How to stay calm when you know you'll be stressed _ Daniel Levitin
두번째 테드다.
스트레스를 받을 때, 현명하게 대하는 법에 대한 연설이다.
신경과학자인 Daniel Levitin은 스트레스를 받았을 때, 현명한 대처를 하지 못했던 자신의 일화를 소개하며
스트레스를 받을 때, 코티졸이라는 물질이 분비되어 논리적이고 합리적 사고를 방해한다고 했다.
따라서 우리는 사전 분석이 필요하고, 특정한 매커니즘이 필요하다고 역설했다.
full script
A few
years ago, I broke into my own house. I had just driven home, it was
around midnight in the dead of Montreal winter, I had been visiting my
friend, Jeff, across town, and
the thermometer on the front porch
read minus 40 degrees -- and don't bother asking if that's Celsius or Fahrenheit, minus 40
is where the two scales meet -- it was very cold. And
as I stood on the front porch
fumbling in my
pockets, I found I didn't have my keys. In
fact, I could see them through the window, lying on the dining room table
where I had left them. So I quickly ran around and tried all the other
doors and windows, and they were locked tight. I thought about
calling a locksmith -- at least I had my cellphone, but at midnight, it
could take a while for a locksmith to show up, and it was cold. I
couldn't go back to my friend Jeff's house for the night because I had an
early flight to Europe the next morning, and I needed to get my passport
and my suitcase.
So, desperate and freezing
cold, I found a large rock and I broke through the basement
window, cleared out the shards
of glass, I crawled through, I found a
piece of cardboard and taped it up over the opening, figuring that in the
morning, on the way to the airport, I could call my
contractor and ask him to fix it. This was going to be expensive, but
probably no more expensive than a middle-of-the-night locksmith, so I
figured, under the circumstances, I was coming out even.
Now,
I'm a neuroscientist by training and I know a little bit about how the
brain performs under stress. It releases cortisol that raises your heart
rate, it modulates adrenaline levels and
it clouds your thinking. So the next morning, when I woke up on too
little sleep, worrying about the hole in the window, and a mental
note that I had to call my contractor, and the freezing
temperatures, and the meetings I had upcoming in Europe,and, you know,
with all the cortisol in my brain, my thinking was cloudy, but I
didn't know it was cloudy because my thinking was cloudy. And it wasn't until I
got to the airport check-in counter, that I realized I didn't have my
passport.
So I
raced home in the snow and ice, 40 minutes, got my passport, raced back to
the airport, I made it just in time, but they had given away my seat
to someone else, so I got stuck in the back of the plane, next to the
bathrooms, in a seat that wouldn't recline, on an eight-hour
flight. Well, I had a lot of time to think during those eight hours and no sleep. And I started wondering, are there
things that I can do, systems that I can put into place, that will
prevent bad things from happening? Or at least if bad things
happen, will minimize the likelihood of it being a total
catastrophe. So I started thinking about that, but my thoughts didn't crystallize until about a month later. I was having dinner
with my colleague, Danny Kahneman, the Nobel Prize winner, and I somewhat
embarrassedly told him about having broken my window, and, you know,
forgotten my passport, and Danny shared with me that he'd
been practicing something called prospective hindsight.
It's
something that he had gotten from the psychologist Gary Klein, who
had written about it a few years before, also
called the pre-mortem. Now, you all know what the postmortem
is. Whenever there's a disaster, a team of experts come in and they
try to figure out what went wrong, right? Well, in
the pre-mortem, Danny explained, you look ahead and you try to figure out
all the things that could go wrong, and then you try to figure out what
you can do to prevent those things from happening, or to minimize the
damage. So what I want to talk to you about today are some of the things
we can do in the form of a pre-mortem. Some of them are obvious, some of
them are not so obvious. I'll start with the obvious ones.
Around
the home, designate
a place for things that are easily lost. Now, this sounds like common
sense, and it is, but there's a lot of science to back this up, based on the way our
spatial memory works. There's a structure in the brain called the
hippocampus, that evolved over tens of thousands
of years, to keep track of the locations of important things -- where
the well is, where fish can be found, that stand of fruit
trees, where the friendly and enemy tribes live. The hippocampus is
the part of the brain that in London taxicab drivers becomes enlarged. It's the part of the brain that
allows squirrels to find their nuts. And if
you're wondering, somebody actually did the experiment where they cut off
the olfactory sense
of the squirrels, and they could still find their nuts. They
weren't using smell, they were using the hippocampus, this exquisitely evolved mechanism in the brain for finding things. But it's really good for
things that don't move around much, not so good for things that move
around. So this is why we lose car keys and reading glasses and
passports. So in the home, designate a spot for your keys -- a hook
by the door, maybe a decorative bowl. For your passport, a particular
drawer. For your reading glasses, a particular table. If you
designate a spot and you're scrupulous
about it, your things will always be
there when you look for them.
What
about travel? Take a cell phone picture of your credit cards, your
driver's license, your passport, mail it to yourself so it's in the
cloud. If these things are
lost or stolen, you can facilitate replacement. Now these are some rather
obvious things. Remember, when you're under stress, the brain releases
cortisol.Cortisol is toxic, and it causes cloudy thinking. So part of the
practice of the pre-mortem is to recognize that under stress you're not
going to be at your best, and you should put systems in
place. And there's perhaps no more stressful a situation than
when you're confronted with a medical decision to
make. And at some point, all of us are going to be in that
position, where we have to make a very important decision about the
future of our medical care or that of a loved one, to help them with a
decision.
And
so I want to talk about that. And I'm going to talk about a very
particular medical condition. But this stands as a proxy
for all kinds of medical decision-making, and indeed for financial decision-making, and social decision-making -- any kind
of decision you have to make that would benefit from a rational
assessment of the facts. So suppose you go to your doctor
and the doctor says, "I just got your lab work back, your cholesterol's a little
high." Now, you all know that high cholesterol is associated
with an increased risk of cardiovascular disease, heart attack,
stroke. And so you're thinking having high cholesterol isn't the best
thing, and so the doctor says, "You know, I'd like to give you a
drug that will help you lower your cholesterol, a statin." And
you've probably heard of statins, you know that they're among the most
widely prescribed drugs in the world today, you probably even know
people who take them. And so you're thinking, "Yeah! Give me the
statin."
But
there's a question you should ask at this point, a statistic you should
ask for that most doctors don't like talking about, and
pharmaceutical
companies like talking about even less. It's for the
number needed to treat. Now,
what is this, the NNT? It's the number of people that need to take a
drug or undergo a surgery or any
medical procedure before one person is helped. And you're thinking, what kind of crazy statistic is
that? The number should be one. My doctor wouldn't prescribe
something to me if it's not going to help. But actually, medical
practice doesn't work that way. And it's not the doctor's fault, if
it's anybody's fault, it's the fault of scientists like me. We
haven't figured out the underlying mechanisms well enough. But
GlaxoSmithKline estimates that 90 percent of the drugs work
in only 30 to 50 percent of the people. So the number needed to treat for
the most widely prescribed statin, what do you
suppose it is? How many people have to take it before one person is
helped? 300. This is according to research by research practitioners Jerome Groopman and Pamela Hartzband, independently confirmed by
Bloomberg.com. I ran through the numbers
myself. 300 people have to take the drug for a year before one heart
attack, stroke or other adverse event is prevented.
Now
you're probably thinking, "Well, OK, one
in 300 chance of lowering my cholesterol. Why not, doc? Give me the
prescription anyway." But you should ask at this point for another
statistic, and that is, "Tell me about the side effects."
Right? So for this particular drug, the side effects occur in five
percent of the patients. And they include terrible things -- debilitating muscle and joint pain, gastrointestinal distress
-- but now you're thinking, "Five percent, not
very likely it's going to happen to me, I'll still take the
drug." But wait a minute. Remember under stress you're not thinking
clearly. So think about how you're going to work through
this ahead of time, so you don't have to manufacture the
chain of reasoning on the spot. 300 people take the drug, right? One
person's helped, five percent of those 300 have side effects, that's
15 people. You're 15 times more likely to be harmed by the drug than
you are to be helped by the drug.
Now,
I'm not saying whether you should take
the statin or not. I'm just saying you should have this conversation with
your doctor. Medical ethics requires it, it's part of the principle
of informed consent. You have the right to have
access to this kind of information to begin the conversation about whether
you want to take the risks or not. Now you might be
thinking I've pulled
this number out of the air for shock value, but in fact it's rather
typical, this number needed to treat. For the most widely performed
surgery on men over the age of 50, removal of the prostate for
cancer, the number needed to treat is 49. That's right, 49 surgeries
are done for every one person who's helped. And the side effects in that
case occur in 50 percent of the
patients. They include
impotence, erectile dysfunction, urinary incontinence, rectal
tearing, fecal incontinence. And if you're lucky, and
you're one of the 50 percent who has these, they'll only last for a year
or two.
So
the idea of the pre-mortem is to think ahead of time to the questions that
you might be able to ask that will push the conversation forward. You
don't want to have to manufacture all of this on the spot. And you also
want to think about things like quality of
life. Because you have a choice oftentimes, do you I want a shorter
life that's pain-free, or a longer life that might have a great deal of
pain towards the end? These are things to talk about and think about now, with
your family and your loved ones. You might change your
mind in the heat of the moment, but at least you're practiced with this
kind of thinking. Remember, our brain under stress releases cortisol, and
one of the things that happens at that moment is a whole bunch on systems shut
down. There's an evolutionary reason for this. Face-to-face with a
predator, you don't need your digestive system, or your libido, or your immune
system, because if you're body is expending metabolism on those things and you don't
react quickly, you might become the lion's lunch, and then none of those
things matter. Unfortunately, one of the things that goes out the
window during those times of stress is rational, logical thinking, as
Danny Kahneman and his colleagues have shown. So we need to train
ourselves to think ahead to these kinds of situations.
I
think the important point here is recognizing that all of us are flawed. We all are
going to fail now and then. The idea is to think ahead to what those failures
might be, to put systems in place that will help minimize the
damage, or to prevent the bad things from happening in the first place.
Getting back to that snowy night in Montreal, when I got back from my
trip, I had my contractor install a combination lock next to the
door, with a key to the front door in it, an easy to remember
combination. And I have to admit, I still have piles of mail that
haven't been sorted, and piles of emails that I haven't
gone through. So I'm not completely organized, but I
see organization as a gradual process, and I'm getting there. Thank you
very much.
