By Eleanor Vogt, BSPharm, MEd, PhD; Julie Reed, MSSW, PhD; and Darlene Mergillano, MS.
Regarding inventing the incandescent light bulb, Thomas Edison said: “I have not failed. I’ve just found 10,000 ways that won’t work.” So, if failure does not exist, what about fear?
We typically respond to the possibility of failure and risk with fear. As Robert Sapolsky and others have revealed, fear is a primitive survival instinct. On one hand, we will pay good money to scare ourselves silly by watching the latest horror movie or by jumping out of an airplane—or we try to avoid fear at all costs. Yet avoiding present realities, or resisting them, is not actually our best approach.
Failure can be a foreign concept for high-achieving students. You may have had little experience with it on the road to pharmacy school. It’s understandable that a new disappointment, scare, or uncertainty is rattling and may expand in your mind beyond the triggering event.
As our personal experiences here demonstrate, sometimes venturing into the unknown, frightening as it seems, is the path to learning and progress.
Eleanor Vogt
What I know for sure (to borrow from Oprah) is that failure can feel very real, yet actually be a label that exists only in our minds and sometimes in our hearts. Yes, I have lived long enough to allow myself to feel hurt, dejected,
depressed, anxious, and fearful, comparing myself to others or to some imagined standard.
For example, there was that D grade in O Chem that I “achieved” in undergrad pre-pharmacy. In my own mind, I labeled that D a failure, but with a little advice and insight I changed that D to a lesson learned about how to study for this particular professor and the value of doing more investigation in advance as to which professors had more effective teaching styles! There was that time when I was a project co-director who heroically raised more than $300,000 for an innovative community pharmacy diabetes patient counseling program, and then witnessed it fall apart, just before launch, due to unforeseen company policy changes. We could have labeled this a failure (and initially we did), but soon realized that we had a significant lesson and meaningful message to share about the multi-factorial nature of launching a major program in the corporate world.
Julie Reed
When I gave up my most prestigious job and entered a period of mid-career exploration, risk and fear were everyday experiences. Embedded in the risks of not gaining entrée to a new career field, of sacrificing my earned reputation, of financial and psychological hardship, I could succumb to fear, and sometimes did, or I could persevere. Wrestling with a failure mentality, I felt less capable and worried about distant “what if’s.” In the process, I learned that fear neither equipped me for the challenging present reality, nor better prepared me for future unknowns.
I started focusing on present goals: network with one person this week, write one cover letter today, go for a bike ride now. Rather than imagining potential future failure, I was mindful of my current reactions and focused on what was good: I had enough funds for now, supportive loved ones, the skills to have meaningful informational interviews, and I was increasingly clear about what inspired and fulfilled me. Intentional mindfulness practice helped me let go of negative ideas and move forward. The more I did it, the more I had the necessary energy to manage fear and take risks.
Ultimately, this led me to the meaningful career I desired, working with students every day to help them reframe failure, stay present in anticipation of risk, and move through fear so it exhilarates rather than exhausts. The silver lining to failure, risk, and fear for me is that I earned the tools to coach others through them, just as you can use your experiences to help patients through their challenges.
Fear exists in our mind and is a natural response to something unknown (can I do this?), which can lead to the thrill of accomplishment. “I finished that race” (and did my personal best). “I finally gave that speech” (and now I know how to improve). “I ended that unhealthy relationship” (and moved through my deepest worries). Here is the secret—fear is far less intense when you do not resist it. It is the resistance that creates the unease in us. Recognize it, observe it; breathe with it and then notice how it subsides; now you can re-label it as anticipation, excitement, or courage. It is your choice.
Train your brain
Science estimates we have anywhere from 58,000 to 78,000 thoughts a day and, fortunately, we do not pay attention to most of them. However, some thoughts linger. The more attention we give those, the more they literally become a part of us, building neural pathways, like highways, in our brains. As Donald Hebb postulated about neural plasticity, “neurons that fire together, wire together.” This neuronal firing ultimately affects our emotions and our behavior, so if paying attention to specific types of thoughts strengthens those neural pathways, then we can use mindfulness to build positive mindsets and the healthy emotions and behaviors that flow from them.
Science also shows that feeling good is physically good for us (think serotonin, the “bliss” hormones and the “rest and restore” effects of the parasympathetic response) and that feeling chronically bad is physically bad for us (think adrenaline, cortisol, and the sympathetic “fight or flight” response). Apologies if this all sounds academic, but as student pharmacists, you may know that there is abundant neurocognitive research demonstrating that we shape our reality through our perceptions—and our perceptions are based on our thoughts.
So our notions of fear and failure and all our perceptions are, actually, “inside-the-mind creations.” How amazing this is! And why didn’t we (un)learn this in kindergarten? When you tell yourself (or others) that “I am stressed,” it is more correct to say, “This situation is stressful.” Now we know we can train our brains to pause and respond in a healthy way; we can choose and change our thoughts. Now you can think confidently, feel content, and be grateful. Tell yourself, and the world, a new story.
One of the most effective ways to understand/experience how our thoughts affect us is to simply observe them as they come up; i.e., to not react to them and let them slip by. This is the essence of mindfulness, a well-studied, evidence-based, accepted therapeutic intervention for primary anxiety, depression, high blood pressure, chronic pain management, and general well-being.
To mindfully observe and understand our response to fear, we can draw upon Tara Mohr’s (an author and expert on women’s leadership and well-being) distinction between two kinds of fear. Pachad is our stressful response to feeling threatened. We imagine an outcome and panic: “the fear of horrible rejection that will destroy us or the fear that we will simply combust if we step out of our comfort zones.” Although the second kind of fear, yirah, can initially feel like the same anxiety, it arises from being on the cusp of a greater source of energy, new possibilities, or a fuller version of oneself. We may experience fear (of failure, and aversion toward risk) even when we embrace an opportunity to grow and thrive, such as when students (and lifelong learning professionals) open to learning something unfamiliar or venture into a new career area.
Our subconscious doesn’t want volatility, so it tries to keep us in psychological equilibrium, just as our bodies seek physiological homeostasis. Simple mindfulness on our reaction (or overreaction) can remind us that our well-being is not threatened. In fact, taking the risk may carry us toward a deeper flourishing. So when you feel afraid, instead of resisting it, stop, breathe, and explore which type of fear it is and whether you can move through it to new positive reality.
Darlene Mergillano
I have conversations with students every day that involve the cause-and-effect relationship of fear and failure. One student described being so worried about not passing an OSCE that she forgot how to collect a patient’s medication history. Another recounted that when his first day at his IPPE site was less successful than anticipated, he immediately felt distressed about the implications for his future pharmacy career. Some new students report that the first exam is the most daunting: they do not know what to expect or how it will be formatted, causing them test anxiety.
Students’ perceptions of the meaning behind their first exam performance can carry much more weight than I imagine. They believe that if they do not do well on their first exam (or exams in their first year), they are not good students and therefore will not be competitive for residencies or fellowships, not be competent pharmacists, and not achieve success. And these negative understandings extend beyond academics to stories of failure with love, friendships, family, and leadership positions. Regardless of the issue, letting my students share their stories has been key. I encourage you to find that person to share your story with, reach out for support, and use your resources. You will find you are not alone. And don’t forget to rewrite your narrative.
As PharmD students, you face real challenges and will make real contributions. Focus on today, become aware of your thoughts, and persevere. As poet Nayyirah Waheed put it: “fail splendidly. fail comfortably. use failure as a redirect. not a measure of your worth or value. fail beautifully.”