Taking Control of Your Health, a Q&A

Leslie Michelson’s terrific book on navigating the healthcare system, The Patient’s Playbook, is coming out in paperback later this month.

Navigating the realities of the system due to a family medical emergency at the time when the book was released, I found the advice and guidance Michelson offered so helpful that I requested a copy for everyone in my office. At that time, I wrote:

“Within every conversation about healthcare is also a conversation about our mortality. While none of us want to go through chemotherapy or surgery or chronic disease maintenance, one thing is true: if you don’t act as a defender of your health, who will? And with The Patient’s Playbook on your bookshelf, you will have a game plan for turning defense into offense in order to take control of your own healthcare.”

Handing a book on healthcare to someone, and saying “you’ll need this someday” is what you might call a tough sell. People don’t want to think about. But the conversation is important, and with the paperback coming out this month, we thought we’d revisit it.

I sent Leslie some questions, and he was kind enough to answer. This interview was originally posted on 800-CEO-READ’s In the Books site. Below is an abbreviated version of our conversation; please click over to read more of my Q&A with Leslie Michelson.

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Sally Haldorson: It seems as though in writing this book you’ve a strong commitment to insuring that people realize doctors are human, with as many presuppositions and influences and biases as any professional. In your introduction, you write in regards to the demands on primary care physicians: “No matter how charismatic, empathetic, and effective a doctor is, he or she cannot care for a human being in fifteen minutes.” Yikes! I think most of us can think back to our last doctor’s visit, whether 15 minutes or longer, and wonder just what was missed. How does planting this seed of doubt in the process (dictated by insurance companies) help empower patients? And do you think it is key that you aren’t an MD, so you can raise such questions?

Leslie Michelson: Physicians work very hard to do the best that they can in a world of constraints. They’re under enormous pressures to see more patients, more efficiently, while meeting enormous regulatory and reporting responsibilities. They’re very aware of their constraints, and part of my goal is to make sure that the patients who are the beneficiaries of their services have the same kind of knowledge of the constraints in which the doctors work, so they can better partner with the doctors.

My view is that our system doesn’t have the resources to provide everybody the quality of care that they aspire toward, so we should tap into this tremendous reservoir of 320 million Americans who have the energy and the ability to act as effective consumers, just as they do across the rest of the economy. So, it’s not so much sowing a seed of doubt. It’s informing patients so that they can use their intellect, their energy, their experience, and their intuition to team with their doctors to get better outcomes.

And you see that happening in other spheres. For example, at virtually every school in the country, parents are helping teachers by providing additional resources so they can spend more time teaching students. A lot of people are now do-it-yourself folks for home repairs, so they go to centers around the country, they get online videos, and they figure out how to do home repairs. In the medical profession, patients will get better outcomes if they become more engaged consumers.

SH: You advise that “[f]orging a strong partnership with a caring and committed primary care physician is one of the most important first steps you can take in protecting your health.” Isn’t that easier said, than done? Many of us are forced to see nurse practitioners or physician’s assistants instead of ever getting to see a doctor. I know that my son hasn’t seen his primary neurologist for years now, and while we very much like his physician’s assistant, it certainly has done nothing to strengthen our relationship with his neurologist, and if something traumatic were to happen, that doctor wouldn’t know, hands on, much about my son’s past few years. How do we go about asserting our need for an attention-giving PCP when the system seems to be moving further and further away from enabling such a relationship?

LM: I am an enormous believer in the value of advanced practice clinicians. Nurses, physician assistants, nurse practitioners—they all have high levels of clinical training. They are under-utilized and can be extremely important participants in a properly configured healthcare delivery system in the future. If you’re generally well, and you’re regularly seeing a capable advanced practice clinician, you can get excellent care, because those professionals are trained to identify significant clinical issues and refer them to physicians and specialists.

Our experience has actually been very positive with them. My experience with other similar professionals is also very also positive. Every major law firm in the country has a cadre of talented paralegals. There is no dentist’s office that functions without effective dental hygienists. I’m a big fan of it because I’ve seen it really work. For example, in my personal experience, as I related in The Patient’s Playbook, I had a surgery by the Chairman of Surgery at Yale New Haven, Dr. Rob Udelsman, who had, at every step of the way, Patricia Donovan, RN, who has been his right hand in doing these things for 15 or 20 years. They are a team working together; that enables them together to provide people with the highest quality care. I had a very complex surgery, and although the surgery was done by Dr. Udelsman, the entire experience could not have been as good without Patricia Donovan being at his side. I don’t think that moves us away from having an enduring relationship with a clinician; I think it moves us forward.

SH: My husband, who was diagnosed with leukemia mid-summer last year, was mis-diagnosed with three different issues over 3 months, before taking himself to the ER where he was admitted to the ICU and it was immediately apparent that he had an astronomical white blood cell count. A friend, upon hearing this, said that it’s not unusual for that to happen because doctors don’t look for cancer in an otherwise healthy, moderately young person. But in some cases, it seems, that the new “Google-fication” of self-diagnosing is bringing about a public of paranoids, so if my husband had gone into the doctor asking them to check for cancer because he was feeling rundown, would they have done so? He certainly felt like he was taking charge of his illness by making appointments with his neighborhood clinic, but he never thought it was cancer, so he didn’t push for that diagnosis. Shouldn’t we be able to trust in the expertise of our medical providers to see what we can’t see?

LM: First I have to say, I’m so sorry that your husband had to deal with a misdiagnosis. Sadly, we know that misdiagnoses, delayed diagnoses, incomplete diagnoses—these are major challenges across the healthcare delivery system. The studies that have looked at this problem find that between 40,000 and 80,000 people a year lose their lives because of diagnostic errors. So, I have to say, I’m really so sorry that this happened to your husband. As we discuss this though, what I’m concerned about is the appointments at the neighborhood clinic.

There are two ways to reduce the probability of getting a misdiagnosis. One is to trust your instincts. We all are in touch with our bodies, and we know when something seems to be more significantly wrong than it’s ever been before. Maybe it’s a level of fatigue that you haven’t experienced before, an abdominal pain that maybe you’ve experienced before but is stronger now and has been going on longer. Or headaches that are happening more frequently, and have greater pain, in ways you haven’t felt before. If you have those things, what you need to do is trust your instincts, listen to your body, and take action on it. If the physicians you’re seeing are telling you, “It’s all between your ears, there’s nothing to worry about,” or “Your gut is wrong,”—then go to additional physicians in a timely fashion until you get a diagnosis that sounds right to you.

The second thing to be discussed here is the notion of a neighborhood clinic. Particularly when it comes to primary care, I believe very deeply that you need to have a strong and enduring relationship with an individual physician. That person can see you over time and have the benefit of observing changes in who you are and how you’re functioning. They’ll be looking at you, and they’ll say, “You were here 12 months ago, and it looks to me like you’ve put on some weight,” or “you look particularly pale right now,” or “you’re generally energetic, and you’re looking down and depressed, what’s going on? Talk to me.” Those kinds of observations about who you are holistically can make a difference. They can enable a primary care physician to exercise his or her clinical intuition and identify potentially serious issues earlier.

If in fact your husband had such highly elevated white blood cell counts, he probably had some symptoms. If he had a strong and enduring relationship with a primary care physician, that physician likely would have recognized those symptoms and/or those lab results as being aberrant, and she or he would have perhaps ordered additional blood work, and made the referral to a hematologist, which is what the first person who saw your husband should have done.

You should believe in the capability and the competence of your physicians, but if you don’t—if you have reservations about them—you need to change physicians. But, even if you believe in your physicians, you need to respect your perceptions of your health and your intuition. So, if you’re feeling off, even in a vague way, and the physicians that you’re seeing are incapable of giving you a diagnosis or developing a treatment that addresses it, I suggest you take yourself to a higher level of expertise. Get in touch with an academic medical center, figure out which therapeutic area might be most appropriate, and make an appointment. Bring your medical records and have someone with fresh eyes look at what’s going on.

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ABOUT THE AUTHOR

Leslie D. Michelson is the founder, chairman and CEO of Private Health Management, a unique patient-focused company dedicated to helping individuals and corporate clients obtain exceptional medical care. You can learn more about Leslie, The Patient’s Playbook, and “The No-Mistake Zone with Leslie Michelson” podcast at www.patientsplaybook.com.

Big Magic: Creative Living Beyond Fear by Elizabeth Gilbert

This review and reflection originally appeared on my company’s In the Books site. This is an edited version. Go there to read this one in full, or for more of my awesome colleagues’ reviews.


Just because creativity is mystical doesn’t mean it shouldn’t also be demystified—especially if it means liberating artists from the confines of their own grandiosity, panic, and ego.

Here is the question that I think anyone who creates has had to come to terms with at some point in their lives: What is at stake?

For some people the answer is easy: Nothing. They create, put that creation out into the world without obsessing over it for too long, and the response to their creation matters not one whit. If people don’t like it, so be it. They simply feel the need to put their creation into the world, and they’ve succeeded just by doing so. (Cheers to those people!) For others, the answer is also easy: Everything. These are the people who create obsessively, or avoid creating obsessively, but ultimately the response to their creation is, again, unimportant. To them, the process is what’s important. (Response be damned!)

For most everyone else, the answer is complicated, and their relationship to their own creativity (or perceived lack thereof) is ambivalent at best. But Elizabeth Gilbert, in Big Magic: Creative Living Beyond Fear tells us there is nothing at stake unless you choose not to create, robbing yourself and the world of that which you would create. And no, she’s not going to let you get away with claiming that you just aren’t creative, because she believes that creativity is part of every person’s DNA.

If you’re alive, you’re a creative person. You and I and everyone you know are descended from tens of thousands of years of makers. Decorators, tinkerers, storytellers, dancers, explorers, fiddlers, drummers, builders, growers, problem-solvers, and embellishers—these are our common ancestors.

What is important about the above quotation is that being creative doesn’t have to be about writing stories, or painting pictures, or making birdhouses, or designing t-shirts. Creativity is also about styling your hair and choosing your tie. It’s about throw pillows and selfies. It’s about building a deer blind, it’s about making your own curtains, it’s about singing at the stoplight, its about helping your kids learn how to count using buttons and bobby pins. Because all of those things are creations. The act of making, in whatever small way, will help you access the hidden creative in you.

The universe buries strange jewels deep within us all, and then stands back to see if we can find them. The courage to go on that hunt in the first place—that’s what separates a mundane existence from a more enchanted one.

While I consider myself creative, my life doesn’t really feel enchanted by the process of creating. I struggle with fear on both sides of the creative gulf: I fear the results of the hard work itself will not meet my own expectations, and I fear that my hard work will not be received in a way that meets my own expectations. That fear gets in the way of my ability to create without (self)judgment. Gilbert reveals the key to resolving the fear—that shiny object—our inner magpie can’t help but find distracting: “I’m talking about living a life that is driven more strongly by curiosity than by fear.” So if there isn’t anything at stake in the act of creating besides satisfying curiosity? If you simply create (or make, if that’s a more comfortable word for you to embrace) because you do, because you want to see what you can make, then you have no expectations and failure becomes a nonstarter. Fear, to paraphrase Gilbert, will still come along for the ride, but it doesn’t get to drive.

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I don’t consider myself to be a name-dropper—largely because I am too introverted to know my neighbors, let alone famous people—but I have met Elizabeth Gilbert several times. Now, before I get ahead of myself, I want to be clear: Elizabeth Gilbert doesn’t know me at all. But she lives in the same town as my good friend, we have been to Gilbert’s import warehouse several times during which I have been introduced and reintroduced to Gilbert, and I wear a scarf that I bought there often during winter. I even have a picture of Gilbert when she graciously joined a commemorative group photo of my friends during our first visit. As one-sided as our acquaintance is, here is what I can tell you about “Liz” Gilbert: she likes my friend, whom I love very much, so she has good taste. And, more importantly, each time I have met her, she has been warm, friendly, accommodating, and completely… normal. Sure, she was portrayed by Julia Roberts in the movie based on her memoir, Eat, Pray, Love, and she has traveled to exotic places and taken risks many of us only dream of taking, and she runs her own import shop, and she is considered to be one of Oprah Winfrey’s circle of influencers, but that’s not the person I met, however briefly. And it isn’t the person I think of when I read her work or wear that scarf.

The reason I am mentioning my passing acquaintance with Gilbert isn’t to say I have an “in” when it comes to interpreting her work, but to explain why I’ve felt compelled to read an inordinate amount about her work over the past, say, 7 years, and in doing so how I’ve been fascinated with how she and her work is perceived in a way that only someone we’ve met, no matter how briefly, bubbles up in our interests again and again. I’ve found myself—somewhat surprisingly because Eat, Pray, Love wasn’t a transformative read for me like it was for some people—in the position of Gilbert-defender.

Why, for Pete’s sake, would Elizabeth Gilbert need me to advocate for her? Well, she doesn’t (and I’ll get to that), but I find myself, more often than not when Elizabeth Gilbert comes up in conversation, even in our book-loving company, saying something to the effect: Elizabeth Gilbert isn’t Eat, Pray, Love. Or at least, she isn’t only Eat, Pray, Love. And she certainly isn’t what everyone thinks of Eat, Pray, Love, especially when its popularity soared and her life, as described in the book, became scrutinized and criticized as the story of “white American privilege appropriating foreign cultures” or a narcissistic ode to “First World Female Discontent.” Over the years, mention of Eat, Pray, Love, like so many other good things that receive backlash due to hyper-fandom, has taken its beatings, and as a nonfiction writer myself, I feel rather passionately about defending other writers who, through memoir, are telling a specific narrative and making choices about what parts of themselves they choose to share in that particularly storyline. The very thing that makes a memoir or personal essay good is the craft, and for any story to be good, the story has to be focused.

So, anyone who thinks they know the nonfiction writer really only knows the story she is choosing to tell. And Elizabeth Gilbert’s story about searching for herself via her travels to Italy, India, and Indonesia is effective for the very reason that she isn’t trying to tell a number of other stories about herself as well. No doubt Elizabeth Gilbert is many selves—including an effective, entertaining, and impassioned pursuer of a creative life, for herself and for us, with a deliberately stern opinion of criticism.

Imagine if I’d tried to create a definition of myself based on any of these reactions. I didn’t try. And that’s the only reason Eat, Pray, Love didn’t throw me off my path as a writer—because of my deep and lifelong conviction that the results of my work don’t have much to do with me. I can only be in charge of producing the work itself. That’s a hard enough job. I refuse to take on additional jobs, such as trying to police what anybody thinks about my work once it leaves my desk.

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If I’m looking for enlightenment in regards to my own creative process, then the above quote is it. I’ve struggled with my preoccupation with the response to my creative work most of my life. In fact, my desire to control other people’s reaction to my work has hurt my productivity significantly for nearly 30 years. But still, I wonder how this is supposed to work. I mean, as a writer, I want to create something that is meant to communicate my inner self (whether it is my emotional self or my intellectual self) to an audience. And when I get a response that is out of line with that desire, then how is that not failure? How do I not fear that end result and allow it to ride roughshod over my willingness to broadcast my work? (Right now, I’m thinking: why do I insist on messing up a perfectly good book review with my own narcissistic navel-gazing? I mean, what will people think!?!) I mean, what’s NOT to dread about sharing our art? Isn’t that the whole point of being a tortured artist?

Well, Gilbert’s greater philosophy of Big Magic solves this question for us: “A different way is to cooperate fully, humbly, and joyfully with inspiration.” Let’s let her lovely and entertaining writing fill us in even more on how a change of perspective can change our relationship with our creative selves:

Inspiration, like any notion of the divine, settles onto us only when we are open to it. Inspiration is beyond our control, so we must stop trying so hard to wrangle it, to wrestle it into submission. Inspiration is not ours to own. Such thinking comes from a wretched allegiance to the notion of scarcity—from the belief that the world is a place of dearth, and that there will never be enough of anything to go around.

Some people may assume Gilbert is telling us to get down on our knees to pray or to cross our legs to meditate in hopes that inspiration will visit us. And while belief is a big part of Big Magic—she has a spiritual, even paranormal kind of relationship with creativity—Gilbert is clear: you must do the work. If you do the work, even the hard stuff that is not inspired, or is a struggle, or is a mess, eventually inspiration will descend, an idea will take root, and the work will take flight. But that ONLY happens when you put your nose to the grindstone.

Hoping for inspiration is hopeless; waiting for the good idea will leave you waiting a good long time. Walking toward inspiration through hard work is the only way you’ll get close to the thing. But what happens if no one else approves of what you do? What if no one likes it? And is that truly fear of failure, or is it hubris? Gilbert doesn’t grant much quarter to either of those factors, because, she believes, creativity isn’t something that can be judged, by yourself or others. Essentially, if creativity is in our DNA, if we are creative, like it or not, there is no failure, there is no flattery, there is no fraternity; there is only fulfillment of your fate.

Look a little further back in your family’s history. Look at your grandparents: Odds are pretty good they were makers. No? Not yet? Keep looking back then. Go back further still. Look at your great-grandparents. Look at your ancestors. Go back far enough and you will find people who were not consumers, people who were not sitting around passively waiting for stuff to happen to them. You will find people who spent their lives making things. This is where you come from. This is where we all come from.

So really, none of us has anything invested in any kind of notion of success when it comes to our creativity. To bastardize Descartes (as so many have): I am, so I create. Instead of protecting our egos by keeping our art or our expression of our creative selves to ourselves, Gilbert encourages us to tap into a sense of creative entitlement. Because we are born creative, we have a right to create.

[C]reative entitlement simply means believing that you are actually allowed to be here, and that—merely by being here—you are allowed to have a voice and a vision of your own.

Since I was very young, I have kept a journal. When I was a little older, about 15, I started writing stories. And I was relentless. Granted they were a teenager’s version of Harlequin romances (if only I’d thought to add vampires in 1986!), but I wrote, by hand, on lined paper, a lot. In part, to escape what I regarded as the dreariness of growing up, often alone, on a farm and going to school in a small town; in part because life had already physically and emotionally beaten me up a bit, and the only way it made any sense was to write about it or write myself out of it. The only person who read my stories was my best friend, and luckily she and I were of like tastes (i.e., my writing was great). But my teachers knew I wanted to be a writer, and I still remember those moments of being validated, whether via a gold star, or a comment like the one I received from my English teacher in response to the serious, unsmiling me in my senior pictures: “There you look like Sally the Writer.” (One of the greatest compliments I’d received in my short life.) I considered not going to college in order to start my Writing Life immediately, but I wasn’t brave enough to strike out on my own, so I followed that best friend to college and I believe it was the most important choice I’ve ever made. In Big Magic, Gilbert is suspect of going to school to learn creativity, but for me, I learned at school the kind of writer I wanted to become: a respected one. Which, I suppose, was a double-edged sword. I wanted to be published.

Sure, I’d always wanted to be published, but now I had expectations. I wanted to be published in literary magazines, in anthologies, in collections, and of course, in my own books. Problem was: I couldn’t get down with the rejection part. Just one rejection indicated to me that my writing wasn’t yet good enough; not that I should have faith, as Gilbert believes, that my work would eventually find its rightful place in the world. Full stop.

So I opted for self-protection. I wouldn’t submit my work until it was good enough to be accepted. (Right: how on earth can you know your work is good enough to be accepted unless you send it somewhere? But I wasn’t thinking about that.) I expected perfection from myself. And I expected others to consider my work perfect for their specific purposes. I would write the perfect piece, pick the perfect outlet through which it should be published, and there would be no rejection. My commitment for actually doing the work waned, because who needs that kind of pressure each time you sit down to write? I became dependent on external affirmation to drive me, so obviously external criticism—”Your piece is not right for us at the current time”—stalled my efforts.

So let’s jump to the middle of the story: I stopped writing and I got a job. Luckily, I got a job that required me to write. I started reviewing business books and writing marketing copy, and figured it was enough. I’d become a writer—a professional writer—just like I’d always wanted, right? And a side effect of when your job is to write, and you’re on a schedule and someone is expecting you to generate words, you stop caring about perfection. Yes, you’re still trying to craft the best piece you can, but you aren’t waiting. You aren’t talking yourself out of doing the work. And since we didn’t accept comments on our book reviews, and all I really needed to do was press “publish” on our website in order to be published, I didn’t have to deal with rejection. Win-win for all of us, right? Except I still wanted what I wanted. I wanted to be published and read by the literati. I wanted my own work to make the cut. I wanted to be judged and come out the winner. And most of all, I wanted it to be my story, my style, my thoughts, my internal self, my experiences put in print, because I truly believed that I was a writer. That’s what I wanted, and yet I remained afraid to pursue a sort of multi-layered creative life that included both the professional and the personal.

I cannot even be bothered to think about the difference between high art and low art. I will fall asleep with my face in my dinner plate if someone starts discoursing to me about the academic distinction between true mastery and mere craft. I certainly don’t ever want to confidently announce that this person is destined to become an important artist, while that person should give it up.

But then life happened. In my case, since I had never birthed the Great American Novel/Novella/Collection, etc., and my job at that time had become somewhat rote, I decided to have a baby. The clock, it seemed to be ticking, and clearly I needed to devote my energies to creating something, and that something would be a child. (Funny how these decisions work: Gilbert set off on her exploration of self after deciding she did not want to have a child, while having a child has set me off on a parallel but very different journey.) I’d never been particularly kid or family-centric, but I figured I’d regret not having children more than I’d regret having them. It was the right choice at the right time. Of course, you don’t always get what you want, and my child was born with a neurological disorder, cause unknown, that is the root cause of his global developmental delays. For the past 10 years, I’ve been living a life I’d never have chosen for myself, because I would never have chosen this path for him. For the past 10 years, I’ve been trying to write my way through this uncharted territory, particularly the hard stuff, particularly the ugly stuff. For the most part, I wrote for myself. But being a writer still means wanting to be read. And while I shared some of my work with friends, and at times I’ve tried to craft that writing into something with a through line, and less often worked on a formal proposal for the kind of book my writing could become, the slightest hint of resistance or critique or even distaste (not everyone is comfortable with the confessional) made me retreat right back into my shell. Those 400 pages of writing? On a zip drive.

Until, life happened again. My husband was diagnosed with leukemia and, around the same time, I read Brene Brown’s Rising Strong. Completely unrelated, but the confluence of these events, my husband’s illness (and again, my need to write my way through it) and Brown’s message about vulnerability and bravery, made me realize that I finally didn’t give a damn about failing anymore. Brown writes: “Failure can become nourishment if we are willing to get curious, show up vulnerable and human, and put rising strong into practice.” And I decided to embrace the practice, or as Gilbert would say, “do the work,” and stop wanting something from my writing. Sure, I wanted to communicate with other people via my writing, and I still believed that living a writing life (i.e. a creative life) also included making my work public, but I no longer needed affirmation. I just needed to become a “maker” instead of worrying about being an “artist.”

The art—or rather, any external praise for my work as art—didn’t matter; the creative outlet did. The process did. No, the incarnation did. For the nth time in my life, I started a blog, but this time, I didn’t take it down one week or one month after beginning it. I didn’t pressure myself to craft my work, or to mimic other successful blogs, or engage with a readership, or post on other blogs in hopes of building up my stats. Instead, I just hit the “publish” button and put my creative work on the screen. This process has reinvigorated my love of writing that my previous perfectionism and preoccupation with the end result had smothered. It’s all out there for people to see if they want to see it, in whatever form—fiction, nonfiction, poetry, short form, prose poem, lyrical essay, rough draft, memoir, hybrid—my idea is inspired to take. Because it is the doing that matters. And in doing, not every piece I write or revise is going to be good or going to be “enough,” but occasionally I’ll bump right into [my version of] perfection without having tortured my way through the process or denied myself the moment it takes flight.

Just say what you want to say, then, and say it with all your heart.

And that, I believe, is what Elizabeth Gilbert is trying to convey in her theory of Big Magic. If you sit down at the computer and type the words, it isn’t all going to be glorious or glorified. But inspiration will come and find you if you sit there long enough. (Please feel free to extrapolate that to any creative activity you engage in: Gilbert’s example as she tours to support this book? Karaoke!)

Most of my writing life consists of nothing more than unglamorous, disciplined labor. I sit at my desk and I work like a farmer, and that’s how it gets done. Most of it is not fairy dust in the least.

Which is why fear is such a nonstarter for Gilbert, and she says, for you too. Leading a creative life isn’t about the drugs you take, the sleep you miss, the money you make, the tools you use, or the sacrifices you make. It’s about doing what you are doing when you make anything. How easy is that? If you tend a garden, you live a creative life. If you build a dog house, you are living a creative life. If you turn up the volume on the stereo and dance while you clean the house, you’re living a creative life. You are embodying and communicating that which inspires you. If you want more of it? If you wish to make it a practice and access those good feelings regularly, do more of it. Rent a plot of land and go hog-wild with your seeds and your dreams of starting your own salsa-making start-up; once you’ve mastered the dog house, maybe it’s time to buy more wood and build your own garage; Sign up for dance classes at your local studio, and who knows, maybe you’ll fall back in love with tap dancing in the way you’d loved it as a child. Gilbert reassures us that it is actually that simple.

That’s all. That’s what I call creative living. And while the paths and outcomes of creative living will vary wildly from person to person, I can guarantee you this: A creative life is an amplified life. It’s a bigger life, a happier life, an expanded life, and a hell of a lot more interesting life. Living in this manner—continually and stubbornly bringing forth the jewels that are hidden within you—is a fine art, in and of itself.

So, to be ready for it, get yourself primed, welcome the idea, do the work, keep at even the uninspired stuff, keep at the stuff that garners you no affirmation or applause. And, ignore that voice that is editing you. Rethink the way you think about possibly failure, or even real failure.

No shame no despair—just a sense that it’s all very interesting. Like: Isn’t it funny how sometimes things work and other times they don’t? Sometimes I think that the difference between a tormented creative life and a tranquil creative life is nothing more than the difference between the word awful and the word interesting.

Right now, I love writing more than I have in a very long time, in the midst of the most chaotic time in my life. Why? Because the stakes have changed for me.

Perhaps I love it as much and as freely as I did when I was writing those terribly unoriginal full-of-teenage-angst romances when I was 15. And I don’t need to set a mood (or go all La Boheme, as Gilbert calls it) with isolation, booze, candle-light and mood-music to do it. (Not always true: as I write this, I’m listening to Deva Premal’s Dakshina because it seems fitting to fostering thoughts on creativity inspired by a woman who studied in India and imports Buddhas.) Instead, when my kid has gone to sleep, or maybe when I wake early and cannot sleep, I write something. And then I read it a couple times, fix a few things here and there, then decide whether it is worth putting up on my site, or whether it needs to simmer a bit longer as a draft, or whether it might never see the light of day because it wasn’t the right idea or execution to begin with. It matters because the writing is important to me; it doesn’t matter because the response is not as important to me.

But isn’t being creative supposed to be more painful or at least painstaking than this? I mean, I have suffered over my writing (or rather, loving writing, but hating revising because it felt like I was overworking the clay) for years! I have started any number of blogs. I have applied for residencies. I have attended workshops and writing festivals. I have tried to shape my writing into short story collections, into novels, into memoir. I have tried, tried, tried, thinking that someday everything would come together and make a cohesive thing, and only then, only when that thing was just right and everyone who read it would see that it was ready for birth, only then could I release it because it was finally finished. Totally wrong-headed thinking, says Gilbert.

Your creative work is not your baby; if anything, you are its baby. Everything I have written has brought me into being. Every project has matured me in a different way.

As cliche as it sounds, my husband’s illness has made me fully embrace that control is a facade and life is too short to worry about getting approval from some unknown critic. That doesn’t mean I don’t believe in quality, or that I don’t want my writing to find a mate in the ether that is communion between two people, one who needs to say something and one who needs to hear it. And I’m certainly not claiming genius, perfection, or even proficiency. But what I have to say needs to be said before anyone can hear it. And maybe I need to say it in order to be able to say the next thing that needs to be said and so on and so forth. And maybe one of those things will be written just right, or maybe it won’t, but I’m thinking that the act of doing trumps a life of hesitation.

You do not need anybody’s permission to live a creative life.

As I write this, I’m feeling a little surprised in myself. I have, for many years, beaten myself up for my fear of failure. I’ve imagined myself as becoming one of the courageous, or at least one of the care-less, who writes for writing’s sake, and bombards publishers, agents, and editors with work until someone recognizes the brilliance. I’ve considered myself as having failed my dream because I am not that person. But applying Gilbert’s philosophy of creative living, I see that over the past 10 years I’ve been doing the work. I’ve been writing regularly for my company, and I’ve been writing regularly for my sanity. But I wasn’t ready to let go of my fear or my need for control until my husband’s illness convinced me that being vulnerable on the page isn’t much compared to being vulnerable in love and in life. Putting words on the page and clicking publish isn’t life or death. But it is living.

Brene Brown’s Rising Strong

(This review appeared on 800-CEO-READ’s In the Books here.)

I was an enthusiastic supporter of Brene Brown’s previous book, Daring Greatly, touting it as one of the best business and personal development books of 2012. And I also found myself sharing ideas from the book with friends. It seemed to me that encouraging leaders to be vulnerable was a daring endeavor in and of itself. It’s tempting, as a leader or manager of a business, of a household, of a life, to believe you must be invincible, unwavering. But when those qualities are just protective coatings like so much Teflon, we miss out on tapping into real strength, which Brown says is sourced in vulnerability. Just as it is said that a broken bone weaves itself back together more strongly than prior to the break, being vulnerable is scary and painful, but we become stronger when we live as “wholehearted” people.

Coinciding with the publishing of Daring Greatly, Brown participated in Oprah Winfrey’s Super Soul Sunday, expanding her reach to an enormous audience even beyond her 2010 TED Talk that has garnered over 21 million views. In Rising Strong, there is a tendency for some “Oprah-speak” to bleed into the text which was somewhat refreshingly absent in her earlier work. Here you will hear Brown refer to “standing in your truth” or “living your best life,” but if you are either drawn to that language, or able to skim through it, you’ll find many valuable insights within. In other words, don’t let her current mainstream appeal distract you from the fact that Brene Brown is a research professor—an academic first and a public figure second.

In her 12 years of study of social theory, she says in her more recent 2012 TED Talk on shame, that she has learned that vulnerability is the most “accurate measurement of courage” there is. And what we believe to be weakness in ourselves (terrified of getting up to speak at a public speaking event) is most often seen as courage by other people (the attendees of said public speaking event who are too terrified to get up and speak themselves). Doing “it”—whatever it is that scares you, or makes you uncomfortable—regardless of the fear of vulnerability or shame is the bravest thing you can do to reach deeper into what you are truly capable of in this one life. That’s pretty convincing and motivating stuff and why I thought Daring Greatly was a game changing book, especially for the workplace. Brown advocates:

Vulnerability is the birthplace of innovation, creativity, and change.

Which brings us to Rising Strong. In the years between books, Brown realized that just advising people to get their emotional hands dirty wasn’t the whole picture, so here she is instructing us on how to survive during and thrive after our forays into vulnerability. Opening yourself up to plumb the previously untapped depths both within yourself and within your life sounds great, but there is a reason we resist: failure hurts. That seems obvious, but Brown makes the wise observation that if we don’t take that risk, we risk all the more because when we put up walls we don’t just protect ourselves, we tend to hurt others when they run (or we push them) headlong into those walls.

There are too many people today who instead of feeling hurt are acting out their hurt; instead of acknowledging pain, they’re inflicting pain on others. Rather than risking feeling disappointed, they’re choosing to live disappointed. Emotional stoicism is not badassery. Blustery posturing is not badassery. Swagger is not badassery. Perfection is about the furthest thing in the world from badassery.

(Side note: I love when Brown drops the Oprah-speak and embraces instead her Texas-talk.)

Certainly the self-help messaging will find its audience of people who are instinctively curious about their inner life. But Rising Strong has a universality—everyone is going to fall (i.e., be struck down by disappointments and losses in life) so how you get up matters. What you learn from the struggle matters. For Brown, rising strong is all about finding your vulnerability first, and instead of running from it, experiencing your emotions instead of acting in reaction to them. That’s what she terms the “reckoning.” And she makes clear that all people are, by design, feeling people, and so this work can happen in every facet of your life. In other words, you can’t leave this work at home.

Just because you’re standing in your office or your classroom or your studio doesn’t mean that you can take the emotion out of the process. You cannot. … The most transformative and resilient leaders that I’ve worked with over the course of my career have three things in common: First, they recognize the central role that relationships and story play in culture and strategy, and they stay curious about their own emotions, thoughts and behaviors. Second, they understand and stay curious about how emotions, thoughts, and behaviors are connected in the people they lead, and how those factors affect relationships, and perception. And, third, they have the ability and willingness to lean in to discomfort and vulnerability.

Because Brown focuses her work on qualitative research, it can seem like her work is more anecdotal than scientific (despite her frequent references to her research); however, that is an approach that makes this particular message most effective. The stories of how other people have learned to work with instead of against their emotions makes the practice seem substantially more doable. While this book is definitely for those people going through grave life struggles, it is also for people who are struggling to find their way in relationships or at work. In fact, it is with the small instances that it is best to practice accessing your vulnerability and the process of Rising Strong.

Brown gives her own example of this small scale struggle and revelation within her own marriage. (She might disagree with the idea of this instance being small scale because each small incident adds up to big bad life habits.) She recounts a story about taking a risk to share a tender emotional moment with her husband, only to be rebuffed. Her instinct, as is typically ours, is to shut down, create stories in her head for why he refused to be engaged, and prime herself to lash out. Instead, she encourages them both to reflect back on that moment, dig deep into both their vulnerabilities for why he rebuffed her (he was fearful of looking weak in a frightening situation.)

This is what Brown refers to as “the rumble.” When we feel something, instead of running from it, we should turn around face it, and engage with it. A friend of mine, many years ago, taught me the idea of “sitting with” emotions. At the time, because I hadn’t done much of that practice, let me tell you, I didn’t really get it. I thought I was really good at hanging out with my emotions simply because I was an emotional person who reflected on those emotions an awful lot. But over time, I’ve realized what that means. As Brown says, when we do feel emotions, we tend to jump a la hopscotch to other ones, rationalizing or controlling them through story, rather than really spending time with ourselves. Whether you “sit” or “rumble” with your emotional response, the trick is to stay with it in its most basic form.

In each chapter, Brown presents a story about how someone (often herself) has rumbled with emotions, including, in Chapter 9, called “Composting Failure” which deals with “rumbling with fear, shame, perfectionism, blame, accountability, trust, failure, and regret.” That’s a lot, but a lot that I’m familiar with too. In 2004, after receiving a stack of rejections from publishers and agents, Brown decided to self-publish her first book, then titled Women and Shame. That doesn’t seem like such a big risk now, but self-publishing was definitely not the norm a decade ago, and she became ashamed of having asserted herself (I wrote a book, and it’s worth reading!) without the backing of a powerhouse publisher endorsing it. Even after getting enough word of mouth and republishing more traditionally, as I Thought It Was Only Me, the book fell flat.

In a moment of desperation, I scrambled to put together a book reading in Chicago, where I was already doing a lecture for mental health professionals. It was the coldest February day on record. Five people came to the reading. One woman was drunk, and two of them were there because they thought I was a mystery writer.

(From my experience working in the bookstore world, readings are the ultimate in vulnerability.)

Finally, her books were remaindered (she calls it “composted”) and the entire process filled her with shame and feelings of failure. Considering her current successes, it’s easy to see that she successfully rumbled with those emotions. “As I would learn, the hardest part of coming out from hiding is facing the painful work of rumbling with the real story. And the real story was that I had set myself up for failure.” Given her massive successes following that experience, clearly Brown figured out how to leverage the realization that, next time, she  “wasn’t going to … wait for someone to knock on my door and ask me about my work. I’d put on my shit-kickers and start knocking on doors myself.” And that realization becomes what Brown calls a “revolution” in thinking. And in this case, she embraced the lesson:

Failure can become nourishment if we are willing to get curious, show up vulnerable and human, and put rising strong into practice.

I’m writing this review of Brene Brown’s latest book, Rising Strong, on the very day that it’s due to be published here. My coworkers in the marketing department are expecting me to produce this piece, as I committed to it several months ago. Several months ago, I was pretty pumped to read this book since, as I mention above, I was a big fan of Daring Greatly. And back in May at Book Expo America I came very close to meeting Brown in person at an evening cocktail party put on by Penguin Random House. Just as I moved to approach her, she was spirited away to have her picture taken with Gloria Steinem. I ended up leaving the party without speaking to Brown about her work and new book, sad that I’d missed the opportunity, but still giddy about having worked up the nerve to approach Gloria Steinem and introduce myself earlier in the evening.

But things change quickly in life, and having nothing to do with Brene Brown and her book, I got sidetracked. My husband was diagnosed with leukemia over the summer, and this event and the following treatments left us feeling like we’d been either hit by a train, or that we were pawns in some kind of practical joke. Many times over the past two months, I’ve looked at the cover of Rising Strong on my desk, thinking how ironic it is that this book likely speaks directly to how I can better deal with my family’s current circumstances, but I couldn’t bring myself to pick it up and read it. It felt a little too on the nose. My instinct was to coil away from the book, thinking, I don’t need anyone telling me to keep my head up.

Despite the heavy distractions weighing on me from home, I am committed to doing my best work at the office when I possibly can. I love this company, and my coworkers are such a comfort and support to me, that it’s often with great peace that I spend some time at my desk plotting strategy, brushing up on upcoming titles, answering emails… or writing book reviews. So it is that the deadline for writing a review of Rising Strong arrived and I’d not written a single word. (You can imagine what Brown would say to this: that I was refusing to rumble.)

But, when my son woke up at 3am this morning and I had some time on my hands, I knew what I wanted to write. I wanted to write about how Rising Strong has indeed influenced my understanding of events and reactions in my own life. Having finally opened the covers over the past two days and reading the words I found myself afraid to read—I don’t just get to gloss over my feelings while my husband fights this cancer, but I’m going to have to deal with them??—well, I felt reassured that it was something I would be able to do. I could reckon with my fear and my inconvenience (because let me tell you, cancer turns your well-planned life upside down); I could rumble with my emotions instead of tamping them down in an effort to contain them, to be stoic, and to present myself as in control (since that’s pretty much impossible); and I could find within myself the ability to keeping “choosing curiosity and connection rather than walking away or shutting down,” a revolution in and of itself.

As you can imagine, it is easier to create stories around my husband’s diagnosis, stories that include blame and anger and jumping far into of the future, than to accept this random happening as…random and outside my control. It’s also easier to create a role to play so that you needn’t show people the extent of your fear, your hurt, your burden.  In her chapter “Easy Mark,” Brown describes what happens when someone puts on a suit of emotional armor, or “learned behaviors for getting out from under fear and uncertainty” when confronted by the loss or potential loss of a loved one:

Over-functioning: I won’t feel, I will do. I don’t need help, I help.

Under-functioning: I won’t function, I will fall apart. I don’t help, I need help.

Upon the news of my husband’s illness, I definitely dove head-first into over-functioning. I told a coworker in defiance, yes I can do it all! I can work, I can parent, I can support my husband, and I can have a life, all at the same time. Damn it, I was going to cope like no one had ever coped before! Super Woman has nothing on me. And then I looked at the long view. I looked at what this illness would cost us, both in time and in money. I realized how aged I was already feeling when trying to do it “all.” I realized that it was going to be a long road despite the many friends offering help. Not only was it completely out of my norm to ask for help; I didn’t know how people could help me in real time. It would have been tremendously easier, if lonelier, to put people off and contain our struggles within the walls of our house instead of sharing them with others. This was going to be hard.

Brown, in her first chapter on “The Physics of Vulnerability” lists some basic laws. And the one that struck me the most intimately was this:

This journey belongs to no one but you; however, no one successfully goes it alone. Since the beginning of time, people have found a way to rise after falling, yet there is no well-worn path leading the way. All of us must make our own way, exploring some of the most universally shared experiences while also navigating a solitude that makes us feel as if we are the first to set foot in uncharted regions. And to add to the complexity, in lieu of the sense of safety to be found in a well-traveled path or a constant companion, we must learn to depend for brief moments on fellow travelers for sanctuary, support and an occasional willingness to walk side by side. … For those of us who prefer to cordon ourselves off from the world and heal alone, the requirement for connection—of asking for and receiving help—becomes the challenge.

After some initial waffling, over the past two months, I have made myself more vulnerable than I have ever been comfortable with in the past. While my husband was in the hospital, I accepted daily dinners dropped off on my porch by local friends. My dog has received more walks than he has come to expect all his life due to my willingness to say yes to friends who are willing to take him through the neighborhood (and trust me, that’s not an easy job because he’s not an easy dog). And, successfully working my way through my pride and shame, I created a gofundme campaign to ask our friends and family to help me fund childcare for my son as my husband will be unemployed and unable to care for our child during his illness and lengthy recovery. The process and response was humbling. And, if I’m honest, I know I will need to continue rumbling with my feelings of shame. I will need to continue rumbling with the fear of lost friendships; that the burden of helping will drive people away. And I will need to continue rumbling with feeling unworthy.

So as I read Rising Strong, instead of feeling like I was being lectured on how to master my emotions, I found an ability to reframe the experience of putting myself out there: I feel the helping hands of a hundred people reaching out because I was willing to be vulnerable and reach out to them. The circle of strength that flows through that circle of hands will get us through the upcoming challenges. And I suppose, by telling this story here, spreading the word even further, gives me more practice in vulnerability, and wholeheartedness.

When I first became the general manager at 800-CEO-READ, we held a meeting at which I tried to explain to everyone why I was confident I could do this job. At the time, even before my husband’s cancer, I’d had plenty of challenges in my life that have ‘knit my emotional bones” together, making me strong. I shared these challenges, these losses and disappointments and hoped that this would help them understand why they could trust me to lead. And now, in the face of this new personal mountain to climb, I hope that as I continue to offer my story and lead with my (very human) super powers that include effort and attention, rather than perfection and control, our staff at 800-CEO-READ is made more comfortable leading their own whole lives in the workplace, knowing that we establish team trust through vulnerability and strength through support.

And perhaps an introduction to Brown-speak will give us some common language with which to improve:

Curiosity, clean communication, circling back, and rumbling become part of the culture. Just like people, when organizations own their stories and take responsibility for their actions, they get to write the new endings.

Brene Brown’s work in social theory, which is an engaging mixture of qualitative storytelling and quantitative research, has some valuable skills to teach us, whether our struggles are small-scale or life-altering. Learning to partner with our emotions as opposed to making them the enemy—which is exactly what Rising Strong will help you do if you are willing to invest the effort—can lead to what Brown calls “wholehearted living,” and what I would call survival.