“Marry a doctor or be one,” my father frequently advised, “because every family needs one to get good medical care.” Risk-averse to my core and an unwilling guest at his annual gastroenterology department dinners, falling in love with a doctor seemed like a statistical long-shot and an unappealing romantic prospect. What I had really wanted was to be a journalist. I imagined myself as an adult combination of Harriet the Spy and Trixie Belden, traveling around the world with a pencil and notebook, exposing corruption and combating social injustice, my pen mightier than any sword.
But you know how they say culture eats strategy for lunch? I say logistics eat fantasy for dinner. How, exactly, did one become a journalist? What was the path to career advancement? Where was the guarantee that hard work paid off? Going to medical school seemed like the pragmatic alternative to investigative reporting. Sure, it lacked excitement and intrigue, but then again, I was the type of teenager who saved up a decade’s worth of change and cashed it in to open a Roth IRA. The allure of a rigidly defined path to entry, a stable income, and lifetime job security was impossible to resist. Couple that with the ability to help people, lots of interesting things to write about, and an expert perch from which to pen my thoughts, and medicine seemed to offer this worried wannabe writer the perfect Plan B.
In my imagination, becoming a doctor offered a noble path to lifelong learning, relieving suffering, and ensuring your loved ones received good medical care. But I hadn’t really thought it through. I’m bad at science and dislike touching people. I was unprepared and ill-equipped for the rote memorization of inborn errors of metabolism and checking pedal pulses. I hated everything about medical school. All I wanted to do was talk with patients and try to understand their experience of the world.
Then I discovered psychiatry. A discipline where communication is the currency. Where our definitions and descriptors compensate for our lack of lab tests and procedures. A field where the power of language is recognized and respected. Psychiatrists are the journalists of medicine. Keenly aware of the potential of words to influence and inform, to harm or to heal, we choose them as carefully as the medications we prescribe, and often with better results.
We realize, for example, that most patients would prefer reading a note that characterized their subterfuge as “distortion” or “misrepresentation” as opposed to one that accused them of lying. Similarly, a patient behaving helplessly is demonstrating an “external locus of control.” Emotional intensity becomes “hyperthymic affect” and yelling and swearing is described as “emotional dysregulation.” As the rare English major among you who accepts the challenge of actually reading our copious clinical notes knows, our terminology is terrific.
Psychiatrists understand that language matters, both at the bedside and beyond. The ability of words to influence emotion is universal, and we are wise to remember this or face the consequences, as my children recently learned the hard way. Bickering over an acceptable term for their household duties, my son objected to “chores” and my daughter rejected “tasks,” resulting in a power play that briefly united them against a shared enemy as I chose the word “opportunities.” They should have known better. After all, “Talking,” my son noted at age five “is our family sport.”
It may come as no surprise, then, that a significant portion of my discretionary time is spent analyzing my own word choice to determine how accurately it portrays what I intend to communicate. Through this relentless pursuit of optimal self-expression I have developed three linguistic habits that are useful in shifting the emotional tone of both my internal monologues and my conversations with others.
Consider influence, not control. Like most doctors, I like to be in charge, an occupational hazard I have written about elsewhere. Merriam-Webster’s Dictionary defines control as “to have power over something” or “to cause (a person or animal) to do what you want.” As any parent or sentient being living through a pandemic knows, however, we control very little, and when we use this word, we are both overstating our own agency and setting ourselves up for failure. Influence, by contrast, is “the power to cause changes without directly forcing them to happen” or “a person or thing that affects someone or something in an important way.” Exerting influence is even described as “an emanation of spiritual or moral force,” which sure beats “micromanager.” Utilizing the concept of influence provides a crucial bit of distance and is helpful in seeing my involvement in any situation as one of a multitude of factors that can contribute to a shared outcome, as opposed to feeling like I am solely responsible for how something turns out (or doesn’t). As the great Lily Tomlin reminds us, “If trying harder doesn’t work, try softer.”
Set intentions, not goals. In my thirties, I set an un-ironic personal goal to avoid unnecessary goal-directed activities. I recognized then that the thing I most needed to prove to myself was that I no longer needed to prove things to myself. Very meta, I know, and easier said than done. Goals, “the result or achievement toward which effort is directed; aim; end” were all I knew. Even the example on dictionary.com hit way too close to home: “Her goal was clear—to get accepted to Yale.” But what about all the hours she spent studying and all the gratification deferred? It wasn’t until my forties that I discovered a concept that allowed me a way of working toward something without the harsh binary construct of achievement or failure. Something that honored the process and the progress, not just the outcome. A word that captured the “purpose or attitude toward the effect of one’s actions or conduct.” Since then, my intention has been to only have intentions.
Use “and” instead of “but.” Start to pay attention and you will likely notice how frequently people say important things that they immediately negate by use of the word “but.” Take this example: “I’m having a hard time, but I know that I’m really privileged,” or “You really upset me, but I still love you.” Then try saying them with “and” in place of “but” and see how much that changes the emotional valence of each sentence. This idea of the dialectic, or union of opposites, forms the foundation of an entire psychotherapeutic modality that is effective in teaching some of the sickest patients around how to “get unstuck from extreme positions.” If the ability to accept that two opposing ideas can simultaneously be true helps prevent patients with chronic suicidality from taking their own lives, surely this simple semantic substitution can assist the less troubled in cultivating compassion for ourselves and for others and more skillfully navigate a path through uncomfortable emotions. (i.e., “I love being a doctor, and I’m constantly looking for an exit strategy.”)
These are the ways I have consciously changed my vocabulary to reflect my evolving beliefs and to better communicate important distinctions between views I used to hold and the way I am currently trying to approach the world. Reflecting on our choice of words, recognizing how they may help or hinder the quality of our communication, and being intentional in how we frame things to ourselves and to others is a simple yet powerful way of impacting emotions. My intention in writing this piece is to positively influence your desire to reflect on your own word choices, and I recognize that this endeavor may not have succeeded. Because, after all, I’m a doctor, not a writer.
What sentence can you change from "but" to "and"? Share your new sentence in the comments.
Elizabeth LaRusso, MD, is a Harvard-trained psychiatrist who specializes in women's mental health and physician wellness. She lives with her family in Minneapolis. Dr. LaRusso is a 2021–2022 Doximity Op-Med Fellow.
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