from me. And I finally got to the call room to sleep around 3am knowing we were rounding in two hours at 5am.

I'd be in the OR all day and I'd have to cover cases at least until the afternoon.

And then that experience was rinsed and repeated many times during my residency. And for my fellow surgeons, I know you're scoffing at me thinking about the times that were a hundred times worse in scope than this now seemingly trivial annoyance that I'm recalling.

And if you're thinking that, you're right. But did that experience and many others that were worse build up mental toughness in me? It did. I managed not to break during these years. I grew to be self sufficient as a resident and as a surgeon. And there were very few situations where I felt I didn't know how to handle it, even if I was alone or without assistance. My confidence grew. Whatever I had to do, no matter if I was alone, sleep deprived, juggling 15 tasks, faced with the worst or most challenging issues, I would draw on my always ready to surface internal pool of anger, clench my teeth, and get the job done myself.

But years of these experiences and training also resulted in some unpleasant personality traits, including a constant feeling of tenseness, a lack of patience, being easily irritated, blowing up at the smallest of issues, and then often being angry or aggressive. Disdain or bullying for others with a lack of empathy for those who were less competent or didn't put in as much effort as I did.

And unfortunately, I was in good company. Many of my mentors acted the same way, both in and out of the OR. And since we learned from the best, my peers and I acted the same way as well. Many of us drank excessively, or engaged in potentially risky or impulsive activities outside of work. And all of these behaviors were classic signs of post traumatic stress disorder and indications of burnout.

A study years back suggested that over half of surgical residents screened positive for PTSD symptoms, or showed signs of being at risk. And for a lot of us, including me, it took years to realize that this type of behavior was not normal and appropriate, just because we were big shot surgeons. But that this was maladaptive and hurtful, not only for us, but for those around us.

And as much as I have worked to overcome these issues and found coping mechanisms, I know they linger for me, and they will continue to linger, probably for as long as I live. Certain issues will still push my emotional anger button. I still have difficulty sleeping many nights. And the constant weird, vague, nagging concern of something just waiting to go wrong... will always be sitting in the back of my head no matter what I do.

So what price did we all pay to achieve mental toughness? Was it worth it? Is it worth it to teach our kids how to be mentally tough? Is the goal of mental resilience a better mind state to strive for? Or is that just a bunch of fake psychologic fluffery that we use to try to convince ourselves that every kid is above average, and we should all deserve participation trophies?

I don't have the answers. Looking back, I wouldn't trade my experiences because they made me who I am now. But I certainly wouldn't want to wish those experiences on anyone else either.

So whether you're an advocate of the minimum effective dose leading to mental resilience, or you lean toward the what doesn't kill you make you stronger philosophy. I'd like to hear from you. Let me know what made you mentally tough, or how you teach mental toughness in others. And I'd like to talk about the best ones on a future episode of the podcast.

My weekly thankful is yoga and mobility work. One of the things I've had to learn the hard way about fitnessing is that more is not more. And after nine years of CrossFit and being nicked up and banged up, still recovering from my shoulder injury, which is thankfully so much better, I am still learning the hard way that what I do outside the gym is more important than what I do inside the gym.

I've started going pretty regularly to a stretch and mobility class weekly, which has helped me in subtle ways, maybe more than I realize. And that kicked me off to go back and try hot yoga again, since it's been over a year since my last class. I realize now that not all hot yoga is the same. And it's not all stretch work and mobility.

The hot vinyasa flow class that I took was extremely dynamic, and there was a high degree of intensity, and it was fast paced. Taking that class, but dialing down the poses and moving very slow, has helped me out a lot compared to how I tried to approach hot yoga in the past. But both stretch class and yoga have allowed me to continue my fitnessing, which I love, speed my recovery, as well as hopefully reducing my risk of injury.

I also use a Theragun a lot which helps, by the way.

What are your favorite recovery methods? Let me know.

Thanks again for listening, and please, as always, DM me @BotoxAndBurpeesPodcast on Instagram. Or leave a comment at YouTube.com/@BotoxAndBurpees. Thank you.