By Rob Cooney (@EMEducation)
The Coddling of the American Mind – by Greg Lukianoff and Jonathan Haidt
I’m not sure if it’s a purely American problem, but there seems to be a fundamental change occurring on campuses. Over the last few years, we’ve noted the rise of “cancel culture” and the push for “trigger warnings” and “safe spaces.” Curious about this phenomenon, I stumbled onto the “The Coddling of the American Mind” by Greg Lukianoff and Jonathan Haidt. Together, the authors explore the rise of fragility, safetyism, and hostility towards free speech on college campuses and in society at large. The authors identify three “Great Untruths” that have taken root – the Untruth of Fragility, the Untruth of Emotional Reasoning, and the Untruth of Us vs Them. The authors explain how these untruths potentially foster an inability to deal with adversity, a belief that feelings should govern actions, and a tribalistic us vs them mentality. While aimed at a general audience, the book contains valuable lessons for medical educators. An interesting aside is that these untruths are view through the lens of cognitive behavioral therapy and I particularly appreciated the candor offered by Greg Lukianoff as he explained how he learned CBT while recovering from his own severe depression.
The Untruth of Fragility is the belief that students must be protected from any ideas or experiences that could potentially upset them. This manifests in demands for trigger warnings, safe spaces, and the disinvitation of controversial speakers from campus. In medical education, we cannot shield students from disturbing material – as educators, we know that caring for sick patients necessarily involves exposure to traumatic situations, difficult emotions, potentially ethical dilemmas, and challenging viewpoints. Attempting to overprotect students does them a disservice by inhibiting their growth and resilience. A better approach is to directly acknowledge that clinical training will be emotionally and intellectually rigorous, while also providing appropriate support resources.
The Untruth of Emotional Reasoning posits that emotions should dictate what is acceptable to discuss or express. On campus this leads to calls to avoid ideas that could make anyone uncomfortable. In medicine, emotional reasoning can manifest as avoidance of difficult counseling conversations based on the belief that a patient’s subjective feelings outrank the objective clinical findings. It’s important that students learn to empathize with patients’ experiences, but also to analyze situations rationally based on evidence. Unchecked emotional reasoning can promote poor medical decision making.
The Untruth of Us vs Them divides the world into “good” people who are part of the moral in-group, and “bad” people who are the enemy out-group. In extreme cases this can resemble actual paranoia, with people seeing “micro-aggressions” and hostility everywhere. For medical educators, this tendency is concerning because providing optimal patient care requires embracing diversity – both of the patients we serve and of the healthcare team members we collaborate with. An “us vs them” mindset undermines the open communication, trust, and inclusion that are vital for coordinated care.
To combat these untruths in (medical) education, the authors argue that we must promote intellectual humility, viewpoint diversity, and emotional resilience from day one. This means:
- Teaching students how to acknowledge and work through negative emotions in a healthy manner, rather than avoiding anything uncomfortable.
- Creating an environment where diverse perspectives are openly debated and critically examined, rather than falling into partisan tribalism.
- Exposing students to differing ideas and life experiences through interdisciplinary education, standardized patients, and clinical rotations.
- Directly addressing hot-button societal issues related to medicine in a dispassionate, evidence-based manner.
- Modeling professional behavior and emotional regulation in difficult situations.
The diseases and disorders faced by physicians caring for our fellow human’s bodies and minds can be messy, traumatic, and disturbing to encounter – there is no way around this core reality of medicine. Overprotecting our learners from the field’s inherent stressors does them no favors. Instead, we must systematically challenge the three great untruths and instill the fortitude required to thrive in clinical practice. A coddling approach may feel kinder in the short term, but will undermine wellbeing by inhibiting their resilience, critical thinking, and promote feeling-based reasoning over a commitment to truth seeking. By directly addressing the untruths outlined in this book, medical educators can produce a generation of healthcare professionals who are emotionally strong, intellectually humble, tolerant of diverse viewpoints, and unwavering in their dedication to evidence-based care. These virtues will serve them, their patients, and the entire medical field immensely well.
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