For the conflict-averse among us, just agreeing to something is often the easiest path. Sunita Sah is a trained physician and professor at Cornell University. She joins host Krys Boyd to discuss why it’s so hard to go against the grain in our lives, strategies for putting your foot down and why we should look at defiant teenagers in a new and positive light. Her book is “Defy: The Power of No in a World That Demands Yes.”
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Transcript
Krys Boyd [00:00:00] I was once waiting for an event to start in a hotel ballroom when a very scary alarm started blaring, complete with this prerecorded message announcing there was a fire in the building and everyone needed to get out immediately. This seemed to me like a smart thing to do, and if I had been alone in that ballroom, I guarantee you I would have laughed. But there were lots of other people around me taking their seats, looking at their phones. They hardly seemed to notice as the alarms screamed on and on for at least five full minutes. So even though I personally was worried I might be wasting valuable time in a life or death situation, I just sat there trying to conceal how freaked out I was. From Kera in Dallas, this is Think I’m Krys Boyd. I’m here with you today, so, as you can probably guess, it did turn out to be a false alarm. But I didn’t know that at the time. Why did I not just follow my own judgment in case there really was an emergency? No matter how independent we believe ourselves to be? It turns out to be surprisingly hard to go against what everyone else is doing. Even in cases where we quietly suspect everybody else is factually or even morally wrong. And that is what my guest has written a book about. She’s written a book about the importance of defiance, which she defines not as rebellion for its own sake, but acting in accordance with our own values when there is pressure to do otherwise. Sunita Sah is a trained physician and professor of psychology at Cornell University. Her book is called “Defy: The Power of No in a World That Demands Yes.” Sunita, welcome to Think.
Sunita Sah [00:01:30] Thank you so much. It’s wonderful to be here.
Krys Boyd [00:01:33] To make it clear how much defiance or compliance can matter in the real world, you share the example of George Floyd’s murder. We all know he was killed by one officer. It’s easy to overlook the fact that there were other officers present on the scene that day. Two rookies who were close enough to see the danger Floyd was in, but did not challenge Derek Chauvin’s authority.
Sunita Sah [00:01:55] That’s correct. And it’s actually a very common thing that we do. We put our trust in our superiors, our bosses, and we think that they know what they’re doing. And even when we do suspect that something might be wrong, it’s very difficult for us to challenge authority. And even what I’ve found in my research, most people find it incredibly difficult to fight any kind of order, even an unspoken one, whether it’s from an authority, a peer, or even a stranger.
Krys Boyd [00:02:29] How is your definition of defiance a little bit different from the standard dictionary definition?
Sunita Sah [00:02:34] So the Oxford English Dictionary definition for defiance is to challenge the power of somebody else so boldly and openly. And I’m not one to disagree with the Oxford English Dictionary. I grew up in the UK after all. But I think this definition is too narrow for us, and I have spent decades looking into and studying influence, advice and authority. And what I found that is crucial and substantially changed. How I think is that we’ve misunderstood what it means to defy. And so I came to this revelation that we do need a new definition for defiance. And my definition is that to defy is to act in accordance with your true values, especially when there’s pressure to do otherwise. So in that way, we reframe defiance not as a negative connotation, but as a proactive, positive force in society. Because if you think about it, our individual actions of consent and dissent, they built up to the society that we live in and our actions. It affects our communities, our workplaces, our lives. And and that’s why it’s so important to get that definition correct.
Krys Boyd [00:03:48] This book made me think about how easy it is to fail to think through the moral implications of compliance. We might think long and hard before we defy, but we don’t necessarily think whether it would be a bad thing if we just go along.
Sunita Sah [00:04:03] That’s so true. And what I found is that is because we’re so socialized to comply. I mean, when I was a child, I was known for being an obedient daughter and student. And mostly I lived up to that aspect of being good. And what did that mean? It meant that I did what I was told. I got up when I was told to. I did my homework like expected. I even had my haircut the apparent the way that my parents insisted. And these were the messages I received, not just from parents, but from teachers and the community. And they were to be good, to obey, to fit in and not make a scene. And we start equating being compliant with being good and defiance with being bad, and that can end up causing serious problems. So when I delved into this more, I found that one survey showed that nine out of ten health care workers, on average, many of them nurses, felt uncomfortable speaking up when they saw a colleague making an error. And that’s similar to findings in other industries. So, for example, in another survey of more than 1700 crewmembers on commercial airlines, they only spoke up half the time when they noticed a mistake. And these could be life and death situations. We want these people to be speaking up and to be asking and not just complying with what’s expected of them. And I started to wonder, what if it’s sometimes bad to be so good and not speak up, not make a scene, not challenge somebody else’s decision. What do we sacrifice by being so compliant? And even if it’s not life and death situations, keeping silent when you think something is wrong can be soul destroying. So I often felt muted and drained. And that feeling was what inspired a lot of my work and research.
Krys Boyd [00:05:57] So, Sunita, your parents raised you to be obedient? My parents did the same. But you witnessed some acts of defiance by your folks that complicated your understanding of all this. Can you just tell the story of what your mom did that took you by surprise at the time and has stayed with you ever since?
Sunita Sah [00:06:15] My mom, I always thought of her as being a very compliant person. So she did all the cooking, the cleaning, the grocery shopping. She looked after all of us in the family, always putting her needs last and putting us first and never complaining. And one day I was walking home with her from the grocery store. I think I was about 7 or 8 and we had with a rickety shopping cart. It was on two wheels, a bit like wheeled luggage that you have. And we were going through and we were walking home, which was quite a long way. And we decided to take a shortcut through what we call a snicket in Yorkshire in England. And it’s just a very narrow alleyway. And often we get told not to go through the Snicket because, you know, you don’t know what you’re going to find there. But we decided to do this to cut down our time. And in the Snicket, we were confronted with several teenage boys and they blocked our path and they started shouting out some things to us and telling us to go back home. And my reaction to that was instant. I grabbed my mom’s arm. I looked down. I did not want to look at them in the face. And I just wanted to maneuver as fast as possible through the boys to get home. But my mom, she stopped. And she put the shopping cart upright and she put one hand on her hip and she looked at the boys and she said, What do you mean? At which point I grabbed her arm even tighter and whispered to her, “come on, Ma.” And she shook me off. She said no. And she looked back at the boys and said, no. What do you mean? And they didn’t say anything. So she started saying, you think you’re so strong? Big, strong boys. Very clever. And they did not answer the back. And they looked at each other. And one of them just said. Let’s go. And they dispersed and my mom grabbed the shopping cart and she started walking through the alleyway really fast. And I just stood there thinking, what just happened? I never for a moment would have thought my mum would react in such a way. And I just ran to keep up with her. But that moment showed me so many things. First of all, it showed me that being a defiant person isn’t a personality. Being defiant is actually a practice, and it’s a skill set that we can choose to use or not. It’s not a personality. It’s not a character trait. It’s a skill set. And so even if compliance is our default, it is not our destiny. The other thing that they showed me was that with defiance, I found that it really transforms you. It makes a difference to you, but it can also make a difference to the people that are observing it. And my mum’s defiance on that particular day stayed with me, as you said, for many years until now. And actually make made a difference to how I think about defiance and the effect that it can have, this ripple effect that it can take. So it only takes one person to make a great difference.
Krys Boyd [00:09:37] The story made me wonder whether your mother had been stopped and harassed more than once by kids like this and had sort of thought about what she would do the next time it happened or whether this was a spur of the moment response by her.
Sunita Sah [00:09:52] I actually think she had encountered those views before, or people like those boys before, but she often used to come home after grocery shopping and she would be muttering to herself. And I just thought she was complaining about the shopping cart. But maybe it was because she had seen these boys before. And I’m sure that she had experience of those kind of slurs before. In fact, I have already heard them when I was with my family out and about growing up in England. But that day, she did something different. And it might be that she had practiced for it or she wanted to show in front of her daughter how to react and not to just take injustice as it is. And maybe she felt protective of me and wanted to show that, though that aspect of having observed it before and thinking about how you will react is also a large part of how we can defy effectively. And what I believe is that once we start practicing defiance, we might not always get it right. It might be that we’ve complied many times before, but once we start practicing, we can change our wiring, we can change the neural pathways in our brain and be able to defy when the moment demands it.
Krys Boyd [00:11:11] Questions around why it is so hard to defy authority, even when we disagree with what we’re told or expected to do. Fascinated the social psychologist Stanley Milgram. Will you remind us of his most famous or maybe infamous experiments?
Sunita Sah [00:11:26] Absolutely. So. Stanley Milgram, and I read about his experiments when I was a psychology student way back in Edinburgh University, and I was fascinated with those experiments that were conducted in the early 1960s at Yale. And he was really trying to figure out whether the just following orders claim from Nazis after World War II was really a psychological reality or not. And in this experiment, he asked members of the community to come in, for he would present the experiment as a learning experiment and punishment, whether punishment helps learning or not. So one of the participants was the learner and had to recall word pairs that were spoken out by a teacher in another room over a microphone. Now the teacher would read out the word pass and if the learner made a mistake, they would have to give that learner an electric shock. And the shock started from 15V quite harmless, up to a very deadly 450V. Now, to be clear, there were no actual electric shocks being given because the learner was an actor. He was in another room. He was part of the experiment. And really the subject, the teacher was the person of interest to see whether they would give the electric shocks on order of the experimenter who was also in the room telling the teacher to go on with the experiment. Now, the prediction from psychiatrists would that most people wouldn’t continue after 150V and that only about 1 in 1000 would go all the way up to 450V. But the results were really quite shocking. Every single one pulled the lever for 150V, but 300V and 65% pulled the lever for the deadly 450V. So Milgram classified the people that went up to 450V as the compliant subjects and the ones that objected to harming another person and objected enough for over four times for the experiment to conclude as the defiant subjects. So even then you now we can see how defiance can be good and a proactive, positive force rather than something that we view often in our society as something negative.
Krys Boyd [00:14:04] Sunita, how can we rely on what is called expert intuition to help guide our decision to defy when it might really matter?
Sunita Sah [00:14:12] Well, expert intuition requires certain things in the context for us to gather that so to when we feel tension or we feel some kind of intuitive thought. Or when people talk about we’re feeling something from the gut, we must be able to differentiate whether really it is our gut speaking to others or whether it is expert intuition or whether it’s something else. Because when we feel that kind of tension or something feels wrong, we need to identify what that is because sometimes it could be expert intuition. At other times it could just be our biases. So for expert intuition, we need something, a predictable environment, something that you’ve seen over and over again and that you get immediate feedback on. Those conditions are rarely present in our world today. Things seem to be changing all the time. And so building up expert intuition, say like a chess grandmaster has when they see a pattern on the board, it’s very difficult for a lot of people when you’re thinking about defying, but you can become more experienced in how to defy. So that is identifying if this is a situation that goes against my values or not. That’s the first question that we want to ask. Who am I? What am I values? And is the situation going against those values? If we feel that tension, it is actually the first step of defiance is identifying that we have tension. And this might be a moment where we should defy because if you didn’t have any tension at all, you might probably don’t feel the need to defy all you might have given all your power and agency to someone else. So that tension is actually something really powerful is the signal that could tell you that you should defy. But most of us ignore that we push it away or say it’s not worth the doubt that we have and the other person might know better. But I would say that the first step of defiance is to feel that tension and then the second one is to really acknowledge it and think about is this now the time to defy?
Krys Boyd [00:16:35] How has NASA tried to build more tension into its processes to make it possible for people at all levels to point out potential problems with missions and with launches?
Sunita Sah [00:16:45] Well, I’m glad you brought up NASA, because in my class I do teach the Challenger case, the Challenger disaster that happened. And in that particular disaster, they they were only engineers from Morton Thiokol that actually objected to the launch of the Challenger. And so they felt tension. The engineers knew something was wrong. They believed that the O-rings. Could have a problem in cold weather. And they spoke up, first of all, and they said we think we should delay the launch because it’s too. The weather is too cold. Now, several things happened after that. And that was first of all, the data that they had at hand couldn’t show a clear correlation between cold weather and corruption of the O-rings. They actually did have that data, but it wasn’t at hand at the time in a way that would show that well. But they had expert intuition, first of all, that the O-rings might fail. So they had worked with O-rings all the time. So that is one aspect of expert intuition. But they also had tension, this tension between what they thought was right and the expectations of Nasser to continue with the launch. And that tension drove them to say something. In fact, after a meeting with Nasser, they were ignored substantially and the launch went ahead and they couldn’t speak up towards the end. Some of them did. And they regret to this day not just not being able to do more. Some of them did speak up, but it was really difficult to them. And an investigation afterwards shows that it was the decision making process that was that flaw. And. Statements such as take off your engineer’s hat and put on your manager’s hat, whatever that means, shows that this was a time to take a risk and not think about the bigger picture of whether it was safe or not.
Krys Boyd [00:18:52] Why should we be careful not to conflate compliance with consent?
Sunita Sah [00:18:57] Well, the two are very different. When I talk about compliance, we’re talking about people going along with something and it’s often externally imposed. So it’s either somebody else or a system that you’re going along with. But consent is actually fundamentally different to compliance. Now, I take informed consent in medicine and my work in medicine and apply it to other decisions that we make in our lives, other critical decisions. So to have informed consent as a patient, five elements need to be present. So the first one is capacity. We need to have the mental capacity so we’re not under the influence of any drugs or alcohol or illness. We have the mental capacity to make a decision. Next, we need the knowledge, so we must be given information about the decision that we are about to take, and we need good understanding of that information. We need to know the risks, the benefits, the alternatives, and really understand it. And then the fourth one is that we need the freedom to say no, because if we can’t say no, we don’t have the freedom to say no, then you don’t have to consent. If all those four elements are present, then the fifth one is your authorization. Either yes to informed consent or no to informed refusal or dissent. And if we take those elements, that’s where you get what I call your true. Yes. Consent is very different from compliance, which is just going along with something, even when those elements are not present.
Krys Boyd [00:20:40] It turns out we are quite good at predicting in advance what we might not truly consent to, but we’re not so good at accurately identifying whether or not we will actually comply. Why is it often easier to comply in the moment when we don’t actually consent to something?
Sunita Sah [00:20:58] It’s just incredibly difficult for most people to defy in a situation, especially if we haven’t encountered it before or if we’re surprised. Surprise, really disenables defiance, but anticipation enables it. So that’s one way we can prepare. But in the moment of crisis is not when to learn about defiance. We need to start learning long before the moment of of crisis, because in the actual moment we feel enormous pressure to go along with other people and we might not really understand the difference between compliance and consent or we don’t have the skill set that once we decide to defy, we don’t know how. And there is many studies that show this, but one that I particularly think is informative is one by psychologists where they asked women what how they would react if they were presented with these three questions in an interview. These questions were things such as do you have a boyfriend? Do people find you desirable? Do you think it’s important for women to wear bras at work? When they asked women how they thought they would react or imagine how they would react. They said that they would be angry and walk out. But when this actually happened to a group of other women with the same demographics in a situation of a job interview, the women said that. They didn’t feel angry. They felt fearful, and they actually smiled nervously because it was so difficult to say no in that situation. And this really demonstrates the empathy gaps, this empathy gap between predicting how you and others will behave in a situation that is different from your current situation. So when we imagine something from our armchair, we feel quite safe and we think about our aspirational selves. But when we’re actually in that situation, if we’re not prepared for it, it’s very difficult to connect with that. And a lot of emotions can come up. We’re so wired to comply that we end up saying yes and complying or not raising that this is an issue when we really want to. There’s another very powerful reason in those types of situations why we don’t say anything and why we comply. And that’s due to a psychological process I’ve discovered in my research, which I call insinuation anxiety. Now, this. It’s a distinct type of anxiety that arises when people worry that their noncompliance with another person’s wishes may be interpreted as a signal of distrust. So it insinuates that the person is not whom they appear to be or should be. So for those women in the job interview being presented with those questions, questioning that challenging the interviewer will be interpreted as a sign of distrust or say that they are insinuating that the interviewer is biased or corrupt or incompetent and unethical in many ways, and we don’t like to do that. It’s very difficult to show that you don’t trust someone else. So if your boss asks you to do something and everybody is agreeing with it, it’s very difficult to tell your boss that they might be wrong. For some people, especially with large power differences and depending on the type of workplace that you’re in, and I’ve found that this aversive emotional state of insinuation anxiety, where we become so concerned with offending the other person happens even with strangers, even in one off situations. It’s a really powerful and it can keep us quiet when we want to speak up.
Krys Boyd [00:24:57] Yeah, you know, it can even happen in situations we at least partially understand to be somewhat adversarial, like between a salesperson and a customer. As a customer, you kind of know the person behind the counter is trying to sell you something. It shouldn’t really matter whether they think you have good taste or you’re smart or you’re getting a good deal. But but it is sometimes hard to go against someone who insists that this is the thing we need.
Sunita Sah [00:25:20] Absolutely. Because it signals that we don’t trust what they’re saying. And with what I call the sales pitch effect as well, is that sometimes it’s also difficult to appear unhelpful to someone else. So I remember a situation where I met with a financial advisor when I was in my first job as a junior doctor at the Western General Hospital in Edinburgh, and I received this invitation to meet with a financial advisor for free at work. So I was working such long hours. At that point I was working what they call a one in 1 in 2, which means that I would work all day from 8:00 all night and then finish at 5 p.m. the next day, take that evening off, and then do the whole thing again. So that’s when I received it. When I received that invitation, I was like, okay, this is a break. I’m going to go and meet with this financial advisor. And that meeting was I remember it well because it was in the posh meeting room at work. Well, as posh as you can get on the UK’s National Health Service, I actually had a nice sofa and carpet and I was like, Wow, I didn’t even know this room existed. And then Dan, when he arrived, the financial advisor, he was tall, attractive, smart suit, and he built up this rapport with me over an hour asking me many questions, mostly about my finances. And that was quite surprising to me because I didn’t have much disposable income at the time as a junior doctor. But at the end of the hour, he said that he. Would write a report for me and follow up with me in a week. But he recommended that I invest in these two particular funds. And I wondered why he was doing all this for free. And so I had to ask him, what’s in it for you? And he said, there’s no such thing as a free lunch and he’s going to get paid commission if I invest in the funds that he’s recommending. So he disclosed that he had a conflict of interest and he would get commission, just like we know that about salespeople. We meet in shops sometimes and. That disclosure of the conflict of interest did change the dynamics of the situation. And in that I did feel less trust, but I didn’t want to signal that distress to happen. So that’s insinuation anxiety. At the same time, I also knew that. If I didn’t go along with what he was recommending, I was going to deprive him of his commission. Not that I should be concerned about his finances when I was there to be talk about mine. But I felt that pressure, that sales pitch effect, that I didn’t want to say no and say no, I’m going to deprive you of your commission now. So we feel pressure to be both helpful and we also feel pressure to not signal distress, to trust the other another person.
Krys Boyd [00:28:20] Sunita, I mean, clearly we should probably cultivate our power to say no when that aligns with our values and what seems right for us. How can we help ourselves by simply pausing before we make a choice?
Sunita Sah [00:28:33] I call this the power of the pause because it is extremely helpful. We don’t want to have our knee jerk compliance or even knee jerk defiance. We really want to take the time to think about how to react in this situations. So it becomes an action, not just an immediate reaction to what somebody is saying or asking or expecting of you. So taking that pause is really powerful. In that pause, we can ask ourselves three questions. Who am I? And here we can think about our values, what is really important to us. And when I ask my executive students to write down their values, which can be very clarifying to write it down, when I ask them that, they come up with many of the similar values year after year. So integrity is one that always comes up. It’s really highly prized at the value and in our society. So integrity, equity, fairness, benevolence, compassion. These are the types of values that come up. So just asking that simple question, who am I? Allows us to think about our values. The next question is what type of situation is this? Is it safe and effective for me to define? Because we do want to make sure that we’re safe. And many times we’re concerned that our defiance is going to be effective or we might want. If not, we might want to delay that to another time where it could be safer and more effective. And then the last question is a really powerful one. It’s what does a person like me do in a situation like this? And that really does tap us into our aspirational selves. What does a person like me with these values of integrity, of fairness, of compassion do in a situation like this? Then we can take action.
Krys Boyd [00:30:26] You mentioned a moment ago, Sunita, asking this question of whether something is safe for us, whether it’s safe to defy how can our social position in in wherever, whatever context we find ourselves in affect the degree to which defiance is even available to us as a tool.
Sunita Sah [00:30:45] That, well, defiance can often be a privilege in that some people are able to defy with far less consequences than other people. So if you are a tall white man, for example, it’s more acceptable for you to defy and question and speak up. And it’s often seen as being assertive, whereas others, they face more consequences for defiance. So we need to be aware of that, that there’s a defiance hierarchy in which some people can defy with less consequences than others. And what is also important to register is that the people that don’t have the privilege to defy are often the ones that need to, because they’re expected to be more compliant to begin with. And there the requests for their compliance is so high that they’re actually put in situations where they do need to defy more often, but it has more consequences for them. It’s quite costly. So it is a question that we need to ask because if it is not safe to defy at a particular time, you might want to defer defiance to a day where it is safer. We might want to think about how we could make defiance safer in that situation. And so sometimes we need to go with what I call conscious compliance, which is that all the elements for defiance or consent are present. Those five elements that I mentioned, which are capacity, knowledge, understanding the freedom to say no and then your authorization. Those elements might be present, but if you feel it is too costly, all the benefits of defiance are too weak, go. That is not going to be effective. Then you can employ what I call conscious compliance is that I’m going to comply. Right now I don’t completely consent, but I’m going to consciously comply. It’s not a default reaction from my wiring. I’m fully aware. I understand the situation and I’m deciding to comply. For now, until I can figure out a way. A later that I can define more safely.
Krys Boyd [00:32:56] If we define defiance as acting on our true values, this complicates some kinds of behavior that we typically call defiance. Right? Like the teenager breaking the rules. We might call that young person defiant, but it’s not really defiant, as you understand it.
Sunita Sah [00:33:13] Right. The way that I understand defiance and to define it is to act in accordance with your true values when there is pressure to do otherwise. And we often refer to children as being defiant when they don’t do what you ask them to do. Now, here’s where it gets really interesting because I also I have a teenage son, and when I ask him to do things, he often says, well, I was about to do that.
Krys Boyd [00:33:40] Oh I’ve heard that a million times.
Sunita Sah [00:33:41] Yeah, I was about to do that. But now that you’ve asked me to, I’m not going to do it. And it’s a really interesting response because if you were going to do your homework before I asked, but now you’re not going to do it because I asked you simply, what are you going to do your homework? It really shows you’re not acting by what you wanted to do. You’re actually fully listening to me and doing the exact opposite of what I want you to do. So in some ways you are actually really listening to what I’m saying, and that is what I call false defiance, is that it is still dependent on what somebody else wants. That false defiance is not something that at the defiance isn’t coming from within you. It doesn’t go along with your true values, but is dependent on someone else. It’s following somebody else. It’s, for example, putting something controversial out to get the likes rather than truly believing in it. It’s going to a march because all your friends are, and in some ways it ends up being dependent on other people, which is not how I define defiance.
Krys Boyd [00:34:53] You know what’s interesting about this is that a truly defiant teenager may be the one who passes up drugs or alcohol when there’s some pressure to do that. They’re doing it quietly. If they say, no, I’m not interested. But but that’s maybe more defiant than, you know, not doing the dishes when they’re told.
Sunita Sah [00:35:13] Right. So if you can defy the peer pressure to not take drugs or alcohol when all your friends are, and that’s considerable pressure for some people. You know, if you’re in that situation, that is positive defiance.
Krys Boyd [00:35:29] So what about something like the January 6th attack on the Capitol building? How is it that you see the rioters as not practicing true defiance?
Sunita Sah [00:35:39] Well, they could be some people within that crowd that believe that they were practicing true defiance and some of them perhaps were. But there were also many people within that crowd that didn’t believe in violence. And one who I read a lot about was Clayton Ray Mullins, who was not a violent man, and he believed the election had been fair. And yet he ended up in this crowd and becoming violent. He regretted it so much. He said that he was swept along with the crowd, but for whatever reason that this happened, whether it was peer pressure, a being a leader, it was not defiance. It was he looked defiance in videos, in what people might think of defiance when he’s holding up a flag or pushing a police officer. But he didn’t go along with his professed values. And so that was so false defiance.
Krys Boyd [00:36:42] What are some examples of quiet defiance? Not the, you know, marching up to the top of the hill and planting a flag, but but quieter acts.
Sunita Sah [00:36:49] Quiet defiance is staying in alignment with your values without verbally or publicly saying no to the other person. And that could be because it’s too costly to say no out loud or that the consequences of doing it would not not be beneficial in any way. So, for example, with the Milgram experiments that we spoke about, that 65% of people went up to the deadly 450Vwhen the experimenter left the room and gave instructions by telephone, then compliance went down to 20%. And it wasn’t because they were verbally saying no. They were actually saying okay, that they were giving the electric shocks, but they were either actually not giving the shocks or they were giving the very low shocks, the 15V again and again and reassuring the experimenter that they were going up. So that’s one example of quiet defiance, is to stay true to your values without publicly saying no.
Krys Boyd [00:37:59] Sunita, what did you learn about your ability to defy when you were about to receive an X-ray you didn’t really think you needed?
Sunita Sah [00:38:09] This is a really interesting situation because I had been in a very similar situation about a year in advance where I was experiencing some chest pain, quite crushing chest pain, and as a physician. So immediately I started worrying about a heart attack, some some cardiac incident. And I went to the emergency room and I was immediately whisked through triage and lots of tests, including an EKG, which showed that everything was fine and the pain was actually subsiding. So I was relieved. I was thinking, okay, I don’t know what that was, but it’s good that I can leave now. All the tests look good. But before I was going, the doctor said to me, Before you leave, you should have a CT scan. And I asked why. And she said, we want to make sure you don’t have a pulmonary embolism. Now, a pulmonary embolism is a blood clot in the lungs and it has particular symptoms. It’s a sharp type of pain. And I didn’t have that type of pain. That was not the type of pain that I was experiencing. I didn’t have any of the other risk factors for a pulmonary embolism, and I didn’t think the CT scan was necessary. So I should have said no. Yet in that situation, I didn’t. I remember asking as I was whisked into the the scanner before I got in completely. I said to someone, it’s just a small amount of radiation, isn’t it, to the technician. Even though I knew it was on average about 70 times more than an X-ray, it’s still a small amount, but any amount of ionizing radiation can cause cancer in the future. And why take the risk? Why have the CT scan when I knew and I had the knowledge and the understanding, it wasn’t necessary yet even in that situation. And I found it too difficult to say no. And I went along with it. And I regretted that so much. Like afterwards. Like what? What made me go along with that when I knew I didn’t want it. So I had felt that tension. I had acknowledged it to myself. I even started asking questions, but I couldn’t get to the final stage of defiance, which was saying no. But in that year, when I was asked again to get this time an X-ray and I knew it wasn’t necessary. I had thought about that situation. I’d visualized it. I thought about what I wished I had said. And that amount of anticipating, visualizing and maybe even role playing and scripting had changed things for me. And so it became easier for me. This time I wasn’t as surprised. And it became easier for me to find the words to say, I don’t want that X-ray. I want to see the doctor before I have the X- ray. Because as I have been taught in medicine, we take a history and an examination before we do any investigations such as X-ays. So in that situation, they were trying to send me for an X-ray before I’d even seen the doctor and it wasn’t needed. So that practice is really important. If we think about defiance again as a practice, not a personality, it’s something that we can all learn to do.
Krys Boyd [00:41:37] Let me put the shoe on the other foot. When you were practicing as a physician, how did you handle it when you felt like you knew best as a medical professional and a patient defied some procedure, refused some procedure that you thought they needed?
Sunita Sah [00:41:53] Well, at the end of the day, we want informed consent, and rather than that situation that you describe. What I would say is that, on the other hand, many of us. As patients comply with our doctors without asking the questions to really understand or we feel that we can’t because the doctor’s too busy or we don’t want to insinuate that the doctor is wrong because the doctor might have what they think is best for you. If they really understand who you are and what your goals are. And there’s a lot of research into this that the recommendations, for example, for end of life are different to what they recommend to patients, to what physicians themselves actually have and would choose for themselves. So it’s important to have a good understanding in these situations. The reason I should have defied with a CT scan and was able to defy with the X-ray is because I did have that knowledge and understanding. Not everybody does. But if it is a critical decision and there is time, it’s worth taking that time to really understand the situation and think about the goals. And there’s many different ways that doctors can give advice. So some people might prefer it to be more paternalistic, that they might prefer to hand over their agency and have somebody else choose for them. But others would prefer more of a shared decision making process or. What I would prefer is that the doctor understands what my goals and values are, and then we make a decision together with that in mind.
Krys Boyd [00:43:32] Where can we look for role models of defiance. People who are doing it right and for the right reasons?
Sunita Sah [00:43:38] Well, my editor asked me about that. She said when I was writing the book, what what is a role model for defiance that you’ve had in your life? When I thought about it, I could not think of one single person that embodied defiance all the time. I thought about particular incidents like the one my mother, where she defied the teenagers. And I thought about an incident with my dad when he had to fight for something with a local council. And I thought about my best friend who was quite defiant at high school. And what I realized then is what my mum showed me is that defiance isn’t a person or personality. It’s a practice. It’s a skill set. And we can choose to be defiant or not defiant. And what I would hope with the work that I have done and what I’ve discovered is that we start thinking about our day to day acts of defiance and consent, because society is really built on these smaller moments. It doesn’t have to be big and dramatic. But ideally, we’re building a society where one of the teens in the alleyway would have spoken up to his peers and told them to stop. So my immigrant mother wouldn’t have to have done that.
Krys Boyd [00:45:01] Sunita Sah is professor of psychology at Cornell University and author of “Defy: the Power of No in a World That Demands Yes.” Sunita, thank you for making time to talk today.
Sunita Sah [00:45:12] Thank you very much.
Krys Boyd [00:45:14] Think is distributed by PRX, the public radio exchange. We’re on Facebook and Instagram and anywhere you get podcasts, you can just do a search for KERA Think if you want the newsletter or to learn about upcoming shows go to our website think.kera.org. Again, I’m Krys Boyd. Thanks for listening. Have a great day.
