Who Are You, Really? Part 2: Your Biogenic Self.

Following my 3 month sojourn (chronicled in Part 1) to Hazelden Treatment Center in 2012, and having retired from my clinical and academic practice at the University of Minnesota, I became a househusband. New job, new identity, new world.

I took over the entire enterprise. I cooked all meals and cleaned the house to a level of sparkle that required dark sunglasses. I drove our 10-year-old daughter Anne to and from school. I made banana bread during the day and put it in the oven before picking her up so it was warm and ready for her upon our arrival home. For the first time in our chaotic, overwhelmed lives, we had order, structure, and more peace.

One year goes by, and I have the whole house husband thing down like a machine. In Part 1, I recounted this moment with my wife Lea Ann:

“In fact, I was such a good house husband that one day, Lea walked in the door from work to a sparkling clean house, flowers on the table, dinner in process, and the girl’s issues all taken care of. She plopped down in a chair, dropped her bag on the floor, started crying, and said, “I guess I am just not needed around here anymore.”

Over time, Lea came to love the new “arrangement,” but I was starting to feel a bit restless. You see, I am a serious extrovert (more on that in a moment), and I was alone most days. Of course, my teenage daughters were company, but they were not particularly keen on having conversations about the many things that were paddling around in the choppy waters of my mind day after day.

One thing that had been floating around in my mind, day after day, was how in the f#&* the addiction thing could have happened to me??? I was a disciplined machine at work and in life. I had (still have) extraordinarily high levels of energy, something my family has found both taxing and valuable, depending on the circumstances.

I simply could not shake the memory of me standing in the closet, every day, and counting the tiny white Dilaudid pills, promising myself that tomorrow I would cut back by one for sure, absolutely no doubt about it, and then failing miserably the next day, and the next, and the next, and the next…..

During surgical residency, we are inculcated with 5 habits that are vital for a surgeon: the discipline habit to keep going when you absolutely do not want to, the be strong habit so you can pretend you are ok even when you are struggling, the self-sufficiency habit so that you can solve all of your personal and professional problems on your own, the fix it habit where you think every problem — emotional or otherwise — can be fixed if you just find the right solution, and finally the say yes to everything habit which creates a mushroom cloud of increasing obligations and responsibilities that over time can bury one in a casket of obligations and responsibilities that eventually suffocates the life out of you.

These habits are fantastic life skills (the say yes habit only when young and experimenting) and are absolutely necessary for surgeons, but like all things, they are good until they are not. When I got my first prescription (for 360 Norco tablets) I remember standing in the locker room stunned by the size of the canister of white pills, and I thought: “you better watch it, you could get addicted to this shit.” But my mental fantasy world and my surgical habits rescued me from reality when my mind told me (hard to say who is talking and who is listening in the dark silent vaults of our skulls) “na, your discipline habit will take care of it.”

The me talking to me about my discipline savior was wrong. As they say in the Big Book — the constant failure to free oneself from the grip of addiction leads to a state of “incomprehensible demoralization.” Yep. It was the first time in my life that I could not control something in my path; in this case, it was a bottle of tiny white pills that had taken over my life, and my soul.

The lock that these habits had on me was profound, and not being able to let myself off the hook for my “failure of discipline”, I started to search for better answers to how I became addicted. The 12-step program that I was brainwashed with at Hazelden gave me little insight. At that time, my view of addiction was binary. I was weak and undisciplined, and that was the issue, and this attitude led to a lack of tolerance of me, by me, for my “failure.” I was weak, and I paid the price. Never mind the chronic pain, the burnout, the lack of connection with my wife and children, the loneliness, the physically addictive potential of narcotics…….

Since I was the problem, I figured there must be a deeper issue. Having always had a keen interest in personal development, I kept searching for some answers. I eventually discovered the Big 5 personality assessment from the Canadian psychologist Jordan Peterson and his website Understand Myself. Until then, I was only familiar with the Meyer’s Briggs type indicator as part of a personal development/leadership program I created for the senior surgery residents at the University of Minnesota.

The Big 5 personality assessment is the most robust and scientifically validated way of measuring what is called our biogenic traits — i.e., traits that are biologically or genetically determined. The Big 5 measures 5 dimensions of personality, and the first letter of each dimension forms the acronym OCEAN:

• Openness — how open-minded and intellectually curious one is.
• Conscientiousness — how orderly, industrious, and detail-oriented one is.
• Extraversion — the degree to which one seeks out social interaction and rewarding stimuli.
• Agreeableness — how caring, compassionate, and polite one is.
• Neurotic — how sensitive to negative emotion one is.

Each of these personality dimensions (sometimes referred to as Factors) is comprised of 6 facets:

Each of these personality dimensions is measured on a percentile basis relative to a large population. So, if my Openness is at the 83rd percentile, this means that I am more open to experience than 83% of the population. There is no name given for the “opposite” trait being measured, but it can be implied. For example, if my openness percentile came in at 15%, one could reasonably say that I am “closed” to new experiences.

The opposite for each trait is: Open to Experience (vs. Closed) Conscientious (vs. Casual) Extraverted (vs. Introverted) Agreeable (vs. Disagreeable) Neurotic (vs. Stable).

Also note that if a person’s percentile is in the moderate range of 35th — 65th percentile, one can reasonably conclude that the individual can be flexible in that trait. For example, if the Extraversion percentile is 55%, that individual can flex both ways depending on the context — at a cocktail party, they may be able to flex up and be the life of the party, while at home, they can be quiet and reserved. People with high or low percentiles on each of the personality dimensions have a much stronger drive or tendency to conform to that trait, regardless of the context. It is like being left or right-handed — it is the personality trait you prefer to use without thinking about it.

But here is the thing: Traits are not fate. We can and do behave in ways that are opposite to biologically driven traits, but this depends on the context and the degree of personal meaning that the behavior represents. More on this in a future newsletter.

So here is what I found out about the me inside my dark, silent skull:

Openness to Experience — 83rd percentile, very high.

Conscientiousness — 85th percentile, very high.

Extraversion — 98th percentile — exceptionally high.

Agreeableness — 71st percentile — moderately high.

Neuroticism — 7th percentile — very low.

Many studies have been done with the Big 5 looking at life outcomes and whether or not we are, as Dr. Brian Little notes, flourishing. By flourishing, he means accomplishing the things that matter to you, living up to your capabilities, being able to love and be loved, being physically well, and having some laughter in your life. Yes = flourishing. No = floundering.

The results of the Big 5 play a major role in how our lives turn out and whether we are flourishing or floundering, and these findings are independent of country, linguistic groups, and culture:

• Open to Experience = High percentiles are a defining feature of individuals who are exceptionally creative.
• Conscientiousness = High percentiles predict traditional definitions of success at school and work. Conscientious folks are punctual and persevering, they tend to avoid drugs and dangerous activities (clearly, I am a deviation on this one!), stay with healthy routines, and live a healthier and longer life. Want to be a jazz musician and your conscientiousness percentile is high? You might consider becoming a classical musician instead!
• Extraversion = High percentile folks are highly responsive to potential rewards in their environments and are quick to move toward the positive stimulation they crave in order to accomplish their daily tasks and projects efficiently. Strong extroverts have more brushes with authority — the 24 arrests as a teen, in my case, validate the power of my extroversion in my early life.
• Agreeableness = high percentiles predict a very trusting person who can be seen as naïve by others. Highly agreeable people also score high on a measure of person orientation, which is associated with empathy, altruism, and an interaction style that conveys warmth and expressiveness. They also attend to the expressive cues of other individuals, and this contributes to their ability to empathize. Those with lower percentiles are cynical and distrustful of others. They display patterns of hostility that raise their risk for health issues, especially cardiovascular problems. In this respect, they resemble the so-called coronary-prone, or Type A, personality, who is typically time-pressured and hard-driving. It is now recognized that the disagreeableness and hostility underlying Type A behavior is the real risk factor for cardiac problems, rather than their drive to succeed. The dark side of being very agreeable is the tendency to say yes to things just for the sake of keeping harmony, which played a huge role in the overwhelm I experienced in the later part of my career.
• Neuroticism = is a measure of one’s sensitivity to negative emotions, and a high percentile predisposes one to anxiety, depression, and vulnerability since negative emotions interfere with one’s quality of life. People with high percentiles are acutely attuned to potential punishment and, in the very old days of tigers and lions, saw danger everywhere and thus helped avoid danger, while the extroverts were the ones who said screw it and went out and explored. Interestingly, writers and artists are often found to have high levels of neuroticism.

I took the results of my Big 5 and made a timeline of my life with all of the major seasons or events in my life and compared my percentiles and biogenic tendencies to those events and seasons. The prediction of so much of my life and my behavior by the Big 5 was stunning. For example:

Openness: I have always wanted to try anything new, be it food or experiences — it doesn’t matter. I also have a ravenous curiosity about nearly everything, including things like whether time actually exists, what makes a person tick, mushrooms I see on my dog walks, birds, and how to best load a dishwasher. The list goes on and on. Curiosity is one of my favorite and soul-filling features.

Conscientiousness: most surgeons (no surprise here) have high percentiles on conscientiousness, as does yours truly. I have exercised religiously for 50 years, and a recent coronary calcium scan showed 0% calcium in all of my coronary arteries (yes!!!). The only variance here is my dedicated career as a juvenile delinquent and the drugs. However, there were many intense mitigating factors inciting both of these behavioral deviations, for which I now give myself grace.

Extraversion: I have always had a wild level of energy and enthusiasm for doing things and for exploring new avenues. My high percentile undoubtedly contributed to my juvenile delinquency.

Agreeableness: When I was working as a clinician at the University, my wife Lea constantly hammered me that I did not demand enough credit or money for my contributions and that I said yes to too many things, which ended up making my life, and by extension, hers, more miserable than it needed to be. She was right.

Neuroticism: my 7th percentile puts me in the ‘water rolls of a duck’s back’ category of humans. I have little in the way of negative emotions when others are engulfed by them, something that, in the past, I simply saw as a weakness. In particular, displays of anger really anger me (I know, I know), but my oiled duck’s back is fantastic for keeping my cool when the shit hits the fan. I am able to think clearly, under duress. The problem? I could never understand why people could get so unraveled by some things (now I do understand more, but still….).

In summary, the Big 5 is fantastic to:

1. Learn about the biological drivers of your personality, which can have a massive influence on how your life unfolds and whether you will flourish easily or have to work harder to get there than others.
2. Alert you to potential pitfalls of having a high or low percentile, such as my high percentile on Agreeableness, which led me to say yes too often. If your Neuroticism percentile is high, it helps you understand (and others, hopefully) that your anxiety/tension/fear is real and biologically driven and not a sign of weakness.
3. Help you understand other humans and what makes them tick, providing a runway for more compassion, understanding, and even embracing each other’s quirky behaviors.

However, although fascinating and revealing, the Big 5 results are difficult to operationalize in one’s life. Although it outpaces the Meyers Briggs by miles scientifically, it has the same general limitation of limited actionability. It shows one’s strong tendencies, which have a huge impact on one’s life, but beyond that, in real-life scenarios, it comes up short in helping one navigate specific circumstances at work and in one’s personal life.

This was solved by the creation of Principles You, a Big 5-based personality assessment developed by Adam Grant from Wharton, Brian Little, a world expert on personality, the Big 5, and author of Who Are You, Really, and Ray Dalio, the founder and current chief investment officer of Bridgewater Associates, one of the largest and most successful hedge funds.

Next up on the personality landscape: part 3 — Principles You.