Theresa MacPhail
Appearances
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I mean, I'm old school. I'm talking about Hobbes.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I said, calm down. You know, we're not China. We're better equipped. Here's why.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Right. They're all science and technology nerds and geeks. And I mean that in the best possible sense. My people. Very driven, very type A personalities. I mean, you don't get into science and tech lightly. It's not an easy subject. And the course load is quite hefty. At some point in their lives, probably the majority, like say 70%, will probably go on to get some sort of master's or PhD.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Engineers, engineers, engineers, and research scientists.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
The whole gamut. They're building your bridges. They're putting up your buildings. They're designing your sewage pipes.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Exactly, exactly. They're designing your airplane engines, everything.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
It's the worst thing that can happen. It's the worst thing that can happen. They're all very high achieving students. So they're used to getting straight A's or close to it. They come in thinking that failure is bad and it needs to be avoided at all costs. And they have imbibed the cultural narrative of, oh, you must learn from your failures and fail better and fail faster.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
But they kind of don't buy it.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I did a research project where a psychology professor and I designed a survey and just wanted to get a sense of how they define failure for themselves and what they think about it and what they think the American culture thinks about it. And they're all really aware.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I know that business schools already teach case studies and failures, like they'll teach what happened to Enron, what happened to WeWork. And that's great for business students, but that's not what I wanted to do. I wanted to really get them familiar with the concept of failure and introduce it as a necessary and natural part of life and as a crucial component of a well-lived life.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Around 2017, 2018, we had a year that had several suicides. And, you know, we're not alone. You pick up the newspaper and you're reading constantly about Penn, Yale, Cornell. I mean, you name a school and they're having a suicide problem. And one of the students who committed suicide in 2018 was my student, one of my students in a class that I had. She was active.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
She was involved heavily in Amnesty International, which is how she came to me because she took my global health class. She was very interested in helping others. She was cheery. She was a pleasure to be around. There were none of the signs when she was in my classroom, at least. of outward struggle. So I really felt blindsided when I heard that she had committed suicide.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And I had heard from friends of multiple students who had committed suicide in that same time frame that one of the things they were all worried about is that they were somehow going to screw up, that they had screwed up, that college was the last good years and then everything else was just going to be a series of failure. And I thought, my God, what is happening?
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And so as a professor, you know, I'm teaching and I teach depressing classes. Let me just be honest about this. I teach about things that can hurt us. I teach about pandemics. I teach about illnesses. I teach medicine, which is all about disease and death. And so my classes are pretty depressing.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And I thought, what can I do to make a difference or like just provide a different perspective to try to help all of this anxiety?
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
So I start off the class with the ultimate failure, which is death. I really think I'm an intellectual granddaughter of Ernest Becker, who famously wrote The Denial of Death. He was an anthropologist as well, and his take was that society everywhere is a living myth of the significance of human life.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
that we defiantly create meaning where none exists because we do not want to deal with the terror that the ultimate mistake is one that's going to get us killed. I start off the class saying, listen, life is terrifying because death is terrifying. And I think evolutionarily, mistakes meant catastrophe.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And that's probably why we don't like them, because if you make a wrong move in the savanna when you're hunting, you're dead.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Yes. But if you look at biology, death is your system's all failing. See what I'm saying? But that's the perfect example to try to get them to accept that failure is necessary. Because the example of something that doesn't die is cancer. And that's not what we want.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And so there's that tension that, yes, death is, if you think about it from that perspective, it's all your system shutting down one by one in a cascade.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And you can see that as the ultimate failure, but then I try to get them to embrace that because, and again, I'm just Becker's granddaughter, because his argument was if we distract ourselves and we try to push down our fears of failing, ultimately that's about our fear of dying, that ironically trying to push all of that down and not talking openly about it creates more problems.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
So that's my take is that, yeah, you have to embrace failure because you can't have a successful life without it. I basically tell them at the start of my classes that I need you to get comfortable being uncomfortable. And I need you to be comfortable with uncertainty. And I really think embracing the idea that you're going to fail is the antidote to that anxiety.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
No. I'm trying to take failure and put it on the table and look at it as a social object. From an economic perspective, what does it look like? From a business perspective, from a science perspective, because failure is a changeable object. Like one failure in one arena doesn't necessarily have any of the components of the same label in another. I mean, I'm old school. I'm talking about Hobbes.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And we're going over things like what is the social contract and what does the social good look like and what does Hobbes think failure will be?
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I mean, it's never good. I mean, here's the thing. So anthropologists often ask, what are the things that all cultures everywhere struggle with? And failure is definitely something that all cultures grapple with on some level. That surprises me.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I don't know about fine. It's great.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
You would think so, but not in my, I mean, maybe someone will listen to this and say, here's the book that answers it all. But the truth is there's something about the time you're living in that it's either hard to see what it is you're doing wrong or it's hard to admit where that buck stops.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Not really, except for embracing it. So I would, I guess.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
think they should offer a Failure 101 course because it works. It changes the students' perspectives on failure. It makes them embrace it. It completely alters their understanding of themselves in relationship to the norm. And I think that's worth it.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Oh, my God. If they could only see me behind the scenes. You know what, though? I think they feel like that because I do show them my failures.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Well, I mean, we're all human beings. There are going to be days where I'm not entirely prepped for class.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I announce it. I say, hey, guess what? I forgot my notes at home, so we're off the books. Let's do this. Or I also will, I mean, we live in the age of lightning Googling. So, you know, if I say something, feel free to fact check me. And if I'm not right, raise your hand.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Because I want them to get the idea that you can be an expert, you can be highly knowledgeable, but there's no way I know everything.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Freedom. Freedom. And a lightness of moving through the world.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
So here's the thing. Before any of us step on a plane, there's been so many prototypes and there's been so many tests. And the thing I'd like to see more is letting people fail. There has to be a space for people to accept abject failure. Failure that doesn't teach you anything.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I think, yes, I think one learns acceptance and out of acceptance comes resilience. I ask my students to reflect at the end of every class. And the answers I get back is that they've totally changed their definition of what failure is. Most of them will say it's not the end of the world. It's a setback that you learn from. And all of them understand that it's subjective and a social construct.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
Simply having a class where you come in once a week for three hours and talk about failure just blatantly somehow made it okay for them to accept their own personal failures. And one of the things that shifts throughout the class is I asked them, what do you think the rate of other people's failures is compared to your own?
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And before they take the class, they say, oh, I definitely fail more than other people. And then at the end of the class, they go, everyone is failing every day at everything. And I'm like, yes, that's right. Correct. You've passed this class.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I am a professor, so if I'm talking too long, feel free to nudge me.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I try to keep track of it, but sometimes, you know, I get enthusiastic, as you'll see.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
The whole point of the whole semester is going to be, hey, everybody fails and we fail at everything.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I actually went on Anderson Cooper during the early days of the pandemic to tell everyone how wrong I was.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
I really thought when we heard the first rumblings out of China in 2019 and early 2020, I was like, we have this. Like there's mechanisms in place. But what I hadn't really considered was what over a decade of cutting funding had done. And it had basically decimated a lot of public health. I thought we were more prepared and it turns out we were not prepared.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
And I felt badly because I had done an interview with Vice News in February and I said, calm down. You know, we're not China. We're better equipped. Here's why. I had to go to the ER in March because I got very sick on March 1st. I went to the ER and I remember the ER doctor saying to me that he had never seen a situation where they were so ill-equipped with PPE or personal protective equipment.
Freakonomics Radio
How to Succeed at Failing, Part 4: Extreme Resiliency (Update)
That's when I realized, oh, I was wrong.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
He used to fight with people to get them to recognize that their issue is food allergy. And now he fights with people to get them to recognize that their issue is not food allergy.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Medical anthropology is looking at all the social and cultural factors involved in healthcare systems. We think about how all those beliefs and politics and economics, how all of that factors into the choices people make about their health and how they view their health.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
I'm associate professor of science and technology studies at Stevens Institute of Technology.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
That's been a puzzle as to why an immune cell will take a look at something that is otherwise harmless and decide that it's not and do it after sometimes years of tolerating it just fine. And suddenly now it's a problem.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
My father died of a bee sting. He died from an anaphylactic reaction to bee venom. He had had a reaction in the past, but it was fairly mild, just swelling at the site. That's mostly what happens to anyone who gets stung by a venomous insect. And he died on the second sting.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
We really don't know how many times he was stung because he was a Vietnam vet, so there's a chance that he was stung prior to that. And I got curious about my own susceptibility to such things. Years later, I was diagnosed with allergies, but I am one of the rare people that do not react to skin or blood tests. I have low levels of IgE, the antibody that is driving the allergic response.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
So there's no way to tell what I'm allergic to, except that clinically you can see the signs and symptoms that I am allergic to something.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
I think, based on my years of detective work, that I'm allergic to grass and probably ragweed and maybe dust mites.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Oh boy, how much time do we have? This is part of the problem. There's a lot of confusion about what an allergy is and isn't. The easiest answer I can give you is that an allergy is when your body responds to something that is otherwise harmless and triggers an immune response. If your immune cells are not involved in the response, then it is not an allergy.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
The classic example is milk allergy versus milk intolerance. On the surface, if you have a mild milk allergy, it's going to look the same, perhaps an upset stomach, feeling kind of gross, some gassiness. But the difference is with the intolerance, there's something else going on. In this case, you're not able to digest lactose because you lack an enzyme.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
But it's producing symptoms that would seem familiar to someone whose immune cells, whose T cells and B cells are producing antibodies and attacking that milk protein. Except that the allergy can, you know, escalate. You can get a skin rash, you can get wheezing, and you can end up in the ER with a full-on anaphylactic event. That's not going to happen with intolerance.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
But if you have mild forms of this, you're going to be confused and you might just assume that you have an allergy. And the only way to know for certain is to see an allergist. The problem there is we don't really have enough of them. They're specialists and you need a referral to see one. And so a lot of people are out there self-diagnosing.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
We think as far as we can tell that they are rising, but it's complicated. We know that rates of asthma and hay fever started to rise post-World War II, like 1950s, 1960s, and continued right up until the 1990s. And now they seem to have been flattened. But what has been rising in the wake of that are rates of food allergies. We know this because of several reasons.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
One is you can look at ER visits. You can see when someone is showing up with asthma or with a rash, like a very bad eczema eruption, or they are having anaphylaxis. The other thing that we can track is EpiPen or adrenaline prescriptions. Those raised three to four times from the 1990s to around 2018, 2019.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
It's bad. It's one of the reasons I can't tell you how many people actually have an allergy.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Right. So in the 1980s, this is after the massive rise of asthma, we're starting to see food allergies. An epidemiologist was curious about this and started collecting data on families and realized that older siblings seem to have more allergic disease than younger siblings. The theory was that older siblings bring home colds and track in bugs to expose their younger siblings.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
And there was something about that earlier exposure that had somehow protected these younger siblings. It was called the hygiene hypothesis. That has morphed over the years to what is now called the old friends hypothesis. which is nice, isn't it? That's a nicer way to put it.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
That there's something about getting the right exposures to the right bacteria or the right viruses and fungi that will help train our immune system. You're born with a novice, a naive immune system that hasn't seen anything.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
And you're born with an innate immune system, which means there are things online from the very beginning that just act as a brute force response to anything that threatens the individual. And then you have an adaptive immune system, which involve your T cells and your B cells and your antibodies that remember the things that you've been exposed to. And so the theory is those have to be trained.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
And they have to be trained in the right order. And they have to be exposed to the same types of bugs, microbes that they would have been evolving with for millennia. The theory is that we've changed so much that some of those are missing. It has confused our immune system to the extent that you're seeing more allergic disease because you're not getting the training.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
It's basically advocacy. And at the forefront of that is a group called FAIR, which is Food Allergy Research and Education. They're privately funded and run by a group of parents. When I started researching the book, one of the first people I sat down with was Helen Jaffe, her and her husband David.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
are some of the founding members of FAIR, and they also have helped to fund the Jaffe Center at Mount Sinai for food allergy research. When they started the foundation, it was because two of their children had quite severe food allergies, but it was at a time where no one was doing this. They live here in New York City, and they had to take the train down to Johns Hopkins to see Dr. Hugh Sampson.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
He's a renowned food allergist and researcher, and he has been doing this for over 40 years. But at the time, there were maybe half a dozen people focused on food allergy.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
And so initially, Helen told me that their focus was really on education and research funding to try to figure out what was going on, why the rates seemed to be rising, figure out more about the biological mechanisms that drove this response. I spoke with Dr. Hugh Sampson now, we're talking about years later, and he said he used to
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
fight with people to get them to recognize that their issue is food allergy. And now he fights with people to get them to recognize that their issue is not food allergy.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
No, it's bad. It's bad. I mean, diagnostics are one of the sticking points. It's one of the reasons I can't tell you how many people actually have an allergy. Because we're stuck with primarily the skin tests, which were invented in the late 1800s by a UK physician, Dr. Charles Blackley. Wait, the late 1800s? Yes.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
And if I exhumed him and revived him, he would have no problem giving a skin test today.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
That is the better situation. It's around 95 percent certain if you do not respond that you are not going to respond in real life.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
Yes, that's good news. That's why we still use them, because it's almost like a differential diagnosis. We can rule some things out.
Freakonomics Radio
617. Are You Really Allergic to Penicillin?
In my grandmother's case, we know because she was in the hospital and had an actual skin eruption and reaction to penicillin. I honestly don't know about my aunt. Sorry if she's listening to this. Because to my knowledge, she's never been tested. So I don't know. She does avoid them, though. At the end of the day, I suppose it doesn't matter.