My decision to take up running was impulsive. A friend of mine (hi Lynn!) informed me that she had elected to start running and was headed to the shoe store to purchase a pair of running shoes. With no hesitation, I asked if could join her.

“When did you decide to take up running?” she asked.

“Oh, I don’t know. I’ve toyed with the idea, but I never seriously considered it. I figure, though, if I spend the money on a pair of shoes, I’ll start running and stick to it,” I answered.

“What if you don’t like it?” she rightfully asked. “Then you’ll have an expensive pair of shoes that you won’t use.”

Indeed, her logic was sound. I smiled and said, “I’m not worried.” That was over six months ago and I’ve been running regularly since then.

I recently learned that her decision to take up running came from her friend in Minnesota (or Wisconsin?). This friend has no idea how she has affected my exercise habits.

Furthermore, Brad’s wife (for all purposes, a stranger) left a comment for me to curse inform me of her decision to start running.

Thus, we’ve all inadvertently influenced each other to change.

Natural change remains an enigma. Consider tobacco smoking or alcohol consumption. Some people simply decide one day to stop—and they do! Sometimes there is a prompting event (insert here the oft-told story about the man who was supposed to pick up his kid from school: It’s pouring rain and the guy realizes that he doesn’t have any cigarettes, so he drives past the school to go to the gas station. He sees his kid standing in the rain, realizing that he was choosing to purchase cigarettes over picking up his kid. Ashamed and horrified, he turns his car around and quits smoking that day…); sometimes it’s a covert decision. Psychotherapies (such as motivational interviewing) are geared towards promoting change, presumably at a faster rate than it would occur on its own, but no one can confidently state how effective psychotherapy is at facilitating change. There is already bias in the population; generally, only those people who have considered change (even if they feel ambivalence about it) pursue therapy. Perhaps their behaviors would have changed on their own without any interventions. (There is data to suggest that psychotherpeutic interventions can reduce some harmful outcomes when related to substance abuse.) Some people speculate that up to 50% of behavior change results from this “natural change”—we never hear about these individuals. (No citation because there is no way to accurately measure this.) They’re out there, living their lives in a different—and hopefully improved—way.

Just how does that happen? Man, if there was a way to bottle that stuff, the pharmaceutical companies would be making a killing.

I can’t explain why I decided to take up running on May 13th, 2007. Some variant of natural change was at work.

A similar situation occurred with my father’s reaction to my decision to enter psychiatry. My Original Plan was to become an infectious disease physician or an oncologist. (I had also toyed with the idea of becoming a nephrologist.) I had sworn that I would never go into psychiatry for the usual reasons: It’s not real medicine. I don’t want to lose the physical exam. I want to be a real doctor. Etc. etc. etc. I don’t think I can completely credit natural change for my own career—the time I spent in my psychiatry clerkship revealed that I possessed a skill set that was useful in psychiatry. And though I found internal medicine stimulating and interesting (as with all of medicine—what an amazing area of study!), I noticed that the topics within psychiatry consistently tickled my curiosity. The “right” decision seemed obvious.

My father, however, thought it was “wrong” decision. He was displeased.

He spent the entire summer after my announcement trying to convince me to go into another branch of medicine—anything but psychiatry! He presented the usual arguments about its questionable utility and diminishment of my status as a physician. He also (inaccurately) suggested that I would not have any job security upon completion of my training—anything to convince me to become an internist, a family practitioner, an actual doctor.

Mental illness, he exhorted, does not exist. There are only character flaws. That are all easily corrected with self-discipline.

There was a lot of sighing that summer. From both of us.

Realizing that his daughter was not going to change her mind (is stubbornness a heritable trait? or simply learned?), he did what any some disbelieving fathers would do: He started to read about psychiatry and mental health.

“I read this interesting article in Business Week,” he said one autumn morning about a year later. “It talked about neurobiology.” (Note: I never expected neurobiology to appear in Business Week, either. Something about nanobots, I think.) “The brain is fascinating! So is this what you’ll be doing?”

He was a bit disappointed to learn that, no, I did not have plans to work with nanobots. However, I encouraged his reading—you gotta take what you can get from stubborn people, you know.

I later worked at an Asian clinic and enthusiastically shared my experiences with him—I appreciated the opportunities to educate and offer support for our people.

A question mark lingered over his head. What? his voice seemed to ask. Asian people are seeing you? Really?

Only after he read some patient information sheets about schizophrenia in his native Asian language did he finally comprehend my training:

If medicine can cure this problem, this is a great achievement in humanity.

I guess compassion and reality is the thing.

That’s when he revealed how much his perception of mental health (and of my job!) had shifted. His ideas had changed.

There’s a lot more to this story. In fact, it is the only story of mine that I believe has any chance of being successfully published in printed media—

—except I just can’t get myself to write it.

I’m waiting for that natural change….

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