Rewiring My Brain to Stop Self-Sabotaging: Part 3 – My Controller

Rewiring My Brain to Stop Self-Sabotaging: Part 3 – My Controller

Many people are challenged by feeling a sense of having lost control of their lives. In an effort to regain a sense of being in control we may act in ways that make us feel like we’re taking charge. In fact, what may be happening is mostly taking place in our brains. The circumstances that led us to feel like we had no control are still there. Our now believing we had regained some sort of control is really a myth. And the impact of the actions we’ve just taken may have far-reaching, long-lasting effects. In this third installment about our Saboteurs, from the framework created by Shirzad Chamine and Positive Intelligence I’m focusing on the Controller, one of my lead Saboteurs.

Like with all Saboteurs, our Controller overuses and abuses actual strengths we have. Physicians are likely to have many of these strengths, as well as to manifest the Controller Saboteur. Let’s explore what these strengths are and how they bring benefits into our lives and those with whom we interact. These include:

  • Confident, action-oriented, decisive persistence
  • The ability to challenge oneself as well as others
  • An ability to do the right thing, even if it’s unpopular
  • Seeing possibilities and having the ability to activate ourselves and others towards those outcomes

Basketball Team

I like the imagery of a huddle, where someone is taking charge, setting up a strategy, helping everyone feel engaged in pursuit of a common goal. When I’m in this position of taking charge like this, I feel like I’m shifting into another gear. I can recall a night on-call receiving a stat consult on a young woman in a coma with almost no platelets (the blood cells involved in clotting). When I got to the hospital, I immediately went to the hematology lab to look at her blood smear. It was clear from what I saw under the microscope that she likely had a condition called thrombotic thrombocytopenic purpura (TTP). This was one of the diagnoses that, when I learned about it in med school, I remember thinking, “Man, I don’t want to get this.” At that time the mortality was > 90%. However, at the time of this story significant advances had been made such that, with ideal management, cure rates were very high. However, treatment needed to be initiated rapidly.

Shifting into high gear, I saw the patient (who was in the ICU), called the docs and nurses involved in her care together, than mapped out our “game plan.” We all had to play our parts. I contacted the Red Cross who were going to bring in equipment that could help filter out the harmful proteins leading to this condition while infusing healthy ones back into the patient. The residents got a surgeon to insert the special kind of IV line needed for this infusion, and talked them through their concerns about doing this procedure in someone with so few platelets. The nurses provided fabulous care and kept the family up to date about what was happening. Within an hour the Red Cross was in the room and their procedure was underway. By the following morning the patient was awake and speaking, her platelet count was on the rise, and she was headed towards the outcome we all hoped for: a complete cure.


There are way too many times when physicians turn into Controlling authoritarians. While sometimes this may result in short-term outcomes that make it look like this is a good strategy, there are long-term consequences- and sometimes catastrophic results. When a person’s Controller takes over they feel the need to be in charge, no matter who knows best. They will push people well beyond their comfort zone, avoiding any danger signs. They actually get energized when others push back, and then they’re surprised when others feel disrespected or hurt.

When I was a med student a patient came onto our service one night who was having a serious gastrointestinal hemorrhage. She was quite elderly and not a candidate for any surgical procedure. The standard medical treatment at that time was a medicine called Pitressin. Our team contacted the patient’s physician to ask for his management plan and he told us to start her on the medication Pitocin. We told him we thought he meant Pitressin but he persisted in insisting that she receive this incorrect medication, eventually yelling at us, “I’m her physician, you need to do what I’m telling you to do!” The following morning, when he reviewed the chart and her orders (what he had demanded we do), he yelled at us that we never should have ordered Pitocin- that we clearly knew he had made an error and we should have overridden him. All of us who cared for that patient that evening were scarred for quite a while- and the patient received awful care. These are the kinds of results that a Controller run amuck produces.

Yacht Image

If you feel you often have your Controller showing up, there are ways to intercept it and make different, better decisions through mental fitness. The sense of not being “in control” can become an opportunity to explore. There are so many things to discover and learn when you are in uncertain situations. Since so much in our lives is uncertain, that means you can grow in many dimensions as you respond to whatever comes your way. Mental fitness uses the imagery of sailing, saying, “While I may not be able to control the wind and the waves, I can still be an amazing sailor!”

Interested in learning more about Positive Intelligence/becoming more mentally fit? Visit my website at or contact me at for a conversation.


Rewiring My Brain to Stop Self-Sabotaging: Part 2 – My Avoider

Rewiring My Brain to Stop Self-Sabotaging: Part 2 – My Avoider

Who really likes conflict? Isn’t avoiding conflict whenever possible an honorable goal? Except what happens when there really are conflicting perspectives- how does resolution happen? If you choose to avoid conflict rather than advocate for your point of view, or at least make sure it’s heard, what happens then? Probably your perspective may not get considered, and, when decisions are made favoring another viewpoint, you may feel disappointed, even resentful. Consider all the energy and time wasted by avoiding some conversation about this conflict…


This is the domain of the Avoider, one of the Saboteurs I often see showing up in me. In Part One of this series I described the Positive Intelligence© framework. As with all Saboteurs, the Avoider overuses and abuses actual strengths that, when used appropriately, make the person the beautiful being they are. Strengths of people with the Avoider include seeking peace and harmony, both internally and with others. These people can go with the flow, feeling calm in stressful situations in ways that make others feel better. They typically are optimistic, expecting that something good is likely to happen in whatever situation they find themselves in. And they avoid judging others, choosing instead to find some positive attribute in almost everyone.

River With Trees

I can recall experiencing this kind of calm leadership when I was still a med student. Our team was re-rounding at the end of our day on a patient who was dying of throat cancer. Earlier in the day, when he was coughing up some blood, the ENT docs following him told us that his tumor was sitting on his carotid artery and there was no treatment available. As our resident led us into the room the patient sat up in bed, opened his mouth, and blood began to pour out. I began to run around like a chicken without a head, asking if I should call the blood bank or anything else.

My resident said to me and the team, “Calm down,” and to the nurse said, “Please give me 3 vials of morphine.” He injected one vial after another while the patient, who had been awake while he was bleeding to death, gradually closed his eyes and died. I’m not sure I ever witnessed a better example of being able to be calm in a crisis and act in the best interest of a patient.

Patient in Hospital

A situation that frustrates many clinicians caring for patients in Intensive Care Units that involves the Avoider is the patient who is at the end of their life as a result of a progressive, fatal illness who is on life support AND has never been engaged in conversation about what care they wanted when their illness got to this point. People who have the Avoider are conflict averse to an extreme, using procrastination to Avoid dealing with challenging, potentially unpleasant tasks. This kind of conversation is not easy or quick, and many physicians choose to Avoid it, saying things to themselves like, “They’re not ready for this yet- I don’t want to take away their hope. There’s more that we can do.” So, what happens? The conversation never takes place, decisions get made that are more comfortable and easier (like “do everything”). Meanwhile patients and families suffer, clinicians experience moral distress, and the physician with the Avoider, somewhere deep inside himself, may be beating himself up, saying “You SHOULD have talked to her about this!” Nobody benefits, everyone is harmed with this kind of Avoidance.

If you feel you often have your Avoider showing up, there are ways to intercept it and make different, better decisions through mental fitness. Tasks and conversations that are being avoided don’t need to feel “hard.” They can actually be viewed as opportunities and gifts- as ways to learn and grow, to become stronger in some way. The “mental muscles” that one uses and strengthens by tackling and completing a challenge that your Avoider would have wanted you to Avoid makes you equipped for even more difficult challenges in the future.

Interested in learning more about Positive Intelligence®/becoming more mentally fit? Visit my website at, or contact me at for a conversation.