Thread by @usnehal

My thread on bullying. Pediatricians are experts on identifying bullying. All healthcare professionals should be. Adult bullying is, arguably as prevalent and destructive. In modern age we now have cyberbullying with the opportunity for 24/7 attacks.
aap.org/en-us/advocacy…

First off, the bully will often play victim. So if you are a high empathy person, you need to move yourself to "rational compassion" in order to maintain equipoise and stay open minded. Your emotions can & will be manipulated so maintain healthy skepticm

theartofcharm.com/podcast-episod…

When we are talking about a child, of course, that's a different story. Pediatricians & child abuse experts can parse this out. That is often picked up by tummy aches, milestone regression, or somatic symptoms. My intention here is to focus on teen, young adult, & adult bullying

The other thing to keep in mind is that adult bullies often are delivering the results their bosses or other decision makers want. They often are very savvy in their behavior, can be chameleons. Bullying is about power - they assess who to please and who to harass or exploit

This matters because you have to understand the difference between corporate or social/cultural narrative & actual reality of people's priorities. You may think people care about kindness, justice, fairness. In fact, you need to find out their top 1-3 incentives and priorities.

Personally, I have dealt with workplace bullies, some of whom had very obvious behaviors, sometimes flat out violation of ethics. But they were "valued" because they delivered revenue, new contracts & claimed they kept others in line, etc.
bigspeak.com/no-asshole-rul…

Oops..error. Deleted a tweet.

Anyone with ethics, of course, sets the culture and standards and threads that through. Ethical culture can guard against bullying. Most places have poor institutional ethics, unfortunately.
hbr.org/1994/03/managi…

Why are people unable to be ethical? It is hard. Requires consistency. It requires some up front work when you come on as a leader and may require "tough decisions" (terminating bullies) yet leaders have goals in first 100 days. They delegate details to managers. You are a detail

This is where the "No *sshole rule" is important. The bully often is a manager/operations person to a "visionary" leader. They take more and more "off the plate" of the leader = control. They often are responsive to metrics and incentives (ego-driven). So in "good books"

I am setting up this framing as, whether you are an arbitrator or a victim of bullying, your own emotional regulation is key. Bullying has huge negative #mentalhealth impacts. Then if you learn "ethics" or "fairness" is narrative, not reality, it is a second betrayal.

Places that lack standards or fair accountability are ripe for bullying. That said, places with strict rules can also be ripe for bullying for those with disabilities, neurodiversity, health issues. So, really, the take away is that there are no safe spaces.

So...with that framing in mind, how do you know there is a bully? One way is if you feel fear or others around you seem fearful. Are you never sure when you will have done something "wrong"? Are the standards, if exist, arbitrarily applied? Are there "favorites" and "out group"?

Gaslighting and "optics" management are key tactics of a bully. Do you doubt yourself? Do you feel shame? Do you feel inadequate or stupid? Are you never good enough? Or do you get sudden praise and sudden criticism? Are things you care about threatened?
health.com/condition/anxi…

Things I recommend to everyone, particularly woman, WOC, POC: document. Make a habit of it. First you can use it for own growth. Often, we give people the benefit of the doubt, then later cannot remember specifics. So be proactive and have a regular space, off company devices.

Also, always ask for clear objectives, standards. If someone starts making everything about you, that is a bad sign. This is intentional and intended to make you lose confidence and be easier to control, vilify, or and later on, to marginalize and isolate from others.

When this comes to cyberbullying, this will manifest in questions about you, your life, your work, "have you ever..." - the thing is sharing personal information is how people bond and is normal. Often there is an initial information gathering later used to control or harass

Really good book on negotiation, by a former FBI agent, that talks about how to use "empathy" and "mirroring" to gain trust and find out people's incentives and barriers to gain control. It is also used by bullies who often mimic empathy for control

thepowermoves.com/never-split-th…

The ways a bully gains control in groups is often to offer to "solve a problem", may position themselves as anti-bully or a savior. Something others don't want to do themselves that is an opportunity. The relief people feel creates an emotional connection that is hard to break

In physician groups often an operations person, an HR person, some non-clinical person or a medical director who tells the leader "I'll take care of those disruptive, whiny, lazy doctors for you, you focus on the important stuff." This already sets it up not believing victim.

So, first, bully enters: problem solver
Next starts to consolidate control and in/out group
Starts to have increasingly unfounded attacks - this spreads fear
Anyone who disagrees is publicly shamed or marginalized
Others become afraid to speak
If challenged, claims is attacked

Among physicians, the fear gets amplified many ways.
There are so many ways to be regulated that so many risks if written up
Generally, perfectionism is a trait that got them the right GPA and scores - that is fear-driven and manipulated by bully
Fear of losing rank in group, etc

Also, there is such current loss of trust, even anger at physicians, plus so much internal jockeying for jobs and turf in healthcare, and mostly employed staff, that the physician is more easily controlled than ever before - disruptive physician can be lead to job loss or censure

We also hear a lot of women being risk averse & embattled at work. There is also a greater desire for "civility." Except, civility/passivity is exactly what allows a bully to maintain control. So tho women prefer more fairness, that may not be the outcome
sciencedirect.com/science/articl…

In fact, as women become more senior, become more risk averse. They are often in a minority & feeling insecure. Woman are offered jobs with fewer resources. All this makes them already so depleted, may not be able/willing to stand up, or may turn bully

businessinsider.com/women-career-r…

This was the hardest thing for me to learn in my career, that the activist women I went to high school with who are out risking arrest to protest are not the perfectionist, risk averse worried women in my career. Pediatricians are feisty advocates, though

https://twitter.com/usnehal/status/1256526954255339520?s=20

If you are WOC, POC, have disability, LGBTQ, Muslim, immigrant, etc recognize that it has become fashionable to be "woke" or to be into equity. Most people have not done mental or emotional labor (fragility) & may retain bias. If bullied on this, #implicitbias will be a barrier.

This will also be a barrier to WOC/POC supporting each other. Bullies divide & conquer. When challenged will go so far as to destroy you in every way possible: mentally, career, etc. Most POC know, if they speak up: "aggressive" or making others "uncomfortable" @COCoQC

These two tweets by @mdawriter are spot on. Personally I went from feeling at margins to feeling accepted & part of various groups, to point of being invited to White House & Beacon Hill events, to realizing, no, am always my skin color & "scary" religion

https://twitter.com/mdawriter/status/1257023276100050945?s=20

Stay aware that not all of these steps are achieved. Others may not want to or have bandwidth to process what they never learned earlier. So you may bring up an issue when gets to breaking point, having tolerated it b4. But if they are also under stress, they get angry at you.

A great person to follow who features the work of BIPOC is @pgorski - found this tweet he retweeted.

If you ask help from someone when bullied, as a WOC, you will often get infantilized (as POC already are), as "help" will be through their biases.

https://twitter.com/TinaBurrell12/status/1213518218943332352?s=20

So what do you actually do if bullied? Well, make sure you have been documenting privately, and also documenting in a way that shows your contributions and value. Find a way to have something that maps to you. If possible be visible to your boss's boss. Find allies. Get therapy.

One thing I have worked with a mentee on is for her to realize that sometimes the talented person is the one bullied. That is a threat to others ego or power or self worth. So don't internalize it. Their reaction to you is their problem, not yours. You are a queen. Above it all.

Another analogy I use is to think of people around you like looking through a glass at an ant farm. You I offer this as a way to create emotional distance & strategic perspective. Step back, observe, assess, plan. Don't react. Bullies try to trigger you then show: "unstable"

This something my mother modeled for me extremely well as a child. Others' ignorance or bad behavior was *their* problem. Do not let it in. Do not let their words in. Do not let their views of you in. They will try to activate shame. What is a shame is their behavior, not you.

Coaches & mentors are helpful too. As with a therapist or any ally, be careful. Always have a bit of separation/space from everyone. People may have different values, goals, beliefs, experiences, struggles. You need to be supported to be you. When bullied, more vulnerable.

Some ppl are big on "grit" - earlier in my career I likely was too. Now focus on kindness to self with accountability for goals & standards - but I don't need to "prove" anything. I am very careful of words I use or accept used around me by friends/family psychologytoday.com/us/blog/think-…

Some additional tweets on bullying - some may be repeats of this but parsed out a bit more to explain the psychological aspects of experiencing bullying and how bullies use fear, shame, control, power, manipulation of social relationships

https://twitter.com/usnehal/status/1257030677901512704?s=20

Mindfulness can be helpful to learn self compassion and staying present in my body. If you do it (even for a few minutes at a time) up to 20 minutes daily for 8 weeks, functional MRI shows changes to improved memory and reduced reactivity and such.

uclahealth.org/marc/audio