Het Tekort van het Teveel (The shortcomings of too much) by Damiaan Denys offers a critical perspective on mental healthcare. The main thesis is that we want to do too much, for too many people. We should focus our efforts on those who are suffering the most, whilst limiting the public investments into helping people who are doing so-so. Going broader than this, Damiaan (or at least my interpretation) argues that we shouldn’t try and solve everything, we should be able to sit with our pain and live with discomfort.
Read: 1x | First: June 2021
“We were in the jungle. There were too many of us. We had access to too much money, too much equipment. And little by little we went insane.” – Francis Ford Coppola (quoted at the start of the book, director of Apocalypse Now, describing the situation in Vietnam
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Summary Review of ‘Het Tekort van het Teveel’
1. The Paradox
One in four people will develop mental health issues during their lifetime (WHO, 2001)
Those suffering from mental health issues have double the chance of dying from cardiovascular diseases
90% of suicides are accompanied by mental health issues
60% of those in need don’t receive mental healthcare, leading to 13,5 million deaths per year (The Lancet, 2018)
The estimated lost productivity and Disability-Adjusted Life-Years (DALY’s) lost between 2011 and 2030 is estimated at 16.300 billion
The investment, per person, on mental health care is but 2,5 dollar per year (between 0,1 to 21,7 dollar, Knapp & Wong, 2020)
Many experts are calling this a ‘global mental health crisis’
Damiaan identifies three problems underlying the crisis:
The incompetence of governments
More than 40% has no mental health care policy, 30% no program, 25% no laws on this (WHO, 2001)
No government is able to provide adequate funding (though, see his later points on this, Andrews & Henderson, 2000)
In developing countries, there is a severe lack of access to mental health care (The Lancet, 2018)
1 billion people living with mental and addictive disorders in 2016
7% of global burden of disease as measured in DALYs
19% of all years lived with disability
Since 1990, there have been no improvements in mental health globally (The Lancet, 2019)
Although there is the same prevalence (number of people with X), the need/demands on care keeps rising (MHF and other sources)
Those living in wealthy (WEIRD) countries are impacted more and are more vulnerable for psychological suffering
The subtitle of the book is ‘The Paradox of Mental Health Care’ and it’s explained as follows:
The first paradox is that you would expect richer countries to do better, not worse
A sub-paradox here is something mentioned in the next section, the people in rich countries are (on average) quite happy at the same time (Our World in Data, 2018 data from Gallup World Poll)
The second paradox is that (in the current system) it’s unsolveable as the actions taken have the opposite effect of what is wanted
The Netherlands
5th place on world happiness ranking (39)
89% thinks they are psychologically health (40)
95% of kids between 12 and 16
40% will develop a mental health issue during their lifetime (42)
In each year (year incidence) this is 20%
21% mood disorders
20% anxiety disorders
19% addiction
9% attention & behaviour issues
The Netherlands spends 7,3 billion euros on health care (43)
4 billion of this on curative (to cure)
1,7 billion on protected living
1 billion on youth mental health care (‘jeugd-GGZ)
0,6 billion on long-term care (44)
The percentage of the budget going to mental health care is the highest in the EU (45)
This care is being done by 19.000 professionals (49)
3.500 psychiatrists
15.000 psychologists
24.000 nurses
“The Netherlands is the best place to go crazy.”
Between 1980 and 1997, there was a doubling in the number of intakes (51)
Between 2000 and 2010, the costs rose from 2,9 billion to 6,1 billion (57)
Between 2003 and 2018, the number of psychiatrists rose from 2400 to 3700 (59)
Or in other words, the number of personell or the abundance of money aren’t the problems here
More health care institutes are filing for bankruptcy (61) WHY?
Waiting lists are becoming longer and work pressure is rising (FIND SOURCE)
At the moment of writing, more than 90.000 people each year are on waiting lists (per year or at any moment???)
It takes about 8 weeks to be referred somewhere
The work pressure is leading to many health care professionals wanting to leave the field
The rest of the book will dissect this paradox by looking at the three components in this system, 1) the health care system, 2) the care offer, and 3) the care demand.
Games People Play by Eric Berne is a book that I probably read somewhere around 2010. An interesting blog summary/analysis by Niel Kakker is what prompted me to put up this post, a full review will be done if I ever reread the book.
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Notes from the summary:
“Eric Berne, the author of Games People Play, says there are 3 big ones: The Parent, The Adult, and The Child. These ego states are different modes of operation in every person. The Adult is the rational logical self. The Parent is the caring, taking care of someone self. The Child is the playful, creative, easily offended self.”
Sometimes the subtext of something being said is what matters, where one assumes a role to entice the other to take a particular action (to show that they are not the role they are implying they are).
Humankind by Rutger Bregman is an enlightening book on how we humans are kinder and more cooperative than we believe. The media, bad scientists (read: some of the key studies I studied in intro psychology), and our own distorted perspective has messed us up, let’s repair that.
Btw the book is published in Dutch too, De Meeste Mensen Deugen (but I found the English audiobook first, so yeah).
Here are some key takeaways from the book:
The psychology experiments like Stanford Prison were very much forced and can be better seen as theatre than actual humans doing bad things
If you don’t make those extreme situations (US prison), you get people just hanging out and being nice (Norway prison)
That is also the way to fix things, not by responding in kind (eye for an eye), but by responding with kindness
We aren’t that cutthroat, we lend people tools, pass along the salt, help a friend. In that way we are communists (social capitalists, or whatever you want to call it)
Kids left alone without supervision will behave like a team, not like Lord of The Flies (book)
We believe that we are good right (I hope so), so does everyone else. We may be selfish, but inherently you can say that people aren’t ‘evil’ in the comic-book or D&D way
The book presents evidence that counteracts a lot of what Steven Pinker (Enlightenment Now) says about ancient civilizations (less murder and mayhem than commonly believed)
Other reviewers do point out that Bregman is putting forth his own thesis in this book, so he might be cherrypicking the evidence too. Anyways, we humans – not that murderous (you know, like the rest of the animal kingdom)
Being faced with having to kill someone, most people chicken out. Soldiers don’t shoot. But the bad thing is that ‘the system’ finds ways to get around this (drones, decimation, etc)
Some cool examples include that of a ‘vrije school’ and medical company in The Netherlands, but I haven’t looked them up yet
How The Mind Works by Steven Pinker presents his enlightening views on how the mind works. Even though the book dates back to 1997, the ideas are still relevant as ever and most of the (neuro)science is alike to what we think now.
Going by my own memory, the book argues that we learn from combining smaller pieces into larger structures. At least, that is what works on the computational/neuron level. But, the same also goes for learning bigger concepts and also how smaller modules led us learn/enjoy other (more complex) things (like music).
He ends the book with something I don’t fully grog yet, that we are not made to understand consciousness. That from our perspective we can’t really. I do get this if we are talking about an intuitive psychologist (just you and me), but we (humanity) also get/compute prime numbers into the millions. So couldn’t we also figure this out by writing stuff down and learning from the work of others? Time will tell.
Ecstasy: The Complete Guide edited by Julie Holland gives a solid and near-complete overview of the scientific and therapeutic knowledge about Ecstasy (MDMA, XTC, Adam, Molly). Although the book dates back to 2001, it’s more complete than one would expect, as much was then already known about Ecstasy. Next to chapters by Julie Holland herself, other contributors are from Ralph Metzner, Andrew Weil, Rick Doblin (MAPS), Sasha & Ann Shulgin, and David Nichols.
Summary
Introduction: Medicine for a New Millennium (Julie Holland, M.D.)
The book starts with an overview of the recreational and widespread use of MDMA, the punishing laws, and the lack of (therapeutic) research that was possible in the decades leading up to 2001. “This book is about the importance of bringing MDMA back into the fold of medicine.” Julie wants MDMA to be researched again, and to become available to the people who need it the most.
Part I: Let X = MDMA
Chapter 1 – The History of MDMA (Julie Holland, M.D.)
MDMA was first synthesized somewhere before 1912 by Merck (pharma company)
The mention of MDMA was only as a intermediary chemical
MDA (more psychedelic-like experience) became popular before MDMA
Later on, it’s learned that (bad) research on this substance was used (in part) to ban MDMA
Sasha Shulgin didn’t invent MDMA but did synthesize it in 1976
In 1985 it was discussed that the therapeutic use of MDMA exceeded 1000 sessions
Only in the 1980s did the recreational use of MDMA take off
After some legal back-and-forth, MDMA was banned on July 1st, 1985 (and finally again on March 23rd, 1988)
Therapists argued that it should be in Schedule III (with medical uses approved), but it was placed in Schedule I, next to cocaine and heroin)
The consequent crackdown on MDMA, of course, made it more popular than ever before
Currently, based on self-reported data on drug use, 33% of participants used MDMA in the last year (GDS, 2019)
Chapter 2 – What Does MDMA Feel Like? (Gary Bravo, M.D.)
Although MDMA’s effects are dependent on the set and setting, there are distinct features of the experience:
Reduces or eliminates the neurophysiological fear response to a perceived threat to one’s emotional integrity
Loving and forgiving awareness
Powerful empathy towards others (feelings of closeness)
Insight into personal patterns or problems (improved self-examination)
Elevated blood pressure, pulse rate, and pupillary dilatation
The chapter lists more effects from different surveys and studies. It also notes that multiple doses (2-3 hours later) lead to less desired outcomes (less empathy, more amphetamine-like side effects). The same is true for repeated use over multiple occasions.
Chapter 3 – How MDMA Works in the Brain (Jessica Malberg, Ph.D., and Katherine R. Bonson, Ph.D.)
“MDMA acts in the brain through three main neurochemical mechanisms: blockade of serotonin reuptake, induction of serotonin release, and induction of dopamine release... MDMA can directly interact with receptors in a variety of neurotransmitter systems and can act as a monoamine (MAO) inhibitor.“
The rest of the chapter explains the exact mechanisms behind these processes (and that the combination of them is needed to create the distinct MDMA effects). It also notes the interaction with other drugs. SSRIs may (completely or partially) block the effects of MDMA. Dextromethorphan (DXM) and MDMA together may lead to serotonin syndrome. The combination with MAO-A inhibitors is dangerous. The combination with hallucinogens (e.g. LSD) may lead to combination effects that can be positively perceived.
Chapter 4 – The Chemistry of MDMA (David Nichols, Ph.D.)
This chapter explains the chemistry of MDMA in layman terms. It explains how MDMA is an organic base (versus acid), and looks very similar to MDA (but with a methyl group added). MDMA is derived from safrole, which comes from sassafras root. You can have two types/mirror images of MDMA, (+)-MDMA and (-)-MDMA, and if your mix consists of both in the same quantities, you have a racemate or racemic mixture. Because MDMA is more lipd (fat) soluble (than MDA), the onset is quicker and the duration is shorter. The added methyl group also mean MDMA doesn’t fit in the 5-HT2a receptor, which produces LSD-like effects. The (-)-MDMA is thus not ‘active’.
There are many crazy myths about MDMA and this short chapter dispels them.
Chapter 6 – The Godparents of MDMA: An Interview with Ann and Sasha Shulgin (Julie Holland, M.D.)
Some quotes from the interview with two legends of the psychedelic world:
“It is an insight drug. That’s its main use. The effect of MDMA, for most people, is that it allows insight without fear.”
“MDMA is also great for marital therapy. It enables two people to step out of the negative patterns that they might set up between themselves so that they can’t communicate openly anymore.”
“[MDMA] is the kind of drug that cannot be used frequently.”
The Shulgins note the positive effect of MDMA on rave culture and even football culture
Part II: Risks of MDMA Use
Introduction
The table at the end of the introduction does a good job of grounding the next few chapters:
tobacco
400.000
alcohol
110.000
prescription drugs
100.000
aspirin and over-the-counter-painkillers
7.600
MDMA
9
Estimated U.S. Deaths in 1998 attributed to
Chapter 7 – Medical Risks Associated with MDMA Use (John Henry, M.D., and Joe Rella, M.D.)
It’s difficult to say how many deaths have been caused by MDMA as in many cases users did other drugs two, were dancing all night, and pills might have contained adulterants. Without saying it, the introduction might also have said that prohibition is the most likely killer when it comes to MDMA.
Hyperthermia is an effect that has been shown to occur occasionally in recreational (club/rave) use, but hasn’t been found in therapeutic settings. Hyponatremia (low plasma sodium level) has also been seen, and is caused by dilution of the blood by drinking too much water. The serotonin syndrome is again mentioned, as are cardiac conditions and liber abnormalities. One interesting fact about the latter is a genetic difference (polymorphism) where the specific enzyme that breaks down MDMA (CPY2D6) is inactive in 5-10% of the Caucasian population. This is, however, only a theory as to this being the reason why some first time users at reasonable dosages have adverse events.
Neurologically MDMA may have negative effects. Studying that with animal models has led to some results, but also highlights that it’s very difficult to make a direct link between e.g. rats and humans (very different (drug) metabolism).
The chapter ends with the following precautions:
Do not take more than one pill
Avoid dancing for prolonged periods of time
Drink electrolyte-rich fluids (sports water), but don’t overdo it, and only drink more if you’re dancing
Wear light loose clothes (to dissipate heat)
Seek medical help early
Chapter 8 – Mental Health Problems Associated with MDMA Use (Karl L. R. Jansen, M.D., Ph.D.)
This chapter also highlights the trouble with researching the negative effects of MDMA use. Adverse psychological effects discussed are psychosis, anxiety disorders and panic attacks, depersonalization and derealization, depression and mania, cognitive deficits, the Pandora’s Box Syndrome, flashbacks and PTSD, and sleep disturbance. Each with limited to no widespread occurance.
The rest of the chapter discussed the ways of treating people with acute or long-term problems resulting from MDMA use. Discussed are psychotherapy, medication, meditation and other calming activities, and antioxidants and food supplements (sources of tryptophan – e.g. banana, chocolate, milk, turkey).
Chapter 9 –Does MDMA Cause Brain Damage? (Matthew Baggot and John Mendelson, M.D.)
There have been limited findings of neurotoxicity in behavioral and animal studies. But for the user who does MDMA a handful of times per year, one should not expect any adverse effects. The chapter mentions the serotonergic changes, and oxidative stress resulting from MDMA use and studies that compare MDMA and non-MDMA users. What is most notable is that in 2001, much more research was needed to establish the specific effects MDMA has (especially long-term) on the brain.
Chapter 10 – The Legal Status of MDMA around the World (Julie Holland, M.D.)
Alas, this chapter is not as outdated as one would hope in 2020. MDMA is still illegal in most countries and only some countries don’t have penalties if someone is caught with an amount for personal use.
Chapter 11 – Minimizing Risks in the Dance Community: An Interview with Emanuel Sferios (Julie Holland, M.D.)
Emanuel Sferios is the founder and executive director of DanceSafe, a drug abuse prevention program/organization. The organization does pill testing and other harm reduction services (e.g. chill-out areas), mostly related to clubbing/festivals. The interview talks about this work and the causes of deaths related to MDMA (adulterants, hyperthermia).
The good thing is that the focus is on harm reduction and not the prevention of drug use (‘just say no’) and DanceSafe seems to be giving honest and reasonable advice that helps save lives.
Part III: MDMA-assisted Psychotherapy
Introduction
MDMA acts as a catalyst to the psychotherapeutic process in four ways:
Connection: it enhances the therapeutic alliance (doctor-patient relationship)
Recall: lowering barriers to remembering childhood or traumatizing events
Insight: able to draw conclusions and make decisions (partially based on the recall)
Acceptance: able to develop compassion and forgiveness for others and self
Chapter 12 – Using MDMA in Healing, Psychotherapy, and Spiritual Practice (Ralph Metzner, Ph.D., and Sophia Adamson)
“It is the primary thesis of this chapter that the empathogenic substances induce an experience that has the potential for dissolving the defensive intrapsychic separation between spirit, mind, and body and that therefore physical healing, psychological problem solving, and spiritual awareness can, and usually do, occur at the same time in the same experience.”
The chapter recounts how MDMA is able to open the heart center/chakra and offers guidelins for sacramental use of empathogenic substances (MDMA being one of them). One key point of individual sessions is the recalling (see introduction), for group sessions there are two possibilities where there is (ritualized) communication or none (inward journey) during the session.
Chapter 13 – Experience with the Interpersonal Psychedelics (Claudio Naranjo, M.D.)
This chapter recounts Claudio Naranjo’s extensive experience with MDA, MMDA, and MDMA and their use in therapy.
Chapter 14 – Clinical Experience with MDMA-assisted Psychotherapy: An Interview with George Greer, M.D. (Julie Holland, M.D.)
George Greer used psychedelics in his private practice when this was still legal and this chapter recounts his experience. He is also involved with the Heffter Institute as a medical director, secretary, and treasurer.
Part IV: Potential Clinical Uses for MDMA
Introduction
“MDMA is a unique medication … that works in an hour to enhance feelings of happiness and relaxation…”
There are many possible clinical uses of MDMA and as of now (2020) some of the uses are going through FDA approval (e.g. PTSD, Phase 3). But it is believed by many that MDMA could be used for most mental disorders. Some of these are laid out in the next few chapters.
Chapter 15 – Using MDMA in the Treatment of Post-traumatic Stress Disorder (José Carlos Bouso)
José Carlos Bouso was one of the first to do research (again) with MDMA, but after the first six patients, the program was shut down again (this took place right after the book was published). The chapter itself talks about the characteristics of PTSD, how it could be treated, and how MDMA could help. Both recall and acceptance are two very important points for people suffering from PTSD.
Chapter 16 – Using MDMA in the Treatment of Depression (June Riedlinger, R.Ph., Pharm. D., and Michael Montagne, Ph.D.)
Depression is very prevalent in the population (between 10-25% and 5-12% for women and men respectively, lifetime prevalence). The underlying (biological) problems of depression may be changed by MDMA (as a serotogenic agent), but most of the research for depression with psychedelics is focused on psilocybin and ketamine.
Chapter 17 – Using MDMA in the Treatment of Schizophrenia (Julie Holland, M.D.)
Schizophrenia and MDMA use has not been rigorously studied, but this chapter does recount some anecdotal findings. Most of the chapter is dedicated to explaining schizophrenia and the two sides (active/passive) that possibly indicate the imbalance of chemicals in the brain.
Chapter 18 – Using MDMA in Alternative Medicine: An Interview with Andrew Weil, M.D. (Julie Holland, M.D.)
Julie Holland interviews Andrew Weil, an author and alternative medicine proponent. It offer some insight in how MDMA is viewed from his perspective and how it could match with (other) alternative healing protocols.
Part IV: MDMA Research
Chapter 19 – Clinical Research with MDMA: A Worldwide Review (Andrew Kleiman, M.D., and Julie Holland, M.D.)
Chapter 20 – Giving MDMA to Human Volunteers in Switzerland (Alex Gamma, Ph.D., Matthias E. Liechti, M.D., and Franz X. Vollenweider, M.D.)
Chapter 21 – Giving MDMA to Human Volunteers in the United States: An Interview with Charles Grob, M.D. (Julie Holland, M.D.)
These three chapters about the research ongoing with MDMA are a good snapshot of what was known at the turn of the century.
For an overview of the MDMA research one could best go to the MAPS website.
Some common findings from the research at that time are:
Increase in certain cardiac parameters (blood pressure, heart rate)
Subjective effects are caused by an enhancement of serotonergic neurotransmission through an interaction with the presynaptic 5-HT uptake site
Women show a bigger response to MDMA
This is in correlation with bigger mood disorders prevalence in women, implicating the same 5-HT system
Part V: MDMA and Society
Chapter 22 – Ecstasy: Prescription for Cultural Renaissance (Douglas Rushkoff, Ph.D.)
Douglas Rushkoff offers his esoteric view on how MDMA is leading/can be used as a catalyst for a cultural renaissance.
Chapter 23 – MDMA and Spirituality: An Interview with Rabbi Zalman Schachter (Julie Holland, M.D.)
Rabbi Zalham Schachter offers his perspective on MDMA as a rabbi and as someone who has used MDMA and other psychedelics.
Chapter 24 – MDMA’s Promise as a Prescription Medicine: An Interview with Rick Doblin, Ph.D. (Julie Holland, M.D.)
The book ends where the rest of the last two decades have remained, with an interview with Rick Doblin. He recounts his personal history with MDMA research and advocacy and the uphill battle that is still being fought. He recounts how he (and the community at large) wasn’t surprised when it got put in Class I, but of course still deeply saddened by it. And how he, with MAPS, is hoping to have MDMA available as a therapeutic agent as soon as humanely possible.
Talking to Strangers by Malcolm Gladwell is his latest book that takes his curious look on society and applies it to interactions between people.
In it, he uses his signature style of stories to illuminate underlying principles. I can recommend the book, here are some of the principles I gleaned from my reading:
People default to truth
We need this for society to work
But if someone is ‘mismatched‘ then things go array
E.g. Bernie Madoff
We think we can ‘read’ other people
But actually this doesn’t work with mismatched people
E.g. Judges are really bad at using this ‘information’ from the suspect
Life is not life ‘Friends’ (series), we don’t show our emotions so perfectly to the world
E.g. Amanda Cox who was goofy, but not a murderer
We must recognize our inability to read others
And at the same time remember that our world is built on trust
1. THE DEFAULT TO TRUTH PROBLEM We do not behave, in other words, like sober-minded scientists, slowing gathering evidence of the truth or falsity of something before reaching a conclusion. We do the opposite. We start by believing. And we stop believing only when our doubts and misgivings rise to the point where we can no longer explain them away.
2. THE TRANSPARENCY PROBLEM Transparency is a myth.
How people are feeling inside often does NOT perfectly match how they appear on the outside, which means we are misjudging other’s intentions.
3. THE MISMATCH PROBLEM We are bad lie-detectors in those situations when the person we’re judging is mismatched.
A mismatch is where someone’s level of truthfulness does NOT correspond with the way they look. I think someone is honest based on how they look and act but in actuality, they are lying and I can’t tell the difference.
4. THE COUPLING PHENOMENON The first set of mistakes we make with strangers… have to do with our inability to make sense of the stranger as an individual. But there’s a second category of error that has to do with our inability to appreciate the context in which the stranger operates… Coupling is the idea that behaviors are linked to very specific circumstances and conditions.
SO WHAT SHOULD WE DO?
We could start by no longer penalizing each other for defaulting to truth… We should also accept the limits of our ability to decipher strangers… But far more important than a little grace and humility over what we cannot do, we should be clear about what we can [do]… There are clues to making sense of the stranger. But attending to them requires humility and thoughtfulness and a willingness to look beyond the stranger, and take time and place and context into account.
10% Happier by Dan Harris is a meditation (ghehe) on meditation and how it has helped him. Although the book is fun to read/listen to, it provides little information per page/chapter. Recommended if you’re into biographies of this kind and fun description, but read a long-form article if you want to learn why meditation is all the rage.
The Art of Learning by Josh Waitzkin is a great book on how to achieve peak performance. It mixes together his personal journey in chess and push hands with frameworks he discovered during his life. In my summary below, I will pick apart the principles and see how I can apply them in my own life. The main question I have is how to apply these things that are applied to the relative or very short timeframe, with learning and performing over longer periods of time without those competition moments.
Incremental Learning
Josh argues that there are two ways of learning. The first is the entity theorists (fixed mindset). The second is the incremental theorists (learning, hard work).
I think most people are aware that we can learn new things (just think back to when you were a baby). Yet that many also think that we can’t become better at many things we do (e.g. chess, tennis, baking).
He argues that the incremental learning approach (of course) is better. And that you can always learn more, especially with the techniques listed below.
Simplify
In chess, Josh applied the simplification by starting with the endgame. This meant he only had to deal with 2-3 pieces on the board. He then also practised with other pieces alone, to get a deep understanding of how they work. This in contrast to learning everything about chess with a full board.
Personally, I see the application of this in many things. One example is learning weightlifting. The Snatch, for instance, is quite the complex movement, but if you focus on one part each time or break it up during warm-up, you learn over time to do the whole movement better and better.
Layering
From this simplified version, can you add extra layers of complexity? Here Josh mentions how he builds up chess positions or tai chi movements again to their full form. Each time with a deep, intuitive, understanding of the layer(s) below.
I guess I already touched upon this a bit with the simplifying example. I can also see this work in business. With Queal we started with just one product, then added flavours, variations, other products, dashboard, etc. Each time building upon the foundations of the layer before.
Making Smaller Circles
A duality or mix of both simplification and layering is ‘making smaller circles’. Here Josh means that you can have an expert understanding of a move or position, but make it even smaller than before.
An example he uses is that of ‘controlling the centre’. Grandmasters in chess can apply this at other places on the board too. For push hands, it means making your moves smaller and smaller so that can outwith your opponent (imagine a boxer’s left hook versus a drunk swinging his arm around).
For myself, I can imagine this applying to the techniques in the Snatch. Or to better understand what entrepreneurial things to work on (versus not). But I don’t have the best example/understanding here yet.
Lose Yourself
Losing yourself touches upon that deep/intuitive understanding of a topic and executing at ‘superhuman’ speeds/levels. I understand it as being able to connect things without having to deliberate about it (using your prefrontal cortex, or ‘talking’ to yourself).
It reminds me of Blink by Malcolm Gladwell and Flow by Mihaly Csikszentmihalyi.
I’ve experienced flow (as described in the book) sometimes but not very often. I think you can apply it to entrepreneurship, but here you also need a lot of research, doing excel, and meetings. Not always the best for flow.
Examples/Coaching
You need a coach (see Triggers). A coach can help you see what is the right way to do something. And together with a coach you can improve faster than if you’re doing it on your own.
I’ve seen this both at Queal and with weightlifting. It’s hard work and sometimes not too much fun, but a coach does really help you learn quicker. Of course, do find someone who can match your learning style and knows how to get the most out of you.
Constraints
At our office we have a ‘game’ in which you are give certain constraints and then have to apply that to your idea. It can help idea new ways of solving the problem, find costs saving, find what the core of an idea is.
Josh mentions that he couldn’t use one of his hands in the lead-up to a tournament, so he had to learn how to defend his body (and attack the other) with just one hand. This led to many creative insights and a technique that was harder to combat by his opponents.
I also remember a story of Toyota (true or not), that they don’t allow debt within each division, which triggers each one of them to think of the best way to make what they need in the most efficient way possible (the company has enough money/ability to borrow, so it’s a voluntary constraint).
Opponents
Find the biggest guy in the room, pick a fight. Ok, that is not exactly how Josh described it, but having good opponents is key. It’s someone (or another company) from which you can learn, someone who has something to teach you.
At Queal, we learn from moves that other companies make. And that includes opponents, but also others outside our space (I don’t remember if he mentions this much, but I think you can learn a lot from other disciplines).
Losing to Win
When you’re facing a bigger/better/faster opponent, be prepared to lose. Here Josh argues that you should check your ego at the door. Don’t be disheartened by loss, but learn how to extract lessons from it.
In the world of business, I think a good example is sales people. Some go home and worry, others see what 1% did go well and try to make that 2%. The most difficult thing here (for me) is to know what is information/signal from all the noise. If our sales go down, can we learn what to do better, or was it just random fluctuations?
Losing to win is definitely something where a coach is very helpful.
Pause to Accelerate
If you keep throwing yourself at something, you may get a breakthrough. More likely you will burn out. So pause once every while and recover (even recover in between sets, or when working 8 hours). And on a large scale, take a summer break and come back with new ideas.
In this fast-paced world, I think this is a great principle to adhere to and something I hold dear. I can’t keep on working and working (maybe unless in the flow for a few hours) and taking a step back is, in many cases, the best thing to do.
Find the Zone
Many people can’t do good work at home. Too many distractions, too many patterns that you trigger that aren’t related to work (doing dishes, tv around, hi neighbour). Josh has found that you should always trigger yourself to find ‘the zone’.
The trigger could be a mediation, a jog outside, your favourite song (a combination of these and more). If you do this every time before you want to do your best work, then eventually this can become the thing that gets you to do your best work.
Josh also combines this with another one of the skills, making smaller circles. What if you don’t have time now for the 15-minute meditation? Try and (over multiple sessions) make the meditation shorter and shorter. So that when there is a situation when you can’t do the full ritual, you can still get in the zone.
His personal example of this smaller circle was a breath. Before he got on the mat to do push hands, just one breath could centre him.
Making Sandals
If you’re walking on glass, you can be angry and pained. Or you can make sandals. Here Josh argues that you can use your passion/anger as fuel to build something better. Is the other guy cheating, don’t break out in a fit, show the a-hole that you’re better than him.
Another way of looking at this is sandals vs not taking the path at all. In our world, we face many problems and we can’t solve everything, but that doesn’t mean we should close our eyes. I personally try and be very rational and see where we could have the biggest impact (e.g. malaria).
Be Unique
At the highest level, everyone is technically adept. Here you need to distinguish yourself by bringing everything you’ve learned, by being unique. That is the thing that others can’t replicate. And the way you might become push hands champion or a chess grandmaster.
Applying this to my own life
During this review I’ve tried to find some examples where I’m applying the techniques/lessons to my own life. I see several places where it could be useful and one thing that it reminds me of is another term: deliberate practice. Not just going through the motions, but being in the presence/zone and actively learning how to do something better.
Weightlifting is what comes to mind, but how to do my work at Queal, how to eat right, and how to do all other things in life, are all places where I can apply some of the lessons above. Again, a recommended book that teaches some great lessons.
Drive: The Surprising Truth About What Motivates Us by Daniel Pink turns motivation upside down. Pink dissects motivation, throws out the old stick-and-carrot and replaces it with autonomy, mastery, and purpose. More illuminating than Drive would be quite the performance. It is based on rigorous science, yet is able to convey one clear message. Motivation needs to be rethought; we are working with an outdated system and need to reconsider how we motivate people.
The old system is a mismatch between what science knows and what business does. The latter depends on stick-and-carrot motivation. They offer large rewards for (individual) performances, but at the same time scare people with threats of layoffs. This system is based on extrinsic motivation and belongs in the 20th century. Yes, it does work there, the stick-and-carrot approach works for left-brain tasks. People work faster and faster when they are rewarded more and more for mechanical tasks. The question now is; how many jobs fit this description?
Almost all jobs in the current workforce ask for (rudimentary) cognitive skills. In the 21st century work consists of right-brain tasks. Instead of a narrow focus (stick-and-carrot), the jobs of today require creativity, problem-solving skills and novel approaches. The famous candlelight problem beautifully showcases this effect. When participants are presented with the classical problem they perform better when given no reward than when given a reward. And between a low and large reward there is a negative relationship; the larger the reward, the longer participants took to solve the problem. Only in the special (20th century) situation where the candles and pins were taken out of the box (making the solution obvious) did rewards have a positive impact.
Motivation in the 21st century should consist of three integrated parts. The first is autonomy; being free to choose what to do. The second is mastery; becoming better at something. The third is purpose; doing something that matters. Drive perfectly explains the three concepts and in the end, gives advice on how to activate the three areas to their full potential. Daniel Pink has written five books to date, he was the speechwriter for Al Gore and definitively knows his way with words. He has made Drive into a clear and concise book that achieves great explanatory power.
