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Fear, Courage and Finding the Way Forward

By Bonnie Horrigan

Over the course of my career I have had the good fortune to have leadership positions through which I could help manifest a new vision for healthcare.   They have been positions in which my personal values and my professional responsibilities were aligned, which has resulted in my having a career I love but also a career that has meaning and value.

As I was reflecting on how I ended up in these positions in the first place, I realized that in every case, fear and courage were involved.

Courage is the quality of mind or spirit that enables a person to face difficulty, opposition, danger, and pain without, or in spite of, fear.  By definition, there is risk involved.  Just because you face opposition doesn’t mean you will emerge the victor.  Just because you face danger doesn’t mean you will come through unscathed — even if you have lots of courage.  But courage enables one to proceed despite the risk.

I love what Senator John McCain says about courage when talking about his internment in a prisoner of war camp.  He defines it as “that rare moment of unity between conscience, fear, and action, when something deep within us strikes the flint of love, of honor, of duty, to make the spark that fires our resolve.”

My encounters with courage are not so extreme but they have involved creating or maintaining consistency between my beliefs and actions despite the external pressures for inconsistency.  In fact, I would say that the calling forth of courage fundamentally requires that you have values to which you attempt to adhere.

I could tell many stories, but in the interest of brevity, I will share only two.  The first instance where real courage came into play for me, which was twenty some years ago, involved facing the fear of losing my credibility and perhaps even my job in order to bring about the change I desired to see.  I was running a publishing company owned by the American Association of Critical Care Nurses (AACN) — and doing a good job.  We published in critical care and because of all the pharmaceutical ads, profits were in the hundreds of thousands.  Life was good, except I wasn’t happy.  I didn’t like promoting drugs so much and the clinical articles seemed very focused on chemical reactions rather than the patient who was having the reactions.  (You have to remember this is back in the day when loved ones weren’t allowed in the ICU, when hospitals served doughnuts to their patients, and nurses, much less patients, did not question “doctor’s orders.”)  In my private life, I was a long-time meditator and on a personal quest to understand the true nature of the universe.  As a result, I thought there was something big missing in healthcare.

This was the early 1990s and the National Academies had just formed the Institute of Medicine and were funding research into alternative therapies.  I was thrilled that other people also saw the need for change.  I quickly recognized that, at the time, no self-respecting medical journal was ever going to publish that research.  Yoga in JAMA?  Homeopathy in The Lancet?  It wasn’t going to happen.  The field needed its own medical journal.

The question was: Should I even present such an idea?  First of all, my employers were nurses and I was proposing a multi-disciplinary journal that would be led by physicians, of all people.  (They did not get along so well in those days.)  Second, I had no idea if I could succeed or not, given how new the field was.  And third, my employers were in critical care, the land of machines and drugs, and I was talking about such things as the mind-body connection and the role of spirituality in health.  At the time, there was significant prejudice throughout healthcare against such things and I faced the very real possibility that by proposing to start a journal in the alternative field, I would destroy all the trust I had built up.  Loyalty was a huge issue for the nurses and it was not that far-fetched to imagine them tossing me out in a blink of an eye with the tag “lunatic” pinned to my dress.

But underneath my anxiety, closer to the core of being, was my very real belief that bringing these ideas into the conversation about healthcare was vitally important and would result in a better healthcare system for everyone.

Tina Rosenberg, a columnist for the New York Times, adds this perspective when writing about those of us who engage in efforts directed to social change.  She says, “There is also something fundamental that underlies all these efforts: the human ability to imagine that wrongs can be righted, and the belief that change can happen.”

After days of internal struggle, I decided that the potential upside was far more important than any personal harm I might have to endure.  No matter how it turned out, I needed to stare fear in the face and act on my beliefs.  If I didn’t, I would be regret it for the rest of my life.

Happily, after several conversations and a formal presentation, the AACN Board of Directors embraced and financed the project.  But the internal pressure didn’t go away.  It simply shifted.  Now I had to perform.  I had to build an editorial team, recruit papers, and sell enough advertising and subscriptions to pay for it all, all in a field I didn’t really know.  Yikes!

I called up Dr. Larry Dossey (whom I did not know although I knew his books and his wife, Barbie Dossey, as she was a critical care nurse) and asked him if he would be the editor.  He said no.

I was crushed.  I knew that long-term success depended on having the right team and I had pinned all my hopes on his stature as a leader in the alternative community, his storied circle of peers, and his wise guidance.  Without him, I was bound to go down in the flames of naiveté.

I basically had three choices:  Give up entirely, settle for second best, or convince him he needed to say yes.  I waited a week, summoned my courage and called him back.  “You can’t say no,” I told him.  “This is too important.”  And I began to explain why.

In the end he said yes and long story short, we are still working together some 20 years later.

The next thing that happened was that I received a phone call from a prominent female publishing executive, whom I won’t name, who said to me, “My dear, I am starting a journal about alternative and complementary medicine and I know what I am doing.  You do not know what you are doing and have no business being in this space.  So shut it down.  You will never get it off the ground.”

Astonished, I meekly told her that I didn’t think that I would do that and hung up.  I was shaking.  I had never been professionally threatened before and again, I was grappling with fear.  What if I failed?  What if she was right?  What if, in going head to head with an obvious pro hell-bent on my demise, I wasted AACN’s money, hurt Larry’s reputation and let a whole slew of other people down?  It was a big risk.

But I finally came back around to my convictions and asked, what if I succeeded?  So I stared fear in the face and kept going.  The rest is history.  The journal still exists today although I have moved on, but we made a huge difference in those early days.  We were a safe place for healthcare professionals to carry on a public conversation about a very important topic, a conversation that had previously been squelched.   And when we were chosen for inclusion in Index Medicus and Pub Med, our impact grew even greater.  With that came establishment “approval” and every researcher in the world had access to the ideas and scientific studies we were publishing.  And in the long run, that truly helped to shift the culture.

Author Anais Nin is quite correct when she says that, “Life shrinks or expands in proportion to one’s courage.”  Those three decisions I made to continue in spite of my fears opened a whole new world for me and for many others.

Fast forward ten or so years.  I was in a new job and very concerned.  There were some unethical organizational behaviors going on, most of which involved money.  I wanted no part of it and actually spoke up but was basically told to “be quiet and stay out of it.”  The question was, should I stay despite the potential crimes being committed, which in my mind made me complicit, or should I leave and take my chances.  I did not have another job lined up and I was making a nice salary.

My husband and I talked it over and we decided together that in the long run it was better to have integrity than a bank account.  It took courage — I can tell you there was a lot of anxiety and fear — but I quit and made it known why I quit.  I didn’t know if or how it was all going to work out but I also held a deep, underlying belief that in the doing the right, I was evoking a better life.

After a few months of staring financial ruin in the face and continuing to tell myself it was all for a good cause, I landed a new, well-paying job doing what I love to do with a company that had values and held to them.  And I was once again working with people I adored.  To this day, I am so grateful that I quit that other job.  Had I stayed, I would have been compromised on a deep level, tainted in a very real way.  Had I stayed the other incredible opportunities that have since come my way, such as being the Executive Director of The Bravewell Collaborative, landing a commission to write The Bravewell Story, being the Editorial Director for EXPLORE: The Journal of Science and Healing, and working for the Duke Leadership Program, might never have happened.

I’ve been trying to sit with the idea of courage for the past few days and these are my final thoughts: We each have the opportunity to create our own lives in keeping with our personal values and desires, and to contribute to making the larger world a better place.  When we encounter obstacles and threats to our internal visions, to that future we desire, we either back down from our vision or we summon courage to help us navigate into the future.

The courage we summon can be strong or weak, depending on how much we trust our own values to guide us in the right direction, how strong our belief is that our vision is something worth fighting for, and how willing we are to accept the consequences of our actions, no matter what.  To this effect, courage can be strengthened by an examination of our own values and by a resolve to stay in integrity with those values.  Courage can also be strengthened by closely examining our vision for the future and adjusting that vision as we learn and grow.

The field of integrative healthcare only exists today because of the courage of the many, many wonderful people who stood up for their beliefs, fought for what they felt was right and pursued their vision of a better healthcare system.  I only have one final word — thanks.

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