Howard Forman, MD

by Devon Price, PhD; New York: Atria Books, 2021.

Editor's Note: As clinicians who treat mental illness, we have undoubtedly seen individuals who are labeled “lazy.” Some of our patients who are suffering the most may be those who have labeled themselves lazy. Fortunately, for those of us who chastise ourselves for taking even a moment away from work to focus on ourselves, and for our patients who cudgel themselves too, 

. Dr Price, a social psychologist and professor at Loyola University of Chicago’s School of Continuing and Professional Studies, recently sat for an interview, conducted via Zoom, on the topic of laziness. The interview will hopefully whet the appetite to read and recommend this truly helpful book.

Q: When I heard that you had written a book about the concept of laziness, the first question that came into my mind was: have you ever been called lazy?

A. I have only ever called myself lazy. I think I have absolutely been a workaholic in the way that I think a lot of academics are trained to be. You get this idea that you need to have a full course load, you need to be doing service to the university, you need to be doing research. And you need to be a self-starter if you want to have even a prayer of a career. They kind of drill that into you even as an undergrad. I think I have always had that bug in the back of my brain telling me that I was not doing enough. Many of us feel pressure to be a self-made individual and to be very individualistic and successful. So I am someone who has not been called lazy too often, because I have been able to check off a lot of society’s little boxes that make you look like a good little worker bee.

Q: I have always thought that when someone comes to me and tells me “my spouse is lazy” or “my employee is lazy,” they are using a lazy word, because it does not really give a useful description of what is going on. Why do you think the word lazy is used so frequently in our society?

A: The word has always had an air of moral condemnation to it. Its root words mean both feeble or weak willed and morally corrupt. A lot of times it is easier to write someone off as lacking essential qualities, lacking some drive or willpower that you need to succeed, than it is to ask what can be done to help. Does this individual have needs that are not getting met? What struggles is this individual facing that are not being taken seriously? What structural problems are getting in their way? When somebody looks lazy, maybe they just see no reason why they should be doing a task. So that is also an important question to ask. Have we failed to motivate them and empower them?

Q: Those are much more difficult questions to ask.

A: It is hard to ask those questions. It is even harder to solve those problems once the questions have been asked. It is much easier to say, “Oh, I give up on this individual. They lack that essential quality that they need for success.”

Q: Your answers make it impossible to ignore the uneven playing field that so many individuals face when trying to succeed in life, and particularly in science and academia. Do you have any thoughts on how inequities affect perceptions of laziness?

A: It is a thorny problem. When you are teaching and mentoring, it is important (as much as possible) to be flexible when you can. At the same time, I think giving honest feedback is essential. “Listen, I understand that you have things going against you. I know that this is not a reflection of some flaw or failure in you. But we do need to get you to a certain level, and I really am invested in seeing you reach that level. So, what can I do to help support you?” There is a lot of social psychology research suggesting that instructors, especially white instructors, are uncomfortable giving critical feedback to black students. Even black students who are doing really well! They are afraid of being perceived as racist, so they overcorrect, and this is true of sexism and other biases as well. If you can, try to level with them: tell them where they need to grow and give them the same critical feedback that you would give anyone else. Also be there to support them through hardships that are not their fault. I think that can really make a big difference. But it is a steep uphill battle.

A: There are so many areas of life where individuals are made to feel like they are not enough. We have already talked about racism, sexism, and things like that. But workaholism pervades almost everything in American culture and life. That affects individuals’ self-image, their depression levels, their anxiety levels, and how much they put on their plate. We know that those things are huge risk factors for all kinds of psychiatric and psychological issues. If you are doing too much, that looks a lot like an anxiety disorder, or anxiety profile, even if maybe you otherwise would not be in that situation.

is an attending psychiatrist at Montefiore Medical Center. He is the Book Review editor at 

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Patients and care providers often call themselves lazy. But what are the clinical consequences and cultural meanings of this term? 

Laziness Does Not Exist

 on the cover of the November 2010 issue of  the 

 had  many in my residency class talking. In response to more restrictive regulations  of resident work hours 

 Dr Sidney Weissman  penned “Are We Training Residents to be Shift Workers?”

  Regretfully, I agree with Dr Weissman that there are programs that are training  my generation of psychiatrists to think, behave, and feel like shift workers-but  I disagree with him about what is causing this phenomenon.

At my residency program, we often joke about who is the  busiest resident. We are not given any statistics concerning our productivity  because, according to our clinic director, we should “think about patients, not  numbers.” This approach always struck me as overly protective until I ran into  a fellow third-year resident from another local program.

My colleague shared with me a scenario illustrative of shift  work mentality run amok. At his program, one of his classmates requested a more  discreet office because she felt that her comings and goings from the clinic  were being monitored. Lending credence to her concern was a recently held and  specially scheduled meeting with her residency program director where she was  chastised for having only 55 patient encounters during the month of December.  She was shown that the next lowest number of encounters by her classmates  eclipsed 90. The resident was informed her output was unacceptable and she would  be getting a large number of new cases to get her “numbers up.”

Here, both the concern of the resident and program direction  are poor proxies for actual patient healing. The resident’s greatest concern is  the judgment made by those who see her entering and exiting her office rather  than the success or failure of those she is treating. Likewise, the program  director is solely concerned with the “number” of patient interactions with no  expressed concern for what is going on in those interactions.

Is it possible the resident is doing exposures that require  her to leave the office and limit her ability to see higher numbers of  patients? Does her patient panel achieve success with less frequent visits  thereby saving the patient the hassle of needless appointments and New York  State Medicaid from having to pay for unnecessary care? Is the resident missing  out on valuable opportunities to help patients because she lacks confidence in  her skills as a therapist? Although these are the questions that would lead to  fruitful conversations, they are not the questions being asked.

The resident here is being molded into a shift-worker-not by  ACGME regulations but rather by those entrusted to train her in the art of  science of psychiatry. Essentially her program director called her in from the  assembly line and said, “You are just not making enough widgets; how can we  ensure that you make as many widgets as the people working on the other  assembly lines?” ACGME regulations did not induce a shift work mentality, but  are a response to residents being viewed as turbines of economic productivity.

Ultimately it is those who incorrectly equate productivity  for quality that pose far more harm to our profession than any governing body.

Weissman S. Are we training physicians to be shift workers? 

ACGME Common Program Requirements (page 17). 

http://acgme-2010standards.org/pdf/Common_Program_Requirements_07012011.pdf

A recent opinion piece on the cover of the November 2010 issue of the Psychiatric Times had many in my residency class talking. 

Howard Forman, MD

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Laziness Does Not Exist

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