TCC Kaleidoscope Column

A monthly column by Dr. Kisha Holden on diverse topics to support the Morehouse School of Medicine’s vision of “Leading the Creation and Advancement of Health Equity”


holden-headshotKisha Holden, PhD, MSCR
Interim Director, Satcher Health Leadership Institute
Associate Professor, Department of Psychiatry and Behavioral Sciences; Department of Community Health and Preventive Medicine

Effective leaders assume the immense responsibility to exceed expectations and respond successfully to the diverse need of multidisciplinary team members. It is not uncommon for leaders to face stressful challenging situations that require a delicate resolution and gingerly reconciling conflict.  Often, there is a complex interplay of interpersonal issues and demands that require levels of resilience to expeditiously move forward positively.

 

Deconstructing Psychological Resilience

Resilience is a complex concept that encompasses physiological responses, psychological, cultural and spiritual characteristics which may determine how a person will respond and function in times of stress (Resilience Alliance, 2010). Resilience, according to the Oxford English Dictionary, is ‘the ability to rebound or spring back, the power of something to resume its original shape or position after compression or bending’. In philosophical terms, it can be understood within a concept of conatus: a word variously translated as striving, endeavor, tendency and effort, and also with meanings related to power, will, and desire. Conatus is an essential attribute of all things, and in particular of human beings. It is our striving towards self-maintenance. For health researchers, resilience may be an interactive concept which refers to the capacity for successful adaptation in adversity, the ability to bounce back after encountering difficulties, negative events or hard times (Rutter, 2006). It includes a sense of self-esteem or self-confidence, patience and the ability to adapt to changing circumstances, humor in the face of difficulties and a belief that problems can be solved (Connor and Davidson, 2003).  It is the process of adapting well in the face of emotional difficulties, adversity, trauma, tragedy, and overwhelming or unrelenting stress.

 

Core Concepts of Resilience

Core concepts of resilience are: 1) optimism and perseverance, 2) personal competence and tenacity, 3) social competence and support, 4) emotional awareness and tolerance of stress, and 5) internal locus of control (Siebert, 2005); and it can be beneficial for diverse leaders.

 

Selected Characteristics of Resilient People

Some of the common characteristics of resilient people include the following according to Tugade et.al, 2004:

  • They have a sense of meaning, direction, and purpose. They are value-centered rather than reactive and defensive.
  • They realize that the quality of our lives depends on how we focus our energy and our attention. They try to align their thoughts and actions with their values. They know how to motivate themselves to take action.
  • They don’t judge themselves or others harshly when things go wrong. They focus on what they want, not on what they don’t want.
  • They are able to tolerate ambiguity, uncertainty, and imperfection. They have a long-range perspective, so they give themselves and others room to grow. They can afford to be flexible and creative because they are centered in their values.
  • They are reasonably optimistic. Even though they are dedicated to doing things well, they don’t take themselves too seriously.
  • They take responsibility for their mental programming, their emotions, and their actions. If they have ineffective ways of thinking and behaving, they evaluate them and make appropriate changes.
  • They look at adversity as a challenge rather than as a threat. They realize that no matter how the present situation turns out, they will learn and grow from it.
  • They respect themselves and other people. They have a spirit of cooperation, looking for win-win solutions rather than trying to win over other people or ignoring their own wants and needs because of fear.
  • They know how to let go of things they have no control over.

 

Strengthening Psychological Resilience

Building resilience is a personal journey that includes a combination of several factors, including:  (1) establishing and nurturing healthy relationships that create love and trust, provide role models, and offer encouragement and reassurance, (2) demonstrating a positive view of yourself and confidence in your strengths and abilities, (3) harnessing skills in effective communication and problem solving, and (4) delineating the capacity to manage strong feelings and impulses. Some of the tools that may be useful include the following:

  • Try to avoid viewing crises as insurmountable problems—you can’t change the fact that highly stressful events happen, but you can change how you interpret and respond to these events.
  • Try to look beyond the present to how future circumstances may be a little better.
  • Try to acknowledge small and/or subtle changes in how you feel as time goes on; this may help you to better deal with difficult situations moderately.
  • Try to learn from your past-focusing on past experiences and sources of personal strength which can help you learn about what strategies for building resilience might work for you.

 

“If you’re not hopeful and optimistic, then you just give up. You have to take that long hard look and just believe that if you are consistent, you will succeed.”
Congressman John Lewis

 

References

  • Connor, KM., & Davidson, JR. (2003). Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and Anxiety, 18(2), 76-82.
  • Oxford English Dictionary. Resilience.  Retrieved from http://www.oxforddictionaries.com/us/definition/learner/resilience
  • Resilience Alliance (2010). Assessing resilience in social-ecological systems: workbook or practitioners.  Retrieved from http://www.lsln.net.au/jspui/handle/1/8086
  • Rutter, M. (2006). Implications of resilience concepts for scientific understanding. Annals of the New York Academy of Sciences, 1094(1), 1-12.
  • Siebert, A. (2005). The Resiliency Advantage: Master Change, Thrive Under Pressure, and Bounce Back from Setbacks.  Berrett-Koehler.  Portland, OR

In Celebration of Women’s History Month (March), Let’s Honor the Exceptional Ways that Numerous Women Leaders have Contributed Immensely to our Society

Did you know?

  • Men out-rank women in U.S. faculty positions in academia
  • Women are more likely to be found in lower-ranking academic positions
  • 32.5% of women faculty are in non-tenure track positions compared to 19.6% of men faculty
  • Among tenured faculty, only 44% of women are married with children compared to 70% of men

Nevertheless, many women acquire imperative skills necessary to navigate through the complexities of ever-
changing environments that require strong and thoughtful leadership. It is promising that many women leaders adopt the following principles of optimistic leadership.

Principles of Optimistic Leadership

Insight: Awareness of Self and Empathy with Others. Learning self-reflection that includes an increasing awareness of one’s beliefs, values, and abilities, as well an increasing ability to understand and appreciate the beliefs, life experiences, and values of others.

Integrity: Ethical Leadership Principles and Practices. Offering fundamental principles and practices associated with ethical leadership skills, as well as developing congruence between one’s own values and one’s actions.

Synergy: Collaboration and Problem Solving. Demonstrating the ability to work cooperatively and effectively with others in ways that empower individuals by using gifts and contributions from all participants.

Purpose: Sharing a Commitment to Action. Developing the motivation to translate knowledge into action, foster buy-in and support, and to become actively involved in individual and collaborative efforts to foster personal and social change.

Impact: Purposeful Engagement and Citizenship. Promoting positive civic engagement and social responsibility through an ethic of service and a concern for justice.

Still, there are common stressors and issues that several women may experience at some point time during her

lifetime, which engenders a unique set of circumstances. Often it may require some level of resilience—the

ability to “bounce back” in the face of adversity. Some of the selected concerns include:

  • Work-Life Balance-pursuing advancement in one’s career while making quality time for family and/or
  • other personal responsibilities
  • Glass Ceiling Effect-gender based biases in recruitment, hiring, career advancement, promotion etc.
  • Gender Discrimination (actual and/or perceived)-a violation based on gender
  • Sexual Harassment-unwanted/unwelcomed physical sexual advances, requests, and/or verbal remarks of a sexual content/undertone
  • Workload and Role Overload-overwhelming expectations that could lead to workplace burnout

Despite various multifaceted matters, we need competent women leaders. This issue is reinforced by scientific literature that concludes the following:

  • Women leaders add value in diversity of perspectives (Warner, 2014; Boatman, et al., 2011)
  • Women leaders exemplify key behaviors that have a proven positive impact on organizational performance: inspiration, expectation and rewards, participative decision making, and intellectual stimulation (Desvaux and Devillard, 2008)
  • Women leaders have a better awareness of social contexts and cues (social sensitivity) resulting in groups with higher collective intelligence (Woolley, et al., 2010)

Women are remarkable at achieving multiple roles and related responsibilities—mother, wife, partner, sister, daughter, aunt, godmother, employer/employee, friend, church member, community activist etc. We are strong, persistent, and dedicated to ensuring that our families and communities flourish, while simultaneously demonstrating excellence in the workplace. It is amazing how we have survived and even thrived in many cases to unrelenting, atrocious, systemic historical, socio-political, economic, and environmental injustices. It is women (and several others) such as, Abolitionist Harriet Tubman, Attorney/Former First Lady Michelle Obama, Attorney/Former U.S. Secretary of State Hillary Rodham Clinton, Feminist/Activist Gloria Steinem, Scholar/Journalist Dr. Melissa Harris-Perry, Community Rights Activist Angela Davis, Media Mogul Shonda Rhimes, Cultural Icon/Performer Beyonce Knowles, Gymnast Kristi Yamaguchi, Cultural Anthropologist Dr. Johnetta B. Cole, Senator Elizabeth Warren, Chef Maneet Chauhan, Attorney Anita Hill, and Morehouse School of Medicine President & Dean Dr. Valerie Montgomery Rice that continue to empower young women to believe that success is possible.

“It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences”
Audre Lourde ~ Writer, Feminist, Womanist, Poet, Civil Rights Activist

References

~Catalyst. Quick Take: Women in Academia. New York: Catalyst, July 9, 2015.
http://www.catalyst.org/knowledge/women-academia
~http://www.sciencemag.org/careers/2002/10/gender-work-stress-and-health

~Boatman J, Wellins R, and Neal S. (2011). Women work: the business benefits of closing the gender gap.
http://www.ddiworld.com/ddi/media/trend-research/womenatworkgendergap_br_ddi.pdf

~Desvaux G and Devillard S. (2008). Women matter 2. http://www.mckinsey.com/global-themes/women-matter

Warner, J. (2014). Women’s leadership. What’s true, what’s false and why it matters.
http://www.americanprogress.org/issues/women/report/2014/03/07/85467/womens-leadership/

~Woolley AW, Chabris CF, Pentland A, et al. (2010). Evidence for a collective intelligence factor in the performance of
human groups. Science. 330:686–8

Happy New Year, Welcome 2017! Let’s Reinvigorate Ourselves, Relish in Individual Strengths, Refocus Priorities, and Regimen Self-Care

In navigating through the complex maze of life and handling a myriad of responsibilities, many of us are inclined to place our own personal needs at the bottom of our long “to-do- list”. This can be damaging to our overall health and well-being. We must take better care of ourselves– we are worth it!

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices (DHHS, 2016). Mental health is a springboard of thinking and communication skills, learning, emotional growth, resilience, and self-esteem. Mental illnesses are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) and associated with distress and/or impaired functioning. It includes a complex interaction among biological, psychological, social, and cultural factors.

According to the National Alliance on Mental Illness (NAMI, 2016) mental, emotional, and behavioral health issues affect a significant portion of the U.S. population, with an estimated 43.8 million Americans experiencing mental health conditions every year. We know from extensive research that has been conducted that there is a relationship between mental and physical illnesses – there is no health without mental health. Talking with a primary care physician is an excellent first step for you to discuss personal thoughts, feelings, & life stressors. It is also a means to get screened for common mental health problems, such as depression and anxiety (NIMH, 2013). Furthermore, you can choose to get a comprehensive assessment from a mental health professional, such as a psychiatrist or psychologist.

One major concern that is prevalent in many communities is stigma about mental illness. Stigma is a barrier that can discourage individuals from getting any type of help due to the fear of being judged or discriminated against. Nevertheless, do not get discouraged from seeking professional assistance. There may be a problem that you should find help for if:

  • You experience an overwhelming and lingering sense of helplessness and sadness, and your
  • problems do not seem to get better despite your efforts to get help from family and friends.
  • You are finding it difficult to carry out expected activities at home, work and/or community.
  • You worry excessively, anticipate the worst, or are constantly on edge.
  • Your actions may be harmful to yourself and/or to others.

We all have various types of stressors and may experience mental, emotional and/or behavioral health problems at some point in time during our lives. For example, some of the stressors could be: health concerns, personal issues, problems with interpersonal and intimate relationships, daily demands, unresolved pain or trauma, negative life events, job/employment issues etc. Often, it is a combination of several stressors that elevate our risk for mental, emotional and/or behavioral health problems.  Adequately coping with life issues is critical for the prevention of anxieties from becoming overwhelming and/or progressing to a point of being problematic. Here are a few strategies that you should consider:

  1. Self-Awareness and Monitoring-be conscious of your level of functioning and when a break is needed.
  2. Stress Management and Relaxation-engage in pleasurable activities that work for you, such as meditation, reading, listening to music, spiritual fellowship, mini-vacations etc.
  3. Stop Self Destructive/Defeating Behaviors-refrain from negative self-talk, excessive use of alcohol, smoking tobacco, and/or engaging in risky activities.
  4. Social Support-establish a network of people in your life who are positive, empowering, and uplifting.
  5. Self-Care-conduct tasks that encourage health, such as routine exercise, adequate sleep, healthy eating, & seeing a doctor(s) for regular check-ups.

We have the propensity to be resilient. Resilience is the process of adapting well in the face of emotional difficulties, adversity, tragedy, and/or overwhelming stress. It is being able to “bounce back.” We are strong and can effectively manage multiple roles—spouse, partner, parent, daughter/son, professional, community advocate, leader etc. So let us make it a priority to take good care of ourselves and cultivate a personal culture of self-care.

“Mental health is fundamental to a person's overall health, indispensable to personal well-being, and instrumental to leading a balanced and productive life.” David Satcher, MD, PhD, 16th U.S. Surgeon General

For additional resources contact: American Psychological Association (www.apa.org), American Psychiatric Association (www.psychiatry.org), Mental Health America (www.mentalhealthamerica.net), National Alliance on Mental Illness (www.nami.org), and Centers for Disease Control and Prevention (www.cdc.gov).

 

References

National Alliance on Mental Illness (2016). Mental Health By the Numbers. Accessed from
https://www.nami.org/Learn-More/Mental- Health-By- the-Numbers

National Institute of Mental Health. (2013). Major Depression Among U.S. Adults. Accessed from
http://www.nimh.nih.gov/health/statistics/prevalence/major-depression- among-adults.shtml

U.S. Department of Health and Human Services (2016). What is Mental Health? Accessed from
http://www.mentalhealth.gov/basics/what-is- mental-health/

In July 2004, scholar Barack Obama introduced us to the concept of what he labeled as “the audacity of hope”. In 2006, his widely popular book The Audacity of Hope: Thoughts on Reclaiming the American Dream challenged all of us to re-conceptualize our views and become better rooted in fundamental values for decision-making. Our charge was to establish a sense of optimism while delineating inventive paths forward. At the heart of his book he called for “a vision of how we can move beyond our divisions to tackle concrete problems” and he grapples with the role that faith plays in democracy.

Fast forward to November 2016–once again, I am motivated to conduct soul searching and deep thinking about who we are at the core. I am faced with drawing on the power/strength of my ancestors and mentors who have contributed to an unbreakable foundation as to why we honor the countless vials of blood, sweat, tears and back-breaking work of the many individuals that fought for civil rights, women’s rights, and basic human rights. I am faced with a “reality check” and “wake up call” for ensuring that I model ethical leadership, empower others to celebrate diversity, and inspire colleagues to disseminate evidence based science to support advances to health equity.

We are resilient. In philosophical terms, it can be understood by the concept of conatus: a word variously translated as striving, endeavor, tenacity, striving & effort; and also with meanings related to power, will, and desire. Conatus is an essential attribute of all things, and in particular of human beings. It is our perseverance towards self-maintenance. For health researchers, resilience is an interactive concept which refers to the capacity for successful adaptation in adversity, the ability to bounce back after encountering difficulties, negative events or hard times (Rutter, 2006). It includes a sense of self-esteem, self-confidence, patience, the ability to adapt to changing circumstances, and a belief that problems can be solved (Connor and Davidson, 2003). It is a process of adapting well in the face of emotional difficulties, adversity, trauma, tragedy, and overwhelming/unrelenting stress that reflects personal & social cognition.

We must strive to take better care of ourselves—mentally, emotionally, behaviorally, physically, and spiritually. Optimal overall health and wellness is critical. Building resilience can in part start with some basic areas of focus to consider: 1) Self-Awareness and Monitoring-be conscious of your level of functioning and when a break is needed, 2) Stress Management and Relaxation-engage in pleasurable activities that work for you, such as, meditation, reading, listening to music, spiritual fellowship, mini-vacations etc., 3) Stop Self Destructive/Defeating Behaviors-refrain from negative self-talk, excessive use of alcohol, smoking tobacco, and/or engaging in risky activities, 4) Social Support-establish a network of people in your life who are positive, empowering, and uplifting, and 5) Self-Care-conduct tasks that encourage health, such as, routine exercise, adequate sleep, healthy eating, & seeing a doctor(s) for regular check-ups.

We are strong, persistent, and dedicated to ensuring that our families and communities flourish. It is remarkable how we have survived and even thrived, in many cases of unrelenting, atrocious, systemic historical, socio-political, economic, and environmental adversities. I contend that fortifying ourselves in various supportive ways can serve as a positive impetus for guarding against negativity and coping with deleterious situations. Let’s move forward as competent, thoughtful, and fierce professionals.

“When They Go Low, You Go High”
~Michelle Obama, First Lady of the United States of America~

Works Cited

Connor, K., Davidson, J. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 18:76–82.

Fluker, W. E. (2009). Ethical Leadership: The Quest for Character, Civility, and Community. Augsburg Fortress.

Obama, B. (2006). The Audacity of Hope. Crown Publishers, New York.

Rutter, M. (2006). Implications of resilience concepts for scientific understanding. Annals of the New York Academy of Sciences, 1094(1), 1-12.

Health equity is defined as “attainment of the highest level of health for all people” (DHHS, 2011). The inference is that everyone has a fair opportunity to live a long, healthy life; and that health should not be compromised or disadvantaged because of an individual or group’s race, ethnicity, gender, income, sexual orientation, neighborhood or other social condition. Health equity is assurance of the conditions for optimal health for all people. Achieving health equity requires valuing all individuals and populations equally, recognizing and rectifying historical injustices, and providing resources according to need.  Health disparities will be eliminated when health equity is achieved.  

In the Institute of Medicine’s landmark report titled The Future of Public Health (IOM, 1988) one major issue indicated was that “the need for leaders is too great to leave their emergence to chance.”  Also, I contend that principles espoused in the book, Ethical Leadership: The Quest for Character, Civility and Community (Flucker, 2009) are essential to progressive and innovative approaches to build healthier communities. It is critical that leaders adopt leadership principles inclusive of: 1) insight-the importance of self-awareness, personal biases, and having empathy for others circumstances, 2) integrity- ethical governance and developing congruence between one’s own values and one’s actions, 3) synergy-learning the ability to work cooperatively and effectively with others in ways that empower individuals to use their gifts and make contributions that can benefit all parties, 4) sharing the “commitment to action”-developing the motivation to translate knowledge into action, foster buy-in and support, and to become actively involved in individual and collaborative efforts to foster personal and social change, 5) impact-promoting positive civic engagement and social responsibility through an ethic of service and a concern for justice.  In part, it will require focused training in these domains for diverse professionals and community advocates to advance health equity.

According to a first-ever study of U.S. medical schools, in the area of social mission, MSM ranks #1 in the nation (Mullan et.al, 2010). In 2016, MSM received the Josiah Macy Jr. Foundation Award for Institutional Excellence in Social Mission. In order to truly promote community health and responsibility an ethical leadership model must be employed. Focused initiatives may be achieved as we continue to transform the science of ethical decision-making and discovery in research, health promotion, and practice. Health professionals, practitioners, research scientists, policymakers, community leaders, and individual consumers collectively have unique roles as thought leaders in the design, implementation, and evaluation of innovative strategies to promote community health and advance health equity.  This can best be attained with integrity-based leadership approaches; and we must help to develop effective training strategies that are centered on ethical and strengths-based leadership concepts. Moreover, ethical leadership for community health promotion is an integral part of addressing health inequities, particularly concerning the distribution of resources through health education, creating a workforce of persons that target underserved communities, increasing awareness about the role of selected social determinants of health, and working collaboratively to enhance trust with various communities.

A meaningful conceptual model of leadership development should be based on the values and principles of an organization. The model should engender primary constructs that are central to the organizational culture; and promulgated through the actions of its leaders. For example, within the Satcher Health Leadership Institute at MSM, significant values (e.g., integrity, consensus building, trustworthiness, and diversity) support operational processes and a commitment to excellence by faculty & staff for the implementation of community based projects, innovative research, various educational efforts, and health advocacy initiatives.

Identifying and building on the strengths of a team/organization member is critical to the success of any model of leadership development. In particular, utilizing a framework of strengths-based constructs is important, and may include strategies to empower others for improvement in the following selected content areas:

  • Competence
  • Tolerance of Stressful Situations
  • An Orientation/Openness for Positive Changes
  • Effective Conflict Resolution
  • Purposeful Assertiveness
  • Emotional Intelligence
  • Resilience

We have a moral and civic responsibility for the development of ethical strengths-based leaders; who have a commitment to strive for remarkable outcomes, build multi-disciplinary teams that achieve successes, offer mentoring to junior professionals, engender credibility and genuinely care about the communities that they serve. This may be achieved by building trust, promoting transparency, requiring accountability, and demonstrating collaboration.  

The Best Way to Find Yourself is to Lose Yourself in the Service of Others

~Mahatma Ghandi~


 

Works Cited

  • Fluker, W. E. (2009). Ethical Leadership: The Quest for Character, Civility, and Community. Augsburg Fortress.
  • Mullan F, Chen C, Petterson S, Kolsky G, Spagnola M (2010). The social mission of medical education: ranking the schools. Annals of Internal Medicine, 152, 804-811.
  • Institute of Medicine (1988). The Future of Public Health. National Academies Press, Washington, DC.
  • U.S. Department of Health and Human Services (2011).  Action Plan to Reduce Racial and Ethnic Health Disparities: A Nation Free of Disparities in Health and Health Care. Washington, DC.