Shirley M. Mueller, M.D.

Before I retired from medicine, I was showing signs of burnout and did not know it. All I knew was that I was miserable. 

The morning started out fine. By one or two, however, I was ready to flee. My thought was always the same—get in my car and drive West. What I imagined was that seeing the open countryside would make me feel free of all responsibility. At that moment, and, that time in my life, it was a welcome thought.

Well, that drive into the sunset never happened. After trying to scale down my practice, I was still in pain. As every practitioner knows, it is difficult to support staff while deliberately seeing fewer patients to save one’s own soul. I retired.

What might have spared me was not available then. But, fortunately for the medical profession, it is now. Enter Dr. Jed Brewer M.D, Ph.D., a neuroscientist, and psychiatrist, who transforms recent research findings into programs to treat addictions and burnout. Since Dr. Brewer is a physician himself, he is particularly sensitive to the plight of the medical profession, who now are not only under the usual pressures, but those of COVID as well. 

Dr. Brewer calls himself Dr. Jud, I assume to make himself more accessible. And, that he is, with his exceedingly calm demeaner and easy to understand instruction. 

His main message is that we humans are responsive to triggers which lead to an action that, in turn, precedes a reward. In its simplest terms, this is hunger (trigger), eat food (action), satisfaction and pleasure (reward). 

Of course, a nurse or physician’s response to a patient who is suffering is more complicated. When the medical caregiver identifies with the suffering herself (empathy), she hurts as well. This leads to burnout. Dr. Brewer refers to this as learned helplessness on the part of the medical caregivers.

On the other hand, he says that a different response to the same patient’s suffering can benefit both the medical professional and the patient. Instead of focusing on empathy, she places her energy into compassion. Then, even if the suffering on the part of the patient continues, she can feel as though she is contributing in the most effective way she can without a side effect of burnout or learned helplessness. She is not living the suffering, but a partner in obviating it.

Now, for a word about the difference between empathy and compassion, two words with similar but different meanings that can easily be confused. 

Empathy suggests that the caregiver relates to another person’s pain vicariously, as though she is experiencing that pain herself. Compassion, on the other hand, refers to both an understanding of another’s pain and the desire to somehow mitigate it—a broader definition.

Dr. Brewer tells this story in his elegant way in videos which, at the present, can be accessed free of charge by the medical profession. The advantage is that watching them takes little time and there really is nothing to lose except an hour or so. Please see them for a deeper understanding which Dr. Jud explains far better than me. 

Module 4: How mindfulness decreases clinician burnout and builds resilience

Module 5: How to move from empathy fatigue to compassionate action (and build resilience)

Putting Dr. Jud’s Program in Perspective

In the past, I recommended making art and appreciating art as a relief from the intensity of the medical profession, i.e. combating burnout. That series, 

, chronicled four M.D.s who found relief and joy outside of their practices through collecting art, taking photographs, making sculptures, and painting. 

Dr. Brewer’s approach, to me, is different. He wants to nip stress-related burnout in the bud by teaching those who are vulnerable to understand it better so that their response to it is healthier right from the get-go. In this way, there may be fewer cases to begin with—a victory not only for those in medicine, but their patients as well.

The views expressed in this piece are those of the author, not necessarily those of the publication.

Inside the Head of a Collector: Neuropsychological Forces at Play

Articles

As every practitioner knows, it is difficult to support staff while deliberately seeing fewer patients to save one’s own soul. 

Stress and Burnout:  A New Approach

Thirty-three percent of the population collects one thing or another.  Among these collectors, many are physicians with disposal income. This begs the question. Why do we collect?

The reason we collect is simple. It makes us happy. In this faraway place, apart from the rest of our lives, we can imagine. This is different than when we are involved in the routine aspects of living; then, we can reliably predict much of what will happen.

On the other hand, with collecting, we don’t know what to expect. It can take us anywhere, and we can easily anticipate a whole new world of excitement.

Along with these expectations comes a quest for knowledge far beyond just reading. It broadens into joining associations related to our collecting specialty, meeting wonderful people, attending conferences, going on trips with like-minded groups, and individually pursuing destinations of interest. It can take over life itself. What a pleasure.

Collecting isn’t a job. Collecting isn’t a hobby. It’s better. It’s a passion.

When we collect, we do not diffusely seek pleasure; rather, we pursue it in a very specific manner. There are psychological reinforcers that feed into our pleasure center that spark our desire for these items.

One contributing motive is pride in acquiring special objects. This is heightened by gathering a group of like items together for the first time. During the search, excitement is further sharpened by identifying a rare piece that sets us apart from our peers and may provide recognition and admiration from associates.

Other collectors, aside from the rareness of the piece, want to acquire it at a modest price. That is their joy and gives them pride in being so astute. It’s the possession for comparatively little money that excites them.

Then some feel a sense of history when they assemble precious items. By owning antiques, they feel closer to the past or perhaps even ancestors, important figures, or circumstances of long ago.

 The reverse of feeling a sense of history is looking toward the future. This collector may hope to build a legacy by passing on special objects to future generations, for example, giving one’s collection to a museum. 

Some collectors find that the process of collecting provides intellectual satisfaction. The gathering of pieces from a specific area requires discipline, knowledge, and an eye for the unusual or particularly beautiful. This may have been the impetus for Stephen W. Bushell, a physician to His Majesty’s legation in Peking (present-day Beijing) at the end of the nineteenth century. As a medical doctor in a remote outpost, Bushell turned his hobby of collecting Chinese porcelain (readily available in Peking, but still a novelty in his home country of Great Britain) into a passion and then an avocation.

Collectors also gather what they consider treasures to enhance their network of friends; in other words, they have a social motivation for collecting. Perhaps their love of objects came first; then, somewhere along the way, they realized there are others like themselves. They may find them independently or join organizations for like-minded people. Friendships forged through these vehicles expand social lives.

The enjoyment of arranging and rearranging a collection can also be the motivation for other collectors. Though this may serve as a means of control, it could also simply be the demonstration of organizational skills applied to collect as taste and knowledge accumulate.

Dr. Shirley Mueller is a physician turned financial consultant and investment educator. Her fee is hourly, not a percentage of assets. She is also the author 

of Inside the Head of a Collector: Neuropsychological Forces at Play

She welcomes comments at ShirleyMMueller@MyMoneyMD.com. For more information, visit her website at MyMoneyMD.com.

You may not even realize it, but physicians make up a large part of the collector community. Why is that? One reason is the sense of passion it brings that helps balance life outside of the clinic.  

Why We Collect

Fear is a common problem in the stock market and can have detrimental effects. It can lessen portfolio return when investors sell low related to 

, side effects of fear. Here are some ways to combat this issue.

Tom Brady, the legendary football player who helped the New England Patriots win the 2019 Super Bowl, deliberately engages in a routine reported to help shut down his amygdala, also known as the fear center. It is not the well-known 

, an approach used by therapists to methodically expose a client to her or his fear under controlled conditions, and then dull it with relaxation or another technique. Rather, it is a flotation tank. In fact, it is said, the quarterback even has one in his Boston home. Brady is trying to control his stress response.

When the fear center (amygdala) is activated, humans flee the source of fear or fight it directly.  Either can be protective.  But, if the amygdala is overstimulated, stress hormones are sent out to the body, for example adrenaline and cortisol, which, over time, have harmful side effects.

The flotation tank is known as sensory deprivation therapy, or Restricted Environmental Stimulation Therapy (R.E.S.T) and is said by some to produce a meditative state that lessens cortisol levels, that can overstimulate the amygdala, and enhances release of endorphins known to be beneficial to the brain. 

, research from fMRI (functional magnetic resonance imaging) studies demonstrate that floatation can decrease activation in the amygdala. This means that the meditative state induced by the sensory deprivation experience may be equivalent to the effect of drugs prescribed by physicians for anxiety, which can have unwelcome side effects.                                                                                                                                                                                                                                                                                                          

There is more recent evidence that humans can downregulate their amygdala as well. A paper entitled, “

Training emotion regulation through real-time fMRI neurofeedback of amygdala activity

,” demonstrated that fMRI neurofeedback can dampen the amygdala response. It was published by scientists from five different academic institutions in the January 2019 issue of Neuroimage.

In a nutshell, participants in the study underwent four fMRI sessions with neurofeedback of their amygdala activity during introduction of emotional photos.  The control group (green bars above) were trained in emotion regulation but did not participate in the neurofeedback. There were four weekly fMRI sessions.  When the neurofeedback group (blue bars above) was compared to the control group the former showed a significantly decreased amygdala activity. This finding suggests that neurofeedback, like floatation therapy, can help users regulate their amygdala. The advantages related to this ability include:

An outsized fearful emotional response can be attenuated

Use of medications for disorders related to fear may be lessened or ablated altogether

Use of flotation therapy could augment psychotherapy

The downside, of course, is that the neurofeedback technique is now in the research stage and not widely offered, if at all.  When and if it is, the application could be expensive and not covered by insurance.  Desensitization, too, requires an outlay for the therapist and multiple sessions must be paid for.   So, for now, the Tom Brady approach might be a better way to go for investors who experience excessive fear when the market drops. And, surprisingly, this might be cost effective. 

The Physiological Processes that Drive Financial Decisions

With one search for a flotation device in my own city of Indianapolis, IN., I found 

 within seconds.  The price:  $45 for the first float!

Everyone has fears and many people have fears of failure or stepping into the unknown, and that’s ok. No matter how detrimental it becomes there is a way to combat your fears. Even Tom Brady has his own fears, and his method of combating them is one you can do to.

A Lesson from Tom Brady: Effectively Combating Fear

I will be flying to Lake Michigan in a WWII military airplane.

In late April 2018, my husband and I went to what is called a ‘rescue party’ sponsored by Indiana Landmarks, a local historic preservation organization. The objective of the event was to raise money to save historic buildings. We did not expect to spend any money beyond our admission, but when I saw one of the auction items, my brain went into overdrive. It was described, “Fly to Lake Michigan.” Now, that, by itself, would not have seized my attention as my husband and I travel via airplanes all the time. It was the portrayal of the airplane that was captivating, “in a 1944C-45H Twin Beech military plane.” 

Flying in that plane would be an experience. To me, it would be worth a lot. As it turns out, when I bid, not many others thought the same thing. One person said to me, “Why would you want to do that? You could drive to Lake Michigan.” And, indeed we could, but the we wouldn’t have the excitement of flying there in a vintage plane. I can envision it as I write this piece—as we fly in this vintage plane, we plan to enjoy blue, sunny skies with the cornfields of the Indiana landscape below followed by the sandy dunes surrounding Lake Michigan.

recent research from San Francisco State University

, my vision is not uncommon. I was hoping to achieve what that study supports, more satisfaction and greater value for my money from an experience than I would have from buying a material possession. Specifically, the memory of flying to Lake Michigan in a WWII military plane with my husband would be with me forever. Buying an expensive dress for an equivalent amount of money, which I would wear infrequently, would be effervescent.

Thomas Gilovich, PhD, at Cornell University was a pioneer in this area of experiences versus objects. He is wary of physical purchases giving sustained happiness, noting that there is a “wear off” effect. While we may be thrilled with an acquisition in the moment, it is less interesting in hours, days or weeks afterwards. In addition, the next similar purchase often requires hiking up the ante, i.e., the price we pay for it. Finally, we compare what we possess with our friends and neighbors and can never have enough. In sum, this means limited satisfaction with material possessions.

Finally, a 2014 survey by Harris Insights & Analytics, a market research company, suggests that the younger millennial age group (those born 1980-1999), prefer experiences over things. This is important because this group is the largest generation by population in America.

The advantage of experiences as opposed to buying possessions applies to all areas of life, vacations being a prime example. In an earlier column, “

,” I wrote about Sarah Barney who takes her family on vacations. She is honing in on the social value of experiences with her daughters and son and their partners plus grandchildren in new environments. 

Experiences don’t have to involve a lot of money, however. For example, owning a pet or volunteering for an organization in an area that is close to one’s heart can be more than satisfying and provide many memories. In addition, most state parks and museums have free entrance days that can be enjoyed with loved ones.

In summary, memories built through experiences are vivid and often permanent videos in our mind. Possessions are a different kettle of fish—a static photo which easily fades in time.

 Leaf Van Boven and Gilovich further documented this in their research paper, “

” (2003). Later Caprariello and Harry Reis from the University of Rochester demonstrated that “it is the social aspect of experiences that provides value relative to material goods” (2011), Their paper was entitled, “

To Do, to Have, Or to Share: the Value of Experiences Over Material Possessions Depends on the Involvement of Others