Last year I was interviewing healthcare professionals about how they use a specific medical device. Each doctor I spoke to said firmly that there was one proper way to use this device, although each one’s approach was somewhat different from that of the others. The nurses had a different point of view. While each had his or her own approach, they all acknowledged that there are a variety of ways to use this device, and the approach for a specific situation might vary based on several factors, including personal preference. When I told the nurses about the doctors’ POV that there’s only one right way, they all laughed and said something like, ‘yeah, that’s doctors.’

It’s common for people to develop rigid attitudes about things. So common that there’s a name for it: ‘orthodoxy.’ ‘Dogma’ is also a good description.

I’ve written  about how difficult it’s become to have conversations about sensitive topics – introducing the idea of ‘hyper-morality’ to explain why this is happening. But there’s another force at play: an increase in orthodox mindsets. Orthodoxy – the idea that there is only one correct way to do or think about something – has a way of shutting down conversation. I see this across the social and political spectrum.

Orthodoxy can be seductive, and none of us are immune to its charms. Establishing dogma can be an effective way of gaining the upper hand in a conversation or relationship. Orthodoxy can engender group cohesion – if everybody’s willing to buy in – and can also lead to efficiency and predictability. That’s the reason so many organizations, particularly large ones, can be so rigid. Having one way to do or think about something certainly simplifies things.

But there’s a dark side to orthodoxy. For one thing, it can stifle creativity and personal expression. And, in social settings—not to mention focus groups – it can be pretty toxic. When people put forth a point of view as being the only correct one, others can react badly if they are not willing to subordinate their opinions to the orthodoxy being presented. They might shut down or they might become belligerent – neither of which is a good thing.

It’s important to remember that orthodoxy is a mindset. As with all mindsets, we are free to adopt or reject it as we wish. In an age when I hope we’re all looking for ways to get along better, being on the lookout for orthodoxy in our own thinking can pave the way for friendlier, more productive conversations.

A few years ago, I was conducting research on addiction recovery. In a focus group among participants who were successfully managing their condition we got to discussing The Serenity Prayer, written in the 1930’s by Reinhold Niebuhr, and often quoted in addiction treatment settings:

“God, grant me the serenity to accept  the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.”

One participant remarked that this prayer had meant a lot to him during the early, most difficult days of his recovery, and had led him to become an adherent of Stoicism. Another participant piped up: “hey—I’m a Stoic too, and that prayer sums it up perfectly.” One more participant chimed in that she also practiced Stoicism. That was three out of eight. One of the three gave a quick description of Stoicism, causing another participant to remark, “that’s me—I just didn’t know it had a name.” Make that four out of eight. Wow.

Over the remaining four groups, I explored this idea, and discovered another nine people who called themselves Stoics, and two more who realized they had been Stoics without knowing it.Since then, I’ve encountered many people who consider themselves Stoics. Not just those dealing with addiction, but all kinds: healthcare professionals, military and law enforcement personnel and athletes just to name a few.

Until those addiction focus groups, I’d had no awareness of Stoicism as a modern phenomenon—I associated it with ancient Greece. And a phenomenon it is: Stoicism is having a cultural moment. Don’t believe me? Check out the number of recent books about Stoicism on Amazon. Sales of Stoicism classics, such as the Meditations of the Roman emperor Marcus Aurelius, have experienced enormous growth in recent years. And, look at the influential people these days describing themselves as stoics: Tom Brady, Bill Clinton, Jack Dorsey, Keanu Reeves and J. K. Rowling to name a few.

So, why is this happening? Is there something about Stoicism that makes it especially appropriate for these troubled times? I’m thinking, yes. But first, let me provide those among you who were as ignorant of Stoicism as I was with some info on what it is. Bear with me—I’ll keep it brief.

Originating in 3^rd Century BC Greece, Stoicism was intended to be a practical philosophy, designed to help regular people live in the real world. At the core of Stoicism are the ideas that happiness is attained through virtue, that pleasures and worldly goods are to be regarded with indifference, and that living in harmony with the world comes of overcoming destructive emotions. Contrary to popular misconceptions, Stoics are not expected to be emotionless but rather not to be ruled by their passions—emotional resilience if you like. Stoicism emphasizes four key virtues:

Prudence—the ability to act cautiously and to do the right thing at the right time.

Justice—the idea of fairness, of treating others with respect and proportionality.

Fortitude—strength, persistence, and the ability to face fear and the unknown.

Self-control—the ability to moderate one’s own behavior and act sensibly.

Above all, Stoicism stresses focusing on what you can control, and not dwelling on things you can’t – remember The Serenity Prayer.

So, what about Stoicism has led it to being all the rage? My own recent experiences as a researcher suggest that people feel especially uncertain, unsafe, and helpless these days. That being the case, a pragmatic approach to life that stresses focusing on what you can control, deemphasizing what you can’t and not letting your emotions get the better of you has to be appealing. As Ryan Holiday, who has written numerous books about Stoicism observes, “born in the tumultuous ancient world, Stoicism took aim at the unpredictable nature of everyday life and offered a set of practical tools meant for daily use.” Considering how tumultuous our world has been over the last few years, it would almost be surprising if Stoicism weren’t experiencing a resurgence.

Importantly, Stoicism isn’t just a recipe for coping. It’s also a way to perceive things—a mindset that helps adherents make sense of a world that seems to be falling apart. This is why marketers and researchers need to be aware of it. To understand how people perceive brands and marketing communications, it is essential to understand the lenses through which they are seeing those things. Becoming conversant in the basics of Stoicism can provide insight into how people react to marketing strategies and messaging.

Stoicism is a mindset tailor-made for difficult times. For every self-described Stoic out there, I suspect there are several more who have unknowingly embraced some aspects of Stoic philosophy. Marketers and researchers need to become informed about this mindset in order to understand this cultural moment.

Photo Courtesy of: Creative Commons International

I wrote in December about the Covid-related attitudes I’ve been seeing recently as a researcher. Thanks for all your responses.  I’ve also written two posts recently about civility and have received lots of interesting feedback about them. I don’t think it’s a coincidence that we’re on edge because of Covid and that it has become difficult to have civil conversations nowadays.

In conducting qualitative research recently and following current events around the world, I’ve come to see that it’s getting harder to discuss things we used to be able to talk about. This is an urgent issue for qualitative researchers, as conversation is our stock in trade. In fact, it’s urgent for everybody. What’s changed? We’re in an age of what I’ve started calling ‘hyper-morality’ – when we carry moral considerations to an extreme.

For instance, liberty is a fundamental moral value. It’s the bedrock of the Declaration of Independence and the US Constitution and is what makes these documents so remarkable. However, liberty must be balanced with responsibility—our rights to pursue our own interests sometimes must be subordinated to the needs of others, and sometimes group needs must take a back seat to individual needs. If you look at the most intractable issues in the world today, you’ll see extreme views about liberty and responsibility on both sides of the argument.

Here’s another example. Loyalty is a virtue, whether it be to family, social group, political tribe or what have you. However, it’s possible to place such emphasis on loyalty that we end up endorsing actions or opinions inconsistent with our own values. That’s what happens when a legitimate moral concern gets elevated to an unreasonable level.

Conflicting moral views are at the heart of most difficult issues, and that’s what makes them tricky – think vaccinations, taxes, guns, or plant-based diets. Intelligent, empathetic adults should be able to work through these challenges and have productive conversations. But when morality gets ‘turned up to eleven,’ all bets are off. There’s probably no way to have a productive conversation when hyper-morality is present.

To be functioning humans, we must find a way to balance moral considerations. For instance, while you might place a high value on your own freedoms, it’s necessary to balance that against your responsibility not to harm others. And, while you might give great weight to loyalty, it’s important to remember that you also have a responsibility to think for yourself. This all sounds reasonable, right? The problem is that, in a hyper-moralized world, balance goes out the window.

How did we get here? I’m blaming cable news, talk radio and social media for this—the most extreme, controversial, even offensive positions are the ones that get the most attention. There’s no room for thoughtful, respectful dialogue, let alone empathy. We’ve been marinating in this toxic environment for several years now, and it’s affected how we see and talk about things. When influential figures are modeling hyper-morality, it’s challenging for the rest of us to act like adults.

So now what? Hell, if I know. My only suggestion is to think globally and act locally—the world’s a big place, and there’s a limit to how much you can change it, but you can influence your own community. None of us has much ability to influence how prominent figures conduct themselves, but we can set an example of rational behavior for others. In order to do this, it might be necessary for each of us to look inward to see if we are hyper-moralizing ourselves.

And, if you’re a qualitative researcher, how do you negotiate these treacherous waters?

First, resist the natural inclination to judge others for holding opinions contrary to yours.

Secondly, do whatever you can to avoid sensitive topics – if that’s feasible. There’s nothing wrong with overtly cutting off a discussion that you think might get acrimonious.

If you think sensitive topics are likely to come up, and you’re worried this might compromise the quality of conversation, consider conducting one-on-one interviews instead of focus groups. That way, the only person your participant can argue with is you.

If you must do groups, it might be a good idea to avoid putting participants who have divergent opinions on sensitive issues in the same session.

It makes me sad that I felt it necessary to write about this topic. However, in adversity lies opportunity. Hopefully, this fraught time will enable us to develop more empathy and strengthen our conversation skills.

I’ve had many conversations with research participants over the past two years about how the pandemic is affecting their outlook. Here’s what I’ve been hearing recently.

I hear a lot about uncertainty and a reluctance to make plans. People see the world as being in a constant state of flux. The metaphors I hear most involve the ‘ground shifting beneath one’s feet’ and ‘feeling suspended in midair.’

People feel insecure and unsafe, helpless, and not in control of their lives and destinies. Closely related, they feel poorly served— even betrayed— by institutions. This crosses the political spectrum and all socioeconomic strata. The media, the medical establishment and government at all levels are seen with increasing suspicion. They don’t know where to go to get accurate information, and don’t know whom to trust.

Many seem to perceive our society as unraveling, and feel helpless to stop it. They grieve for life in the ‘before times,’ particularly in-person, spontaneous, carefree interactions, making new friends, and interacting comfortably with strangers.

Perhaps the most poignant comments have been about an acute sense of mortality. The pandemic has brought us face-to-face with death and serious illness, and that’s changed how we see the world and our place in it. As a result, people say they are reevaluating their priorities and work lives—they’re less willing to ‘go through the motions,’ and want work that is fulfilling, ‘that benefits people beyond just me.’

This is what I’ve been hearing. How about you? I’d love to know. And, remember all that talk at the beginning of 2020 about ‘the new normal?’ I’m pretty sure this is it. How long it’s going to last is anybody’s guess—this mindset could stick around for years, and brings with it some significant implications:

If you’re a qualitative researcher, it’s probably a good idea to allow participants space early in the discussion to get this topic off their chests. It will put the rest of the conversation into valuable context. I generally avoid bringing this subject up myself—rather, I prefer to let participants broach the topic on their own time and in their own way.

If you’re a marketer, it’s particularly important to conduct research to understand – in as much detail as possible – how the pandemic is affecting perceptions and decision-making. It’s also important to remember that these attitudes need to be tracked over time, as they are going to evolve.

All of us are subject to these feelings—we all face challenges and difficulties. As the incomparable Elaine Stritch used to say, “everybody’s got a sack of rocks.” As we move into the holiday season, we should all try to remember how fortunate we are, despite our worries. Even with feelings of disaffection and uncertainty, we can all find stability and joy in our relationships with the people we love. This is the perfect time of year to do that.

If you know me, you know that ‘awesome’ is a word I rarely use.

It’s trite and usually undeserved. But, when you’re talking about nurses, it’s the word to use. Nurses are fantastic. They work so hard and care so much. And they do it under very challenging conditions. Burnout rates among nurses are high, and there’s a longstanding global nurse shortage, creating extremely difficult circumstances at the point of care.

Evolutionary psychology tells us that our high regard of nurses is hardwired into us—we naturally revere those who provide care and nurturance. But there’s more to it than just that. Nurses are skilled, knowledgeable professionals.

I’ve been doing a lot of healthcare research over the past few years, and have interviewed many nurses. Of all the types of people I talk to as a researcher, they may be my favorite. They’re also underutilized as research participants. However, if you’re going to get the most out of qualitative research among nurses, there are few things to keep in mind.

Before we get into that, allow me to do a bit more gushing about nurses.

They’re knowledgeable. Nurses regularly impress me with their command of their therapeutic areas. Whether it’s understanding the side effects of dozens of medications, or knowing the ins-and-outs of all the equipment and devices needed for patient care, nurses are walking encyclopedias. Those not directly involved in patient care often don’t realize this, and thus don’t understand the value of including nurses in healthcare research.

They’re pragmatic. Nurses are among the most practical people you’ll ever meet, and are problem solvers by nature. They like to keep things simple, not looking to overcomplicate things. They don’t go for increased capability if there’s no clear benefit. This pragmatism is a major strength, but it does have implications for qualitative research. More about this below.

They’re great explainers. Nurses often have primary responsibility for patient education, so they know how to explain therapies and conditions to patients (in a way that’s understandable and not scary) better than just about anybody.

They focus on the patient. While other HCPs focus on procedures, treatments, devices and processes in addition to the patient, nurses focus primarily on patients and their welfare.

They’re gutsy.  I’ve interviewed military nurses who’ve been deployed to very dangerous places, to nurses who’ve cared for Ebola and Covid patients, and to nurses who work in trauma centers in areas with high rates of violent crime. And they do it, because that’s what they do and because it must be done.

Okay. So, let’s get into what you need to know when conducting qualitative among nurses.

If you’re looking to understand patient experiences and attitudes, don’t just talk to patients. Nurses, because they work with so many patients, and because they’re so focused on patient care, sometimes can tell you things about patients’ feelings or experiences that the patients themselves can’t. They can also provide insights into the decision-making processes of patients and their families.

Remember how I pointed out how great nurses are at explaining things? This makes them a tremendous asset for marketers and researchers. If you’re testing any sort of communication materials (package inserts, brochures, websites, advertising, etc.), nurses can be your secret weapon. They know more about how to make things understandable and accessible to patients and HCPs than anybody else.

Remember that pragmatism I mentioned earlier? That’s something to keep in mind when designing research. Nurses focus on the reality of a situation, and don’t spend a lot of time thinking about why things are the way they are or how they could be better. It’s just not in their nature. So, if you’re looking to get insight about the future or the hypothetical, nurses may not be your best bet.

Similarly, nurses are not great at telling you what’s suboptimal about a situation, because they’re such strong problem solvers. Nurses will make the best of whatever circumstances they face—they’ll bend over backwards to find a way to make things work. So, instead of discussing what’s wrong with a specific situation or how it could be improved, focus discussion on the workarounds and hacks they’ve devised. And a related point—most nurses REALLY appreciate it if you get right to the point in market research interactions.

Unlike most research participants (including doctors), nurses rarely flake on you, and they’re almost always on time. So be careful not to overly over-recruit.

So, next time you’re designing an upcoming healthcare or life sciences study, consider including nurses in your research. You’ll be glad you did.

My thanks to my colleagues Caroline Volpe and Colleen Welsh-Allen for their input to this post.