Your Inner Voice Isn’t A Monologue; It’s A Dialogue Between [At Least] Four Explicit Voices

Inner voice, internal monologue, internal discourse, self-talk — whatever you choose to call it — is the running verbal monologue of thoughts while we are conscious. We all have it, and it’s tied to our sense of self. While this has traditionally been thought of as a monologue, I’ve always struggled with this concept because to me, there’s more of a dialogue going on inside my mind. 

I would argue that we all have at least four inner voices:

1. The Anthropologist

2. The Bully

3. The Nurturer

4. The Child

Let me explain further. The Anthropologist is the observer, and without judgement, collects information about what is going on both internally and externally. Internal observations that The Anthropologist reports might include: feeling tired, feeling overwhelmed, or feeling happy, while external observations might include, “I don’t know a lot of the answers to this test,” “My boss seems upset,” or “that car is about to switch into my lane and cut me off.” The key is that The Anthropologist is only interested in the facts and does not cast judgement. 

The Bully, on the other hand, loves to cast judgement. The Bully loves the word “should” I like to also refer to The Bully as the “Should Monster.” The Bully blames, shames, and puts you down. When the Anthropologist observes that you do not know a lot of the answers on a test, The Bully jumps in and shames you for not studying more, and even tells you that you are stupid or a failure. When The Anthropologist observes that your boss seems upset, The Bully jumps in and says something along the lines of, “It’s probably your fault your boss is upset. What did you do this time? Maybe that task he assigned you wasn’t done well enough, or maybe you should have been more prepared.” The key is that The Bully makes you feel bad, shamed, and like you are not enough or you aren’t doing enough.

Think of The Nurturer as a loving parent or grandparent who is kind, patient, and looks out for your best interest. When The Anthropologist observes that you do not know a lot of the answers on a test, The Nurturer responds, “You thought this was going to be easier than it is, and that’s why you didn’t study more. It’s not that you are lazy, stupid, or a failure. Do the best you can, and next time, study more or try to prepare differently.” When The Anthropologist observes your boss is upset, The Nurturer says, “Well you tried your best and followed his instructions, so if he’s upset you shouldn’t take it personally. Maybe he had a rough day. Or maybe the two of you need to talk about how he would like that task done differently in the future, so you understand and can meet his expectations.” The key is that The Nurturer is on your side, builds you up, comforts you, and responds to your physical and emotional needs. 

Finally, there’s The Child. This one’s pretty self-explanatory. When The Anthropologist observes you don’t know a lot of answers on a test, The Child says, “These questions aren’t fair,” or “This test is stupid,” or “I just want to go home.” When The Anthropologist observes your boss is upset, The Child says, “My boss sucks,” or “I hate this job.” You get the idea. 

By this point you might think I’m completely crazy, and that’s okay. But know that I’m not the only person who thinks of discreet inner voices. Thom Rutledge, a renowned therapist, author, and speaker based out of Nashville, Tennessee speaks of the Inner Bully as well. And do you know what one of the most interesting things about Thom is?

He utilized his knowledge of the inner voices to recover from alcoholism. Specifically, he used his knowledge of The Bully. 

That’s right. Thom identified his Bully as the part of him that was the alcoholism and affectionately named him “Mr. Tequila.” Thom then thought of himself as a completely separate entity than The Bully, who was the alcoholism. This may sound silly, but let me explain why this is incredibly powerful.

Thom was able to have an inner dialogue with Mr. Tequila and actively verbally disagree and disobey him. He did this by first identifying the thoughts in which Mr. Tequila was speaking. Mr. Tequila would say something like, “Thom you’re having a bad day so you should just have a drink.” Then Tom would use his Nurturer voice to talk back at Mr. Tequila. He’d say something like, “Yeah I’m having a bad day but having a drink will only make it worse Mr. Tequila. So F*** off.” Throughout the process of his recovery, Thom has actively engaged with Mr. Tequila, arguing with him, disagreeing with him, and disobeying him.

Thom has now been sober for 30+ years, has become a therapist, and has helped countless people recover from alcoholism, substance abuse, eating disorders, and other conditions. Even after being sober for 30+ years and being solid in his recovery, Mr. Tequila still talks to Thom sometimes, and that’s normal. Mr. Tequila will never completely go away, but he will become dormant for long periods of time and creep up during stressful or trying times. And that’s okay, because if Mr. Tequila pays Thom a visit, it doesn’t mean Thom has to follow his orders. 

So what does this mean for you? How can you use the inner voices as a powerful tool in your own life?

Just because you do not suffer from alcoholism, substance abuse, or a different health condition does not mean you do not have an Inner Bully. We all have an Inner Bully, and it’s very unlikely that any of us will ever be able to completely silence The Bully voice. What we can all learn to do, however, is like Thom, learn to talk back at it, disagree with it, disobey what it tells us, and thus, not let it affect us. What does your inner bully tell you? 

I’ll tell you about mine. Recently, my inner bully has been criticizing me for not being further along on a grant that I am writing which will be submitted to the National Institutes of Health (NIH) in hopes to obtain a large amount of money for research funding. My husband and I recently got the sweetest, tiniest, cutest little puppy named Daphne. Getting her was one of the best things that I’ve ever done, don’t get me wrong, but as anyone who has had a brand new puppy knows, potty training, manners training, snuggling, and playing, all take time. So The Bully has been saying, “Why aren’t you further along?” “You should have more done by now.” I was starting to feel a little exhausted and overwhelmed, and then I used my Nurturer to say, “Back off Bully, I have a new puppy and it’s important to me to do my day job, be a good dog momma, and write this grant. I am dedicating 2 hours to the grant each day so that I can have it done before the submission deadline.” I can honestly say that by combating my Inner Bully, both in this situation and many others over the past several years of my life, I’ve become so much more at peace. 

Here’s how you can identify your Bully:

1. Start by thinking about your insecurities. What do you feel guilty about? What are you ashamed of? What are you hard on yourself about? What do you feel you aren’t good at or aren’t doing a good job at? Start being aware of the critical thoughts you are having. 

2. Start labeling the critical thoughts that pop into your head as the voice of The Bully. You can name the bully if you want, just like Thom named his Mr. Tequila. If it’s helpful, you can also think of the voice of the Bully as the voice of an abusive significant other. So for me, my Bully is like a total jerk of a boyfriend. 

3. Once you can regularly identify when The Bully is talking, start talking back at, disagreeing, and disobeying  her/him. 

Your Bully can be general critical thoughts, but it can also be a disease, condition, or emotion. 

If you are suffering from depression, for example, you can talk back at depression. Depression might tell you that you should just lay on the couch all day, but using your Nurturer, you might say “Depression I know you’re telling me I should lay on the couch, but I know I will feel better if I go for a short walk or run in the sunshine.” 

Hatred and lack of empathy towards others stems from hatred and lack of empathy towards ourselves.

I challenge those of you reading to identify your Bully and fight him/her with your Nurturer. I suppose the whole point of this post comes down to treating ourselves with more kindness and empathy, and conquering our bullies within to overcome whatever challenges or demons we might be facing or that might be holding us back. I really believe that hatred and lack of empathy towards others stems from hatred and lack of empathy towards ourselves. Therefore, being kinder and more empathetic towards ourselves will allow us to be kinder and more empathetic towards those around us. A win-win situation. 

Until Next Time, 

K

There’s a big gap between how highly men think of themselves and how little women think of themselves: Here’s what women can do about it

In a 2015 study, Bleidorn et al. assessed gender differences in self-esteem by having approximately one million (!) men and women, ages 16-45, from 48 different countries, complete an online survey. Results from this survey indicate the following:

Men consistently have statistically higher self-esteem than women, and this gap between how highly men think of themselves and how little women think of themselves is wider in more developed countries.

Why is it that women have lower self-esteem than men, especially in more developed countries where women have more rights?

Here’s one theory: According to Canadian Psychologist Louisa Jewell, women feel they need to be excellent in many different domains of their lives, while men feel they need to be excellent in comparatively fewer domains. Women often feel the pressure to be a successful career woman, the mom who never misses a soccer game, a star volunteer at their child’s school, a philanthropist, be thin, be fit, have no wrinkles, have perfectly manicured fingernails, be a rockstar wife, and be at Martha Stewart’s level of housekeeping, cooking, and entertaining. Sound familiar?

Men, on the other hand, tend to have a more narrow focus. Maybe it’s being excellent at their career, and being healthy & fit. Maybe it’s being a good father. Every man is different, but the point is, most men feel pressured to excel in significantly fewer domains of their lives. This is not a dig on men, nor is it meant to suggest that men are less capable or evolved at being successful at multiple different domains. It’s also not meant to suggest that all men fit this generalization. What it is meant to suggest, however, is that our society makes it easier for men to define a smaller set of domains on which to focus their energy.

Women have opened up so many opportunities for themselves in the last century (which is fantastic), but it means our roles and expectations are not as well-defined. Our responsibilities are no longer confined to homemaking and raising children. We have too many domains we feel we need to not only be good at, we need to not only be excellent at, but we need to be perfect at. And if we aren’t perfect in all of these areas, it can feel like we are failing. 

Setting expectations for ourselves to be perfect in all of these aspects of life ultimately results in self-doubt. When we are not perfect at one or more of the things on our very long list of “domains-to-be-perfect-at,” we are often left feeling that we are not enough or that we are failing in some capacity. 

Here’s what you need to know: You are enough. Since those words are easier said than believed, below is a simple strategy that can have a big effect on your happiness.

Consider letting go of the expectations you (but really society) has placed on your shoulders. Choose 2-3 domains that are really, really important to you, and focus your energy on them. Maybe you want to focus on your career, marriage, and/or kids. And maybe this means you let go of the expectation that your house will be photoshoot-ready for Good Housekeeping magazine at any given point in time. Maybe you’re okay with having your house a 5/10 clean and organized. Or maybe you’re like me, and the lowest level of cleanliness and organization you can be okay with is an 8.5/10. It’s okay to be a 3/10 philanthropist, a 7/10 community volunteer, and a 2/10 cook if there are more important domains in your life right now. Domains are transient and change over years, months, even days. 

So here’s to all the women out there…by giving yourself grace, letting go of the expectations to achieve perfection in way too many domains, and cognizantly selecting the domains that are most important to you to focus your energy on, I hope we can begin to close the gap in self-esteem that is currently observed between men and women in our world. Women are amazing, and we deserve to feel that way about ourselves.

Until next time, 

K

Bleidorn, W., Arslan, R., Denissen, J.J.A., Rentfrow, P.E., Gebauer, J. E., Potter, J. & Gosling, S.D. (2016). Age and gender differences in self-esteem – A cross-cultural window. Journal of Personality and Social Psychology, 111, 396 – 410.

What you should know about 23andMe, Ancestry, and other genetic tests before buying them

While direct-to-consumer (DTC) genetic testing companies like 23andMe and Ancestry can be fun ways to obtain clues about your ancestry, common traits, and health, there are some things you should know before purchasing one of these tests. 

What is DTC testing?

Let’s start by defining DTC genetic testing. Most of the time, genetic testing is done through a health care provider. However, with DTC genetic testing, genetic test kits can be purchased directly by the consumer online or from a store. Once the test kit is obtained, the consumer provides a saliva sample and mails the test kit to the company from which the kit was purchased.  

DTC genetic tests are available for a variety of traits, diseases, conditions and have a varying level of reliability, validity, clinical utility, and claims made about them. I like to divide DTC tests into four categories.

In contrast to whole genome sequencing, which cost about $1000-$4000 and look at all the genes in your genome, DTC tests cost about $99-$199 and assess only a very small portion of your genome. This is done by looking at Single Nucleotide Polymorphisms (SNPs), which are relatively common variants in the genetic code that many people carry. 

It can be difficult to interpret genetic test results. In fact, The American College of Medical Genetics (ACMG), recommends that “because of the complexity of genetic information and the challenge of interpretation, genetic testing should not be accessed without qualified health professionals.” The data supports this statement. Many studies, including those of my own research, have indicated that individuals do not adequately or accurately understand what their genetic test results mean for themselves or their family members. In non-DTC testing, a health provider will determine which test is needed, order the test, collect and send a DNA sample, interpret the test results, and share them with the patient. Often times, genetic counselors are involved pre- and/or post-genetic test. Pre-test, a genetic counselor might explain the pros and cons of genetic testing, the type of information a particular genetic test will yield, and what the information yielded from a genetic test will mean for individuals and their family members. Post-test, a genetic counselor might help individuals to understand what their result means, answer questions, think through possible actions or interventions that may reduce the risk or severity or a certain disease or condition, and asess whether and what family members are at-risk. 

Is it really that important to think and talk about all this stuff before and after having genetic testing? It’s really not that big of a deal, right?

Consider two examples. The first example is a man who receives genetic test results indicating a mutation known to be associated with hereditary colon cancer. Even though this man does not currently have colon cancer, he is at increased risk for developing colon cancer during his lifetime. It is important for this man to understand what his result means for both himself and his family members, because taking the appropriate actions could have significant implications on his own health and the health of his family members. The man should speak to his doctor about this genetic test result because it may be appropriate for him to begin colonoscopies at a younger age, or have colonoscopies more frequently, than is routinely recommended for people with an average lifetime risk of colon cancer. It is also important for the man to inform his at-risk family members about his result, because they are at-risk of carrying this same mutation. His family members may then decide whether they wish to speak to their doctor about the test result, pursue genetic testing, and take similar actions with preventative screening (if appropriate). Both the lives and health of the man and his family members could be improved, and/or extended by early detection and prevention of colon cancer

Consider a second example in which a woman is at-risk for Huntington’s Disease (HD), a neurodegenerative disease for which there is no cure or treatment available. Unlike most genetic test results, results indicating one carries the disease-causing mutation in HD mean that the individual will, with certainty, develop HD. A woman who is presymptomatically tested (tested before she has any symptoms) is at risk of severe depression, substance abuse, and even suicide if she learns she carries the disease-causing mutation for HD. However, finding out she has the mutation may also have positive effects, including reducing anxiety about the uncertainty of whether or not she will develop the disease and about life decisions, including financial planning, having children, traveling before versus after retirement, etc. The HD community is very divided on whether to pursue presymptomatic testing for HD. While some individuals find it beneficial to know their gene mutation status to reduce uncertainty and increase their ability to plan for the future, others adamantly wish not to know their gene mutation status. Though DTC genetic testing for HD is not available and must be done through a health provider, this example illustrates the importance of carefully and thoughtfully considering whether and how results from a genetic test might benefit or harm you, and what you will do with that information, before pursuing testing. 

The caveats of genetic risk estimates

Another complication of interpreting DTC genetic test results is that many DTC tests are genetic risk estimates for diseases and conditions. Genetic risk estimates do not tell you if, when, or how severely you will develop a disease or condition. However, risk estimates for diseases and conditions involve not only genetic, but also environmental risk factors.  For example, your genes are not the only thing that influences your chances of getting skin cancer — UV exposure also plays a role. Additionally, most diseases and conditions found on DTC tests are polygenic, meaning that there is not simply one gene associated with a disease or condition, there are many. We do not know with certainty all the variants associated with most diseases and conditions because the field of genetics and genomics is constantly evolving. We are continuing to discover different variants that are, and are not, associated with diseases and conditions. Furthermore, the tests that are available often do assess all of the variants currently known to be associated with a disease or condition. 

Did you know that insurance companies can use genetic information to exclude you from their policies?

A final consideration of DTC testing is data privacy. Some DTC genetic testing companies use your genetic data for internal research, allow external companies and institutions to use your genetic data for research, and/or sell your genetic data to third parties. While many companies claim they “de-indentify” your genetic data before using or selling it, de-identifying genetic data is impossible — it’s the most personalized information that exists. The Genetic Information Nondiscrimination Act (GINA) of 2008 prevents employers and health insurance companies from discriminating against individuals on the basis of genetic information, but GINA has some gaps. It does not cover members of the military, and it does not protect against genetic discrimination for long term care insurance or life insurance. Many insurance companies explicitly ask if you’ve had genetic testing. If you have had any type of genetic testing (including DTC or clinical testing) you must report this to the insurance company, so keep this in mind. 

While the potential harms of DTC testing have undoubtedly been the focus of this post so far, there are also potential benefits that should be mentioned. Benefits include opportunities to be more informed about your disease risk, seek medical advice, and engage in lifestyle changes or preventative interventions that may increase the quality and duration of your life. See the table below for more pros and cons of DTC testing.

Only you can decide whether or not DTC testing is right for you. The intention of this post is not to tell you whether or not to pursue DTC testing, but rather to help you be an informed consumer by offering information about DTC testing. 

Stay informed & curious,

K