Recently, my son, a Rabbi, excitedly called to tell me of a new book he was reading. It is not unusual for us to share such references, given the overlap of psychiatry and religion. This book was Willpower: Rediscovering the Greatest Human Strength (by J. Tierney and R. Baumeister). I still haven’t read it, but did read the article by Mr. Tierney, “To Choose is to Lose”, in the Sunday New York Times Magazine (August 21, p. 33-46). I, too, found it fascinating, and potentially important for our workday and for patient outcomes.
I always felt that my best work was in the morning. I felt less energetic in the afternoon, often needing a nap. Then, at night, more energy seemed to return, and I especially liked to write then. I assumed that was my biological clock. This new work on willpower suggests something else may also be at play.
I work part-time now in a prison, so when the article led off with the following example, I immediately became intrigued. Three inmates in Israeli prisons appeared before a parole board after completing two-thirds of their sentences, but only one was granted early release. Can you guess which one?
Case 1: heard at 8:50 am, was an Arab Israeli serving a 30-month sentence on fraud
Case 2: heard at 3 pm, was a Jewish Israeli serving a 16-month sentence for assault
Case 3: heard at 4:25 pm, was an Arab Israeli serving a 30-month sentence for fraud
The answer was that Case 1 was given parole. The reason turns out to be the timing.
The new research, confirmed by brain scans, that is helping to explain why this happens, can be considered to be a modern update on a Freudian hypotheses. Freud speculated that our ego, or self, depended on a transfer of energy for mental activities. As it turns out, our brain indeed needs a certain amount of glucose to make the most rational decisions.
Making decisions depletes this energy, and saps our willpower to resist other temptations. If our willpower is reduced, we then tend to respond more to immediate rewards rather than to long-term considerations. The judges in Case 2 and 3 were suffering “ego depletion”, aka “decision fatigue”, and took the mental short-cut of leaving things as is. As another example of this principle, decision fatigue can help explain why workers can get angry inappropriately at colleagues at times.
At our jobs, whether we are clinicians or administrators, we have many important decisions to make and many distractions over the course of the day. How can we avoid having our patients receiving poorer care as the day wears on, and how can we avoid making poorer administrative decisions when we are mentally tired?
This new research suggests several solutions:
- the steadier glucose supply from eating protein and other nutritious food in the morning and at intervals during the day is superior to binging on something sweet when we feel mentally exhausted
- recognize when ego depletion is occurring, which, perhaps paradoxically, is a propensity to temporarily experience everything more intensely, and then to take an appropriate break
- structure your day as to conserve willpower by avoiding too many back-to-back patients or meetings
- take short, planned breaks to exercise
- avoid unnecessary distractions that will get your attention, especially on-line
Now, we all just need the willpower to effect these changes!