Girl Doc Survival Guide
Young doctors are increasingly in ‘survival’ mode.
Far from flourishing, the relentless pressure of working in medicine means that ‘balance’ is harder than ever to achieve.
On the Girl Doc Survival Guide, Yale professor and dermatologist Dr Christine J Ko sits down with doctors, psychologists and mental health experts to dig into the real challenges and rewards of life in medicine.
From dealing with daily stressors and burnout to designing a career that doesn’t sacrifice your personal life, this podcast is all about giving you the tools to not just survive...
But to be present in the journey.
Girl Doc Survival Guide
EP102: Cass R. Sunstein on habituation and dishabituation
LOOK AGAIN! A world full of colors can become gray due to habituation. Waking ourselves up to truly see the amazing things around us, as well as the problems that should be fixed, takes dishabituation. This conversation focuses on habituation and dishabituation, how they are defined, and what we can do to get life to resparkle. Cass R. Sunstein is the nation’s most cited legal scholar and is also a prolific writer of popular nonfiction. His most recent book, which he coauthored with Dr. Tali Sharot, is Look Again: The Power of Noticing What Was Always There, which will be hitting bookstores on 2/27/24. He is also the coauthor of Nudge with Dr. Richard Thaler as well as the coauthor of Noise with Drs. Daniel Kahneman and Olivier Sibony. He served in multiple different capacities in the US government and has advised the United Nations as well as the World Health Organization. He is currently the Robert Walmsley University Professor at Harvard Law School.
Christine Ko: [00:00:00] Welcome back to SEE HEAR FEEL. Today, I have the great pleasure of being with Cass R. Sunstein. Cass Sunstein is the nation's most cited legal scholar and is also a prolific writer of popular nonfiction. His most recent book, which he co-authored with Dr. Tali Sharot, is Look Again: The Power of Noticing What Was Always There, which will be hitting bookstores on February 27th. He is also the co-author of Nudge with Dr. Richard Thaler, as well as the co-author of Noise with Drs. Daniel Kahneman and Olivier Siboney. He served in multiple different capacities in the US government and has advised the UN as well as the World Health Organization. He is currently the Robert Walmsley University Professor at Harvard Law School. Welcome to Cass.
Cass Sunstein: Thanks so much. Thanks for having me.
Christine Ko: Could you first share a personal anecdote?
Cass Sunstein: Sure. In 2007, I was part of a small group of people working on a speech for then [00:01:00] Senator and Candidate Barack Obama. And the group hadn't done anything with the deadline emerging. And I wrote a note to my best friend on the group saying something very despairing and harsh about how terrible we were doing. And by accident, I sent that not very cheerful email to everyone associated with the Obama campaign, everyone. And that was very not good because they all hated me because I sent that negative email. But my friend on the group, the little group said, Your reputation is done. Everybody hates you. But there's one person who can help us do the task we're supposed to do. And you should have lunch with her and her name is and was Samantha Power. The lunch went very well, and we now have two children and two dogs. "Reader, I married her," as Jane Eyre says, and [00:02:00] that marriage and those children and the current situation, which is fantastic, would not have been possible without that stray email.
Christine Ko: Oh, that's awesome. I had read that you met your wife, Samantha Power, through the Obama campaign, but I didn't know a negative email set it all off. So your upcoming book, Look Again, I think one of the main themes is this concept of habituation. Can you talk about habituation versus dishabituation?
Cass Sunstein: Yes. So if you go into a smoke filled room, the first minutes you're going to notice an overpowering smoke smell, and then after a certain amount of time you'll notice it less, and maybe not notice it a whole lot. There are probably some sounds in your room right now, there are some in mine, that you don't notice until someone says there are sounds in your room. If you are subject, [00:03:00] let's say, to unkindness or something from a boss, or something in your city that's really lousy, the first day you might think, what a terrible boss I have, or my city's services are not so good. But after a while, you will just think that's my job and that's my city.
So habituation is decreasing sensitivity to stimuli. And it's something we share with cats and dogs and rats and horses and much smaller and more primitive organisms where changes are very noticed. Whether they're fantastic; the first year of marriage, people see a vault in their well being; afterwards, they tend to return to where they were before. People habituate to the fact that they're married to someone amazing. And they don't notice it as much.
Dishabituation happens when something to which we have gotten used to suddenly re [00:04:00] sparkles. It has a surprise signal associated with it, whether it's something fantastic or something terrible.
Christine Ko: Yes. You give many examples in the book that I think really helped to bring home those concepts, and you talk about how, something that's a negative stimulus, you probably don't want to break it up because you'll get used to it. Whereas positive things, maybe you want to break it up and take a break from it and come back to it because you won't habituate as much to that. A positive stimulus, you are happy each time you are stimulated by it. But a negative one, you are just as unhappy each time you're stimulated by it. So you might as well just get the whole thing over with quickly.
In the book, you do touch a little bit on health. Would you have any comments on how to apply the concepts of Look Again to healthcare?
Cass Sunstein: I do. And your timing is amazing. Yesterday I was at the dentist. I had two [00:05:00] cavities. I haven't had cavities for a long time. And to fill a cavity, there's novocaine administered by needle and the second needle I reacted very adversely to. Not a physical reaction, just the needle going into the et cetera. I didn't like it very much. And the dentist, she was fantastic. She was so kind and so understanding and so non mechanical.
She'd done this a million times and she acted as if I was the first person she'd done it to and that my distress was something to be treated with respect and dignity rather than, Now I got to deal with this guy. And then at the end of the successful hour, she said, Let me tell you a story. I have cavities myself. I had one filled not long ago by my brother, who's a dentist, and I couldn't take the needle. I just couldn't take it. I told [00:06:00] my brother, I can't handle it. My brother tried. And so I had to have it done without novocaine. And what she said was, I completely understood your experience.
And what I thought was she, because of her own experience, was not habituated to giving someone what's necessary to fill a cavity. She was completely treating it as if it was fresh. And my negative reaction was for her as if she had never done it before. And I think doctors dealing with patients often do best if they see the patient not as one of a very large number of patients who've been through this, but as someone who it's the first time this has ever happened to a person. And then the doctor's own experience will be better, and the patient's experience will be a ton better.
Christine Ko: It sounds really sad, but I think it's hard to keep in [00:07:00] mind that the patient is human and not just a diagnosis or, Oh, you have diabetes, and then just focus on the diabetes. I think it's a very unintentional thing.
Cass Sunstein: To treat every person as a person is one thing and very important, and a little bit of a cliché. Independent of the well known, treat people as human, it's to dishabituate to the practice of medicine in a way that makes everything re sparkle and seem fresh. I'm alert to this because my own role involves being a lawyer and being a teacher. And if you're a lawyer dealing with problems, you can habituate also. And not see the people as people and not see the situation afresh. And as a teacher, definitely, you can see a student as one of a million students, or as this is the first act, as if this is the first student I've ever had, [00:08:00] and then everything becomes full of color. So the problem with habituation is that things turn gray. And that's literally true about how the brain works. You stare at certain photographs for a while, if they're done right, then the colors will turn gray. So if you, with respect to your point about good tasks and bad tasks, if you're doing something not fun, let's say doing some cleaning.
People tend to think, I'd like to break it up because I don't like it. Not good advice. You want to motor through, and that's because the awfulness of the task will become gray as you do it. You'll habituate to it. You won't hate it so much. So do bad tasks quickly. Don't break them up.
People think that for something good, like listening to fantastic music or going on vacation, to do it for one extended period is best. Not. You want to break it up. Because if you break up a good experience into three segments, then you will have the amazement [00:09:00] of the novelty more than once. For good things, to break it up is often really the right idea. To motor through makes your life less colorful.
Christine Ko: Yes. In Look Again, an insert in the book that I received really brings home the point of what you just said, how a bunch of colors will turn gray the longer you look at an image.
Cass Sunstein: What Tali Sharot and I are emphasizing is how the mind works. A dog who first sees something or someone unfamiliar will be jolted and maybe bark. If that person or that thing becomes familiar, it's desensitized. People in countries that lack freedom, treat freedom as not very important to their welfare, their well being; and people in countries that lack money, treat money as not very important to their well [00:10:00] being. So people get used to a lack of freedom, and they get used to a lack of money.
Now that's not to say that these are wonderful things, a lack of freedom and a lack of money, but it's to say that the human mind habituates to them so as to become decreasingly sensitive to them.
People with mental illness of various kinds don't habituate so much. That's a unifying characteristic of people who have mental health challenges. And that's very revealing, that for us to function, we need to habituate. Patients might get really worried about some change in life that's indicated by their diagnosis, but after a while, it's going to be fine. This is the fundamental topic which in medicine and law and public policy is almost entirely unexplored. To see this as fundamental to medicine, that's really important. You might have a [00:11:00] patient who is in terror about what life's going to be like for the next two years, but here habituation is like a horse riding to the rescue. It's a blessing. People who don't struggle with mental health challenges do tend to habituate quite quickly, but it's also a curse that things that are fantastic in life become gray.
Christine Ko: Do you have any simple tips of what someone can do on a daily basis to prevent habituation, whether in law or medicine or in marriage, daily life?
Cass Sunstein: Sometimes when you wake up from a nightmare, where the nightmare involves the loss of something that you care about, maybe a loved one, maybe a relationship, maybe a job, and then you wake up and have a feeling of profound relief that terrible thing didn't happen, that nightmare is a dishabituation machine, [00:12:00] and we can introduce something like that. We don't want to have nightmares in life, but we do want to have that joy or amazement about good things. Either by taking a break, you go away and then you come back and you think, my gosh, this is fantastic. Whatever the “this” is, it might be a family member whom you haven't seen for a while, or it might be take a night away and you go out with your friends and you're away from your spouse and then you come back and you see your spouse, my gosh, that person's amazing, rather than just the person I live with. So we can do it literally in jobs. You can rotate and do various different things. Then you go back and see your original with fresh eyes, or you can just do it imaginatively. You can think a little bit about something, some other kind of life. And then you see your own and it re sparkles.
Christine Ko: Yes. My son is deaf, and he has cochlear implants. And that reality for him, he's habituated to it. [00:13:00] He is, I think, totally fine with that reality. Much more so than me as his mom.
Cass Sunstein: I love your point. It's profound. Completely fantastic. The fact is that people who have an ability to hear are almost certainly mistaken in thinking what it would be like not to have the ability to hear.
So I can't fly. Imagine humanity was divided into the people who could fly and the people who couldn't fly. The people who could fly would think, poor Cass, he can't fly. But the fact that I can't fly doesn't make me, I think, even a little bit sad. I've habituated to that.
Christine Ko: Yes, it's been so great to speak with you. Do you have any final thoughts?
Cass Sunstein: Yes, thank you for this. Thank you for the fantastic questions. I think my final thought is, working on this book, I've increasingly gotten clear on how habituation is not common sense. It's full of surprises. We've discussed some of them, [00:14:00] and an understanding of the importance of dishabituation can make us experience the amazingness of things we take as background noise and maybe struggle to improve things that we've gotten used to that we really should struggle to improve.
Christine Ko: Thank you. Thank you again for spending time with me.
Cass Sunstein: Thank you. Great pleasure.