Transcript
Transcript: The Outrage Cure: Public Service in an Era of Low Trust and Rapid Change
[00:00:00 The video opens with Taki Sarantakis speaking from a lectern.]
[00:00:05 Text on screen: Taki Sarantakis, President, Canada School of Public Service.]
Taki Sarantakis: Hello, my name is Taki Sarantakis. I'm President of the Canada School of Public Service, and welcome to another wonderful event that we have for you over the next hour, or so. We always have a special guest, but today we have a particularly special guest.
So, the very first time I heard this gentleman's name, and this gentleman is Dr. Alika Lafontaine, was in 2017, almost to the day, because I remember it was at the Public Policy Forum, and you were the inaugural winner of an Emergent Leaders Award.
[00:00:39 A photo of Dr. Alika Lafontaine appears full screen.]
[00:00:46 Taki Sarantakis appears full screen.]
Taki Sarantakis: And you came and you gave a speech, and I think within about 2 or 3 minutes of the beginning of your speech, all of the audience was just drenched in tears. Including me. You told us a story of your life. Which was, when you were in grade 1, your teachers called your parents over and said you have a learning disability, that you would be very, very fortunate to graduate high school.
[00:01:24 A photo of Dr. Alika Lafontaine being interviewed on CBC's "Power in Politics" appears full screen.]
Taki Sarantakis: And you not only graduated high school, you are a medical doctor, and you are the past President of the Canadian Medical Association.
[00:01:30 Taki Sarantakis appears full screen.]
Taki Sarantakis: So, I think your grade 1 teachers were wrong. So, if any of you were told by your grade 1 teachers that you would never be public servants, you should go back and tell them that they were wrong.
Today, Dr. Lafontaine is going to talk to us about something that is actually not in his DNA, and that's outrage. We live in angry times. You see it in our politics, you see it in our schools, you see it on your drive to work, you see it on the bus, you see it on the streets. We are angry right now, and there's something going on. So, we will turn it over to Dr. Lafontaine to talk to us a little bit about his new book called Outrage.
[00:02:30 A photo of Dr. Alika Lafontaine's book, "The Outrage Cure".]
[00:02:34 Taki Sarantakis appears full screen.]
Taki Sarantakis: The last thing I do before I turn over the stage to Dr. Lafontaine is to say that in 2008, I think, the CBC named you as Canada's next great Prime Minister. So, as everybody knows, we don't do partisan stuff here, but Prime Minister Carney, watch out. Dr. Alika Lafontaine.
[00:02:58 The audience applauds as Taki shakes Dr. Lafontaine's hand. Taki leaves the stage, and Dr. Lafontaine takes his place at the lectern. The camera shows various angles of the room and stage as Dr. Lafontaine speaks.]
Dr. Alika Lafontaine: I'm really grateful to have the opportunity to speak to the Public School again. I think out of all the talks that I do, this is one of my favourite audiences.
[00:03:08 Text on screen: Dr. Alika Lafontaine, Physician and Past President, Canadian Medical Association.]
Dr. Alika Lafontaine: You have people who are very deep thinkers, and folks who are shaping the country to be better every day. So, thank you very much for your work.
I think the topic that I'm going to talk [about] today is something that we all feel, but we don't often talk about directly. I think anger, outrage, and indifference are things that we experience personally, and it's definitely things that I think you see every day in your work. It presents differently depending on where you stand.
But it's often not something that we name out loud. When I did my work with the Canadian Medical Association and the Reconciliation work I continue to support, we often focus a lot on metrics around engagement, technical stuff like how do we actually make these things work?
A lot of times the conversation is around how we're feeling and how we're navigating what's going on in the day-to-day is something that we tend to relegate to after-party conversations or late-night coffees or other things. And I'm hoping in talking about this more and more, I can bring it a bit more into the forefront.
I'll share one story just from Canada's Next Great Prime Minister before I jump in. When I was preparing for the competition, and I have the story inside the book, I was actually preparing with my friend Tom. And one of the things that he told me was, if you get into a fight with one of the Prime Ministers – and there were 4 that were the judges – he said, "Just say something super patriotic." And so, I ended up getting in a fight with the Prime Minister, Paul Martin.
And the question he posed to me was, "If Quebec decides to secede with the 51% vote, what would you do as Prime Minister?" And keep in mind, I grew up in Saskatchewan. I live in Alberta. Democracy in the West is 50% plus one. That's like driven into everything that we talk about. And that's what I told him, and it was a big mistake. He turned red. He slammed his fist down on the table, and he kind of hashed it up, and he said, "Over my dead body will Quebec ever leave Canada."
And I remember standing there just horrified, because things were going well up until then. And the advice from Tom came into my mind, and I took a deep breath, and I turned to Mr. Martin, and I said, "Mr. Martin, if Quebec wants to leave, I think we shouldn't be thinking of all the ways we can force them to stay." And then I turned to the audience, who were the actual judges of the competition. I said, "We should instead be asking the question, why would Quebec want to leave the greatest country in the world?"
And the crowd erupted. I got a standing ovation. After, Mr. Martin came up to me – and I ended up winning the competition – but Mr. Martin talked to me after and he said, "I don't think your policy chops are where they need to be, but you sure can work an audience."
[00:06:12 Split screen: Dr. Lafontaine and a slide showing a graph of the intersecting highs and lows of the Three Horizons.]
Dr. Alika Lafontaine: All of you are going through this right now. I'm sure a lot of you are familiar with the Three Horizons framework. But status quos that we depend on in order to plan and shape the things that we do, they come and go, and they come and go in very predictable ways.
[00:06:24 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: If you look at the First Horizon within the Three Horizons framework, this really reflects the status quo as it is disappearing. And I think a lot of you, as you do your day-to-day work, are feeling that a lot of the rules that used to be in place, a lot of the rules that you thought would never change, are now suddenly being turned upside down.
[00:06:45 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: The Third Horizon is where the future emerges. This is where the new rules get formed and new status quos take root and entrench. The problem with the future is it's always tomorrow, so we don't really know what's going to happen with the Third Horizon. I know that there's been a lot of focus on foresight analysis and other things. And I think foresight's really great for giving you different options that might happen, but until the future arrives, we're not really sure what's going to occur.
I experienced this during the pandemic when I led our anesthesia department and then also our northern zone. A lot of the things that I took for granted, as far as workflows and approvals and other things, completely got turned upside down.
Now, suddenly, the OR manager was talking to me about what was going to happen instead of asking me what could happen. Suddenly we were presented with situations where we didn't have access to proper protective equipment or other types of life-saving devices.
I still remember in the midst of the third wave, we actually ran out of epidural catheters. And so, we, for the first time, had a discussion about who in labour pain we'd actually give a catheter to, because we only had 3. And we were a very busy hospital with 20 to 30 deliveries every couple of days. And so, these types of questions, I think, we're all trying to work through right now. And it's quite frustrating, I think.
[00:08:14 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: In the Second Horizon, this is the time where there's the great uncertainty. Our past is disappearing; our future has yet to emerge. This is really where we all are right now. Now, the reason why you move from the First Horizon to the Second Horizon is the predictable part.
[00:08:32 Split screen: Dr. Lafontaine and a slide. The slide now shows an arrow pointing up along the curve of the Second Horizon labelled "STEEP Forces".
Text on slide: H1 disappears because the world changes.
These changes can be social, technological, environmental, economic and political/cultural.
They make the current SQ maladaptive.
Maladaptive SQs cause crises.]
Dr. Alika Lafontaine: Within the world, there's certain changes that occur, and I'm sure a lot of you have seen the STEEP framework: the social, technological, environmental, economic, and political cultural changes and shifts that happen. I think there's a lot of things on folks' bingo cards that they never would have imagined would have happened in the last couple of years. Who would have thought the international trade order would get shut down? Who would know that we'd actually have a supply crisis in oil because we literally were not moving oil from places where we needed to get it. Different alliances are forming across the world. All of these things make the ways that we used to deal with problems maladaptive.
And so, if you stick with the old rules, you actually end up creating your own crises. And whether it's crises in the area of how you engage with stakeholders, or whether it's crises and how you actually solve your problems, these maladaptive status quos are things that I know within the Public Service folks try to avoid, and I know for sure we try to avoid in healthcare as well.
[00:09:33 Split screen: Dr. Lafontaine and a slide. The slide shows a word cloud, including Climate Change; Generative AI; Reconciliation; Trump tariffs; Declining trust; Cybersecurity; Wildfires; Cost of living; Fiscal restraint, etc.]
Dr. Alika Lafontaine: This is just a list of all the different STEEP forces that are at play right now. I would've never guessed tariffs would actually be the big story 5 years ago. That we'd be seeing the type of populism and declining trust that we are experiencing right now with the introduction of technology. I always viewed technology as a disruptive force, but I never thought of it as a force that was, in and of itself, something that could replace humans and people.
[00:10:03 Split screen: Dr. Lafontaine and a slide.
Text on slide: Many status quos we've taken for granted are clearly not coming back: Home ownership; Reliable family doctor; High school = Job; College = Middle Class;
Job stability; Retirement at 65; Predictable weather; US-led Global Order;
Shared sense of truth; Endless economic growth.]
Dr. Alika Lafontaine: So, with these many status quos, I think there's a lot of things that we're just not going to go back to. And this list comes from things that I hear from fellow doctors, as well as from patients and their families, things that we took for granted growing up.
I know when I was growing up, I was told, get a good job, get a home, graduate high school, you'll be able to get a job, graduate college, you'll be guaranteed to be in the middle class, all of these things I think we can't take for granted anymore.
[00:10:33 Split screen: Dr. Lafontaine and a slide. Text on slide: 1st Horizon: Different frameworks ca be applied to help navigate through H2, in some cases an emotional lens might be more practical.
As H1 shifts to H2, powerful emotions become prevalent across systems: Anger, Outrage, Indifference.]
Dr. Alika Lafontaine: And so, different frameworks can be applied to help navigate through the Second Horizon, but I'm going to suggest that there is a framework that I'll share with you today that actually will lead to a different type of lens that might help you be more practical in your approach to folks that you work with, as well as navigating these things and understanding what you, yourself, are going through.
[00:10:33 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, STEEP forces have an impact across the workplace, but they also affect us personally. And as I go thinking through the forces in my own life, there's three that really stand out.
The first is STEEP forces around Reconciliation. I was involved in something called the Indigenous Health Alliance. It was a collaboration among more than 150 First Nations across 3 provinces, but it really had its roots within 3 communities that were asking the question of, why are we so sick?
And it was in those conversations that we started to realize that we were actually asking the wrong question, because within the 3 communities we had very high health disparities. But 90 kilometres away, people are doing fine in towns like Yorkton, and other places within southeastern Saskatchewan.
And Reconciliation at the time was just starting to get momentum. It was 2013 when we started the project, 2018 when we finished. I don't think we would have been able to spread in scale if not for the forces that were happening around us.
We had a person who was Minister of Health, who was a family doctor, and was very sensitive and aware of the issues that we were going through. We had a Public Service that was trying to figure out how it was going to walk the path of Reconciliation.
You had a lot of folks who were pushing against existing status quos and pointing out that Indigenous peoples didn't have a seat at the table. And they didn't have the opportunity to influence things like quality improvement and patient safety. And as a result, those STEEP forces really lifted what we were doing within the alliance and led to our successful implementation of the things that we were trying to do.
In 2016, I reported a noose hung in my hospital. It was directed against a Black surgical assistant. Nothing happened, as far as the reporting, for several years. It wasn't until a CBC News exposé came out several years later that I started to see a lot of things start to change. And it was interesting living through that and seeing the STEEP forces that were going on because obviously there was a racial reckoning that was happening across the US that also was happening across Canada as well.
But locally there was still a lot of resistance towards folks taking that racial reckoning as it was.
And so, I experienced firsthand the effects of what happens when you report harm. And there was a lot of stress, anxiety, fear, and I think very negative impact on myself and the folks who were involved in that.
Pandemic fears are another thing that I think, here in Ottawa in particular, you all understand. At the beginning of the book, I actually talk about my relationship with Tom who had given me advice during Canada's Next Prime Minister, and how the pandemic actually led to us breaking up our friendship for a period of time.
We were chatting on the phone about a press run that I had done with the CMA. We were talking about the budget. Things turned to the Prime Minister and things that were happening with the country, and it suddenly was an existential crisis where he accused me of not caring about the things that he cared about. And as a result, our relationship broke up for a problem that was existing thousands of kilometres away and mostly filled with people that neither of us knew directly.
[00:14:34 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, The Outrage Cure is really a description and me sharing kind of my search for answers around these different emotions. And how the things that I experienced kind of weave in with what people need when they go through these different types of emotions. It's about how relationships break because of these emotional forces, but it also talks about how they can be built up again.
[00:15:00 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, a key insight that I share with folks when I talk about the book is that anger, outrage, and indifference, they signal to people around you different calls to action. I think a lot of times we get used to treating everything the same, I know that anger and outrage are feelings that we often collapse together, and we often talk about as if they're the same. I'm going to suggest that they're very different, and that the sources of them are different, as well as what people are hoping will do as a result.
[00:15:27 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, I've shared this diagram with folks here at the Public School before. This is just a description of how systems change. And as you go through moving from status quo to crisis, people's willingness to let go of old status quos start to loosen.
In the midst of a crisis, people are very willing to try a lot of things that they've never tried before. And in crises, the highest energy for change actually peaks, and that crisis is what carries you through people's intuitive pushback against things that they just don't feel make sense.
Denial is that phase within change where people haven't really figured out why they don't like what's going on, but they know that they don't like what's going on. Resistance, on the other hand, is when people start to realize this change is actually going to have a big effect on how I'm going to work day-to-day. And so, if you're able to get through denial and resistance, you can get through those later stages that I think we all kind of hope for whenever we implement new ways of doing things.
[00:16:26 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: Now, one of the things that I've realized is that anger is actually the driving force of crisis. When things don't work, anger and friction is the inevitable human response. And that anger is really people calling for help to solve problems that have become too big for them to solve on their own.
Anger is actually the reason why we get through denial and resistance. And it's interesting because we actually live in an age where we're told not to be angry. In these spaces where we try and negotiate change, we're often told that if you want to stay at this table, you have to not be angry, you have to not yell, you have to not create friction between people.
But anger is really why denial and resistance are overcome. Angry Canadians are looking to have problems solved and their anger resolved by solving problems.
[00:17:19 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: Now we all know that status quos, they don't always change, and when they don't change, denial and resistance tend to entrench. For anyone who's been part of this change cycle, you've probably experienced the feeling that, as you go round and round failed change, people who originally might have been a little open for change, once they realize change is not coming, they actually double down. And it becomes very, very clear that their denial and resistance gets a lot more intense.
Now, with maladaptive status quos, when people get more and more unwilling to change, those crises actually get more intense as you move on with each cycle.
[00:18:00 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: Anger also starts to get more intense, and as the anger gets more intense, people start to question a couple of things. The first is whether or not people actually have the skills to change. They start to question your competence.
I'm not sure how many folks within this room have been members of teams – don't raise your hands because this is on video – but I don't know how many folks have been members of teams where you've sat and you've thought to yourself, I don't know if my boss actually knows what they're doing. I don't know if the folks that I'm giving advice to actually have the skills to understand what I'm trying to communicate.
There's also a feeling, as you start to question skills, of whether or not people are making decisions in the right sort of way. And so, people start to question not only competence, but also feelings of credibility. And I think when you look at the Canadian response to a lot of these problems, you've probably seen over time that as a government stays in power for longer and longer, these questions are more and more likely to be asked. And I think a big reason is because problems don't end up getting solved.
[00:19:08 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, those feelings of betrayal, those feelings of having folks in place who either don't know how to solve problems, or don't care about solving problems in the way that they should, lead to these feelings of anger and then also these feelings of outrage.
And so, anger is a call for help, like I mentioned before. Outrage is a call for reform. And so, when people shift from focusing on problems to instead focusing on whether or not the folks who are in charge and should be making decisions should even be in those positions anymore, that's when you get a shift from anger into outrage.
[00:19:48 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: Anger is a constructive emotion. I don't know if folks have sat around tables and had that feeling of being yelled at, and then after you get through that feeling, you sit down with the very folks who are yelling at you, and you realize that they actually want to sit down and actually fix the issues that are out there. One of the great things about anger is that it pushes people together. It forces people to have conversations that are often quite hard.
I do a lot of committee work, and I'm not sure if folks in the room have the same sort of experience, but you get around a table with folks that you otherwise wouldn't have talked to before. You have superficial conversations for the first 2 or 3 meetings until someone has kind of a blow-up. If you end up having a good chair for your committee, that chair helps navigate people back towards a space where they can talk honestly with each other again, and then you move from superficial into deep conversations again. And it's in those deep conversations that we actually unpack and figure out what really needs to get done.
And when it comes to implementation, previous friction that you've had with folks is often the biggest reason why you give them space and you project trust onto them, even though in the midst of trying to solve the problem, maybe that trust isn't fully earned.
[00:21:02 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, as outrage grows in intensity, it gets increasingly aggressive and disruptive. Going back to the example of the Ottawa convoy, that was a good example of Canadians being so outraged that they felt like the only way for them to be heard and actually have their problems solved was to show up in a place that was far away from where they lived and cause disruption for people that they didn't even know. They were really trying to get attention and also a call for reform.
One of the most consistent things that came out from folks who participated in the convoy, that I found in reviewing interviews and other things, was this deep desire that they had to actually switch out leadership, as if changing out a single person would change an entire system.
[00:21:48 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, when reform is existential, outrage is often suppressed. And I'll just share this briefly. One of the things that we're often taught within systems is that when folks are outraged and calling for this type of reform, our response should really be to suppress or dismiss their outrage. We're often taught ways to de-escalate what's going on; de-escalate their calls for reform and their calls to action.
We experienced this during the Indigenous Health Alliance, where communities would often reach out to multiple different places politically, and were often told by folks in those decision-making positions, "If you want to move this forward, then the last thing you can do is actually reach out to these other parties."
There's different ways they can go about suppressing this outrage. I experienced DARVO when I reported the harm of hanging the noose. What often happens is you present a harm that has been experienced, and as a result, that very harm that you report gets labelled onto you, and you're told that you're the one who's actually disruptive. You're told that you're the one who's actually causing problems, et cetera.
[00:22:59 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: Gaslighting, bureaucratic delay, narrative control, performative acknowledgement, and subtle retaliation are all other types of ways. I won't go into detail with this, but I imagine that folks around the table who've been a part of trying to advocate for changes like this, you've all experienced this to some degree.
[00:23:15 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: When harm outweighs the reform that you achieve when you're outraged, you actually start to move into that third emotion, which is indifference. So, anger is really a focus on solving problems; outrage is a call to reform. Indifference is when you realize that trying to cause reform actually creates more pain than it's worth.
And, as you sit there with the pain of having the systems of power kind of push back against you, you say to yourself, "Maybe it's better for me just to leave this alone. Maybe it's better for me just to be left alone." And so, as a result, people no longer want to invest the emotional energy into change or reform, and they want to focus on not experiencing harm themselves.
[00:24:02 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, the emotional framework that I share in the book is that loss is the root of anger, anger is a call for help, failed change creates feelings of betrayal, betrayal is the root of outrage. And I think this is an important point here. We often look at folks who are really filled with rage as being unreasonable, and that feeling actually has its root in people feeling like systems have not come through for them, and over and over again change has failed.
Outrage is a call for reform, and as reform becomes an identity – and you could see this through some of the examples that I've shared – relationships and partnerships end up getting destroyed, and the very people that you used to be able to turn to, to solve your problems, actually don't end up being people that you can talk to anymore. As you suppress outrage, people start to become indifferent as they really feel like their voices are not heard and speaking up is actually more harm than it's worth.
[00:24:59 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: And so, what can the Public Service do, coming full circle? I think recognizing and articulating loss is something that's really, really important in our day and age. Responding to anger by solving problems. Recognizing failed change sparks feelings of betrayal. I think really leaning into these feelings of betrayal is something that's really practical and useful for folks in positions of influence like yourself.
We often don't talk to folks about why they feel like the systems have let them down. We have conversations, and this happens on the side in between meetings. Actually leaning into this feeling is one of the really important ways that we actually prevent people from getting more outraged. Responding to outrage by avoiding suppression and then showing competence and credibility.
I think the Canadian population has really shown that in environments where people can communicate competence and credibility, they'll really respond with giving support. And I think we really live in an age where this is more important than ever, and where the Public Service can really offer a huge impact.
[00:26:02 Split screen: Dr. Lafontaine and a slide, as described.]
Dr. Alika Lafontaine: Just to come full circle with the three stories, with the Indigenous Health Alliance, we ended up being very successful with raising quite a bit of money for change. Like with the noose, our outrage was never fully resolved but, like anything, people move on. And we had the majority of folks who were actually involved in these episodes actually move on.
And finally, my relationship with my good friend that fell apart over the convoy, we had the opportunity to reconnect but because of shared grief that we experienced together.
And with that, I'm very happy to enter into the conversation.
[00:26:40 The audience applauds. Vanessa Vermette appears full screen. She is seated in one of two comfortable chairs placed centre stage.]
Vanessa Vermette: What a great talk. I'm so delighted to be here. My name is Vanessa Vermette. I'm here as the Vice President of the Canada School. Dr. Lafontaine is, as Taki mentioned, a return visitor to the Canada School, and every time he comes with a talk, it's just a such an amazing opportunity for reflection and inviting in some concepts that we tend to avoid in our regular work environment.
[00:27:01 Text on screen: Vanessa Vermette, Vice-President, Canada School of Public Service.]
Vanessa Vermette: The emotional framework that he's presented here today, I think, is one that is maybe a little bit different from what we're used to, and I'm delighted to have the opportunity to dig deeper with him as he joins us on stage.
[00:27:16 Vanessa Vermette stands and shakes Dr. Lafontaine's hand as he comes on stage. The audience applauds as they take their seats. The camera shows various angles as the discussion progresses, including full screen views of each person as they speak.]
Vanessa Vermette: Dr. Lafontaine, welcome back.
So, I was just remarking on how unusual it is for a room full of Public Service leaders to be presented with a framework that essentially delves into the emotional landscape of change and loss, and how this is a really great opportunity for us to reflect how we engage with these types of emotions. So, we tend to avoid things like anger. We're focused on consensus, collaboration, and harmony.
Was there a moment or an incident that set off a lightbulb moment for you to say, "Oh, this is where I need to dig in" for your book?
Dr. Alika Lafontaine: Yes, I think when you sit down and you write, there's obviously things that you focus on. I've always been big on frameworks and trying to understand human behaviour. And I found that as I was going through my own experiences, and going through these strong emotions myself, and especially with the breakup of my friendship with Tom, I found that those frameworks were lacking.
And I think that that's one of the things that's really important to understand, especially in the Second Horizon. The things that we used to use are just inadequate to what we need to use nowadays. And I didn't realize the emotional landscape that I talk about in the book, until long after I walked through all those different experiences.
And I think as you sit back and you reflect on your response to the presentation, but also your own reflections on the anger that you might feel, the outrage you might feel about certain things, how you might be indifferent, those things change depending on the place that you're standing and the things that you're involved in. I think you'll realize that that emotional landscape is probably one of the missing pieces to help us navigate through that Second Horizon.
Vanessa Vermette: Yes, absolutely. And that Second Horizon where we're faced with so much uncertainty as we look into the Third Horizon and don't know what's coming at us.
What kind of leadership lessons have you taken away around leading through that Second Horizon of uncertainty? I mean, in the healthcare field, you've had to lead practitioners who were faced with tremendous uncertainty and chaos.
Dr. Alika Lafontaine: So, when I talk about the different emotions, you can probably see that they exist on a continuum. And there's certain circumstances that lead you to transition from one to another. I think within shared emotions that people are going through, there's probably a band of tolerance.
You want people to be angry enough to stand up and actually be motivated to change problems. But you can't get them so angry that they become incredibly outraged because at that point you actually can't control that emotional energy. It just becomes a lashing out of everyone, including yourself.
And I know that during the CMA presidency, that was one thing that I really appreciated in the second half of my presidency. And we had an enormous amount of media uptake. I think we ended up having 6.6 billion impressions over the year that I was president. I would actually leave every interview talking about how hope is people continuing to show up. Because, the feeling of hope, I think, is something that you associate with being hopeful.
But the action of being hopeful is actually showing up to try and solve those problems every day, even in the midst of feeling like those problems actually can't get solved. And I said those things because I knew physicians across the country, and I knew patients across the country, were really questioning whether this whole experience of having a publicly funded healthcare system was actually worth it.
And it's interesting now to interact with folks who are trying to create change. You've all probably experienced the disruption that artificial intelligence is having. It's interesting having folks who have barely gone into clinical practice sit down and tell you how all your clinical practice needs to change.
And I think it comes from a really authentic place, but I think those folks who are coming in trying to make those big changes without actually having tried to make those changes in the system first, they're coming in with a lot of rage already. They're coming in maybe with some indifference, as well.
And I've taken a lot of time with folks in particular who have wanted to have those conversations. And I find a lot of trainees have walked into medicine just feeling like there's not a whole lot of hope. Feeling like the system has let their family down, they've let them down. And to tell you the truth, a lot of the ways that we discuss healthcare are reminding people about how much it's let them down.
And so, I think just coming full circle to your question, it's really important for us to hold both the hope and the harm in both of our hands. There are things that aren't working, and there are people who suffered as a result. But if our option is me trying to figure out how to get a really expensive kind of treatment or intervention in healthcare done myself, or for me to work together with lots of different people across the country to create that opportunity for everyone, I think the latter is probably the one that's going to be more successful.
Vanessa Vermette: Thank you. I'm looking around the room. I'm going to invite your questions now. I'm sure many of you have burning questions for Alika. So, I'm going to go to Taki first since he put his hand up really quickly.
Taki Sarantakis: So, I'll kick off just because people are shy at the beginning.
Vanessa Vermette: There's a few hands.
Taki Sarantakis: Oh, wonderful. OK. I'll take your notion of loss, which I think is really profound and really important, and then add another L word to take it a little bit more.
[00:33:21 Taki Sarantakis appears briefly, then the camera goes back to Vanessa Vermette and Dr. Lafontaine on stage.]
Taki Sarantakis: Which is, when you feel the kind of loss that you pointed out about home ownership, about having a family doctor, about high school equals a job, at some point it goes beyond loss, and it becomes almost like the people in authority were lying to me. My teacher, my doctor, my lawyer, my financial this or that.
That it becomes to the point where you feel like the public sphere is a bit of a mythology, and then that has a very, very pernicious outcome on public life. When we no longer feel that as the rules change – the horizons – as the rules change, there are certain people that keep benefitting. There are certain people that don't feel the loss.
And, if you think about what's happening down south, if you think about what happened during COVID, there seemed to be this notion that not only were we experiencing a loss, but that our leaders were kind of lying to us. And I don't just mean our politicians, I mean our public sphere.
Dr. Alika Lafontaine: Yes, I think that's a very deep insight. And, as you go through those feelings of anger into outrage, and really I think lying fits into that betrayal part, I think when we start to feel betrayed, we are probably more accurate at the beginnings of the feelings of betrayal. We pointed towards the people that actually interacted with us. And I think that that was an interesting experience with Tom.
So, when I write about it in the book, one of the things that Tom actually said to me is he said he didn't see me as a political apologist, and that I made him want to vomit. And honestly, he had never said stuff like that to me before. And, in the moment, I was really mad at him. He's throwing a bunch of things at me. I'm ready to yell at him in return. And he hung up on me and then we didn't talk for quite a long time, like stretching into years.
And when I was unpacking all those feelings, one of the things that I realized was that Tom actually saw me as the system. Tom saw me as someone who was making him promises. And that those promises weren't coming through. We had had lots of conversations around the pandemic, and I'm a student of history, so I had read a lot about the Spanish Flu, and SARS, and all of these other situations. And I told him; these are the kinds of things that you should expect. And those things came, but he was upset because I didn't tell him exactly what was going on now.
And I think that feeling of looking at people in power and feeling like they're lying to you, whether that comes from a real or perceived place, it's really important for us to understand that that's actually why people are raging at us.
I don't know how many folks have been in the midst of First Nation engagement, especially under highly charged emotional issues, it's not uncommon for you to walk into a community and present and then just be yelled at for the next hour and a half. But then people come up, and they give you a hug after. And they often tell you; you're one of the few people that ever let me get those things out.
And I've reflected lots, and I write a bit about this, but just to add another layer to your question, Taki, I've looked at what I could have done differently with Tom, if I was really receiving what he needed, giving him what he needed as he was getting upset. He needed someone to yell at. He needed somebody who was in a decision-making position to hear him. And to maybe say, "Yes, we didn't come through."
I changed the way I talked about the pandemic over the period that I was president. At the very beginning, I focused a lot on speaking points that I was given from comms and the stuff that the public health agency would talk about and just, "Yes, I know this is hard, but it's hard for everybody and we're all just going to have to get through this and it'll be better tomorrow" and all these other things.
I actually started to say, "Your anger and your rage, it actually makes a lot of sense. I'm angry too. You yelling? It makes sense. You being frustrated, it makes sense. The system has let you down. But then turn back to what we're actually trying to build together and what would happen if we stopped."
And I actually found that as a result of having Tom break up his friendship with me, I ended up growing a lot as a person, because I realized that those lies, even though I wasn't the one who was lying, or maybe I didn't realize that I wasn't sharing the things that people needed to hear, I could still change and grow and still reform those friendships. And I think that's a major theme of the book and one of the things that I hope people take away.
We often think we reach this existential point where we have these breaks with folks or individuals or organizations and that we just we can't come back to each other. The truth is, if we understand where people's emotions are coming from, and we really take what they're trying to say to us in the way that they're trying to share it, in honouring that, we can actually come back together. And I think that's a big message of Reconciliation as well.
Vanessa Vermette: Yes, that's such a beautiful message, because the personal is universal and there is no systemic transformation without personal transformation to begin with.
Michael, you had a question back there.
Audience member: Thanks very much, Dr. Lafontaine. My question is about the horizons, the Second Horizon of disruption looking forward to a Third Horizon of status quo. I wonder if we're going to be stuck in the Second Horizon for a much longer, longer period, and that change – constant change – is our new context and that we can't necessarily look forward to a status quo anytime soon.
And, if that's the case, I'm wondering what your thoughts are, in terms of your framework, given that current context.
Dr. Alika Lafontaine: Yes, so I think to some degree how long we stay in the Second Horizon is not up to us, but there are a lot of things we can still do.
I think one of the things that I reflect on as we're seeing this huge upheaval in trade, economics, migration, everything in between, is that a lot of the rules that we built the order on were somewhat arbitrary. And that a lot of the folks that we put in positions of being decision makers, or that we follow, it wasn't something that was said, it was more a choice that we made collectively.
One of the messages that I've really appreciated from political leadership lately was this idea that you recognize where you're at and then you try and build collaboration at the level that you are. Not everybody is an energy superpower. Not everybody is a trade superpower. But that doesn't mean that you still can't try and create that future that you're looking for, to try and pull yourself out of that Second Horizon. The Second Horizon, to me, reflects less a period of instability and disruption that can't be controlled, and it's more a period where people have not decided what rules they want to live by anymore.
And so, there's ways for us to get out of the Second Horizon faster, creating new partnerships, new collaborations, relationships of trust where we can tell people this is how we're going to operate, and we can trust that they're going to say the same sort of thing. When you look at healthcare, we have yet to create national rules on how things work.
To give you an idea of how primary care works for somebody who's graduating from residency, they finish their 7 years of school plus the 4 years of undergrad. They go ask a couple friends in a place that they like – coffee shops – "Is this a place that I can set up primary care practice?" And they either say yes or no. They don't do any business analysis. They go and try and find a lease. They ask a couple friends whether or not it's a good idea. They sign on for 10 years and then suddenly they're providing primary care there.
When you look at what that is, within economic terms, I think the proper term is emergent market. You're not really creating any rules, you're just letting people do whatever. If you look at these Nordic countries that we really admire, a primary care person can't actually set up within a municipality unless it matches their growth trajectory, which is rooted in a strategic plan that people spend years trying to figure out.
And so, if we find a new way and new rules for us to link what we're trying to fix with the way that we want the future to come into being, we could probably get out of the Second Horizon a lot faster than we are right now. But that's a question of, at what point does a crisis have to get big enough for people to actually enter into that space where they're going to make different decisions? Where they're actually going to decide we're going to try and do stuff a different way. And so, the Second Horizon, I think whether or not we get out of it fast or slow really depends on that human behaviour. Are people at a point where the pain is so much that we're just going to decide that we're going to try things out this way?
Vanessa Vermette: Yes. And one thing that I'm hearing in what you're saying is that the Second Horizon is a place of potentiality, where the future hasn't yet been written and people are essentially jockeying for that opportunity to build the new rules and build the future, which is an incredibly powerful place to be.
And a lot of what we're seeing in competing narratives around things like AI and technology transformation are people trying to shape that Third Horizon right now and have us commit to a path. So, it's a really powerful place that we're in, the Second Horizon.
Questions? I think there are a couple of hands over on this side at some point that I saw, or maybe not? Back over here? Oh yes, please.
Audience member: Thank you. I'm interested in the interplay between objectively verifiable truth, data, facts, information, misinformation, against the backdrop of this powerful emotional framework that we're seeing. And for example, in the work that I do, things like residential school denialism, the fallout we're seeing in British Columbia from the Cowichan decision on Aboriginal title, where people are afraid they're going to lose their homes.
And, as public servants, we're trained to do objective analysis and provide the data and the facts, and that's going to be compelling to carry the day. And I'm not sure it ever did, but we believed it did. Where we're in this world now of constant disinformation, being manipulated for political ends, how do we bridge what we know to be true and factual with the emotional backlash and the reaction that we're seeing? How do we leverage that, or is that not useful in this context? Do we need to speak to the emotion first versus the facts?
Dr. Alika Lafontaine: So, I won't go as far as to say that truth is relative because it's not. I did an undergraduate in organic chemistry. If you light certain things on fire, there's going to be an explosion. But I would say that truth exists along a continuum. And there's the truth of, "If you jump off a cliff, you're going to fall to the ground" and the, "We've agreed that this is history." And so, I think on that continuum of truth, the different things that you mentioned have a different relationship with how people bring their own truth and kind of form that together.
I write about this in the book in talking about shared spaces that are either safe spaces or brave spaces. And I think a lot of the issue that we have around discourse, especially in Reconciliation, is that we flatten those two parts together and not been honest with people about how shared truth actually gets produced.
And so, in safe spaces, they're places that you can bring your whole self. And no one interrogates whether or not what you're sharing has validity, you're just embraced as your full person. These are the spaces that residential school survivors needed to actually share their experiences of harm, because they had a lifetime of having people say that this didn't happen. Or that this was your fault, or the things that you're interpreting as harm were actually really great things and look at the wonderful things that have happened as a result.
Brave spaces are where negotiation happens and where we actually create shared social systems. And I think the flattening of safe and brave spaces in all areas, including things like healthcare, have miscommunicated to people how change actually occurs. And so, as a result, people share their stories and then they dust off their hands and they walk away and say, "Well, change is going to happen now." In those brave spaces, it's where you negotiate what parts of everyone's safe space story actually ends up getting put together.
I've been chair of the Downie Wenjack Fund for a couple years now. I've been a part of the organization for years. It focuses on Reconciliation and specifically residential school history. I think when you sit down and you talk with people about Canada's history, they reach an existential point where they start to question, "Well, if all this happened, am I a bad person? I'm Canadian, I'm a part of this Canadian experience, I've benefitted from this dark history. Am I, myself, a terrible person?"
And I think it's in that space that a lot of pushback against actual history occurs, is because people start to think, "If this one thing is true, then something that I've taken for granted, as far as my identity, that must be true as well." And one of the most effective things that you can do when you talk about Reconciliation, whether it's with residential schools, or whether you're sitting down with physicians who've just been treating patients like garbage during their career. And you're trying to help them create a better environment for them to provide better care, it's helping them bridge that gap between, yes, it's true that the history of what you believed in actually does make you a participant in something that caused a lot of harm, but how do you bridge that to the idea that you can still be hopeful, that you can grow and change into something better?
I think Murray Sinclair was really great at this. He was really, really good at helping to show people the harm that existed, but then also bridge them to that future state where it's, "Yes, this harm occurred, but we can become different people. We can fix parts of our history and grow into something better."
Now, when you look at the Cowichan decision, that's a different existential crisis. It's the question of, "Do I still have ownership over lands that I thought that I owned?" And so, I find in the discourse around that, people are attacking Indigenous rights generally, instead of specifically within that specific context. And BC treaties are very different than treaties elsewhere.
I think the key to that is helping people to learn about the actual history, but then to have those spaces for conversations where someone can safely speak up and ask their questions, but then also let them know you may not get the answer that you want. And if you want to change these things, you're going to have to figure out together with folks in those areas, including those nations that are involved.
Vanessa Vermette: Yes, and talking about bridges, and bridging from harm to hope, your question is making me think about the bridge from high-level data and analysis to the reality on the ground.
I think something that we're seeing today is that there's statistics around growth and GDP trends, and people are not feeling the same thing in their communities that they're seeing being talked about in terms of progress. They're feeling affordability declining, precariousness rising, and the narratives are not driving with what they're experiencing on the ground.
So, I don't know if that's something that you've seen around how people react to the authority or the system coming in to talk to them about how things have to be.
Dr. Alika Lafontaine: This reminds me of a conversation that I had with one of my anesthesia professors. We gave a drug; it didn't do what it was supposed to do. We ended up dealing with the situation that had happened, which was something that could have been something really severe, but because of early intervention, it ended up being okay.
And they asked me the question, "When you talk about powered studies, what's the most powerful study?" And I gave him a bunch of answers, and he actually drew out the math, and he said, "The most powerful study is actually an 'N of 1'."
And the lesson he was trying to teach me in that moment was if you do something and it doesn't do what it's supposed to do, you can't look back on statistics and be like, "Well, [it's] only 5% of people [that] this happened to. This is a unicorn moment; this can't be happening in front of me." You have to look at your situation, and the person that you're sitting across from, and just say to yourself, "This is happening, how am I going to deal with it?"
And I think that that's a pitfall that we've run into as far as data. And to tell you the truth, AI is probably making us think this way even more. When you look at whether or not data applies to things, obviously there's a lot of different ways of interpreting that, but people tend to take the position of, "If it's not going the way that I want, I must be those 2 standard deviations away from the mean."
Or if it is going the way that they want, but people don't want other people to change things, they're like, "Well, you're not a part of the mean." So, your experience doesn't matter because it's including the majority of people. And I think going back to that "N of 1" question and having people realize it's probably a graduation of how severe the problem is that should determine whether or not we give people a unique way of solving things versus whether or not they're included within the data that we have or not.
I'm probably going to become a part of the Biobank Advisory Committee on Indigenous Precision Medicine, and one of the fears that communities have is, "Well, if we become a part of this, then what are the people going to do with our genetic material? In what ways are we going to be further harmed?" I think one of the most effective messages that I've seen shared with folks who have those types of fears is that the opportunity to be a part of data and be a part of analysis means that we're a part of creating that story.
I think going back to your original question, which is data and whether or not people are getting what they need out of it, I think we have to go back to how to build shared stories again. We've forgotten how to build shared stories. And I think a big part of it was probably the pandemic. We got really used to just being isolated in our own heads. And if you use AI a lot, you think that you have a friend, but you don't. You know what I mean? It's just software. You're just bouncing your own ideas back to yourself.
We have to figure out how we build that big, shared story again, and I think that's what nation-building truly is at the end of the day, is how are we going to create that shared story about what our country's about, how we're going to support ourselves, how we're going to support each other, and then what's our place in the world?
Vanessa Vermette: I almost wish we were ending there because that's such a great way to cap up the conversation, but we still have a half hour and opportunity for more questions, but I do want to touch on a little bit about what you just said in the context of the brave spaces that you mentioned, and giving some advice to leaders in the Public Service around creating the conditions where people can see past their outrage, or harness that anger, to find enough common ground to actually solve the problems.
How can leaders do that? You have so much experience, so share it with us.
Dr. Alika Lafontaine: Yes, so if people are angry, some of the signs that you can see is that when they sit down and talk to you, they're really focused on solving their problem. They might be focused on solving their problem in the way that they want to solve it, but they always go back to problems when they're sitting down and talking to you.
It's rare for folks who are really angry to point to a single person and say it's that person's fault that this isn't happening or point to one group and blame them for all the undesirable things that have happened in the course of not having that problem solved.
People who are outraged are always looking for reform, so they're looking to expose problems. They're looking to get retribution against people that they believe have harmed them, and they're looking to have justice served, to see someone move out of a position, or someone move out from a table of influence or other things.
Anger is simple. You just solve problems. If you can lean in and solve a problem for an angry person, they'll get less angry. We sometimes try and do that for folks who are outraged and then get really frustrated because we sit back and go, "Well, I actually got rid of the harm that you have, but you're still mad."
You probably see this in political discourse where people are always changing the goalposts of what's acceptable as far as, "Well, I want this to happen. Oh, well, that problem got solved, so I want that to happen." What you really need to solve outrage is create an environment where people can openly talk about their harm, but they need to have the sensitivity to accept the same sort of thing.
We live in this weird digital space where people feel that they can share everything that they're upset about, but they don't want to hear anything from anybody else. That one-way trauma sharing is actually one of the reasons why you stay so outraged. You have to learn to do a two-way.
There's a residential school survivor who was a part of the Indigenous Health Alliance, and I talk about him in the book, but one of the things that he told me, and it was the first time I'd ever heard this from someone, was he talked about why residential school survivors don't share their experiences. And we had a long conversation about it, and then he turned and said, "We are worried that in sharing our trauma, we'll actually get harmed as a result."
Everybody who's harmed by something, they want to tell somebody. But it's human behaviour to share something really deep and meaningful to yourself and then not get the response that you want and, as a result, feel hurt. And so, that layered harm is something that you have to figure out in those brave spaces.
And so, in a safe space, you got to find a way for people to open up. In a brave space, you have to figure out how to help people listen. And it's that two-way listening and then matching the emotional energy to the moment that I think really starts to unwind outrage. If you are so angry that you become outraged and then you're put in a position where you have to feel and experience other people's rage, it puts you into a place where you have to gain perspective. That's one of the things that I've always appreciated about medicine. Anytime I get really, really upset about something, I end up giving care to somebody who had a much worse day than I had. And it's in providing that care and really hearing that person's story that I sit back and say, "Well, maybe I shouldn't be so angry."
But yes, for public servants who are trying to help people work through that rage, I think we're really good at being listeners, but folks across the table have to learn to listen as well. And there's facilitated ways that you can figure out how to do that. But if you don't have that two-way exchange, you're never going to get them unwinding out of that outrage.
Vanessa Vermette: Yes, and there's also another layer of genuine listening versus performative listening. And I think we see a lot of performative listening in activities that the government involves itself in just generally in consulting with people. We say, "Oh, we'll come and listen," and then we don't make any commitments to what's going to come out of the other end.
I'm wondering how this relates to the experience you had with the noose incident that you talked about that never really got resolved, how did that feel?
Dr. Alika Lafontaine: So, when I reported the noose, the first thing I actually thought was I lost my job. And so, it's interesting because you talk to persons of colour, or people who've reported harm before, and they immediately are like, "Yes, I get you." You talk to other folks and they're like, "Why would you lose your job? It's safe reporting. Everything will be okay."
I had had a lot of experiences over my lifetime where I saw people report things that spoke out against folks who were in power positions within organizations. The person who hung the noose obviously felt that they could. And I won't go into a whole lot of detail, but they were somebody who had a whole lot of social capital, strong relationships with folks who were decision makers. And after I reported the noose, I fell into a downward spiral of outrage.
But I was also caught within this frame that I had been taught where, if you report something, as it's more and more intense, like the harm that you're reporting, the more and more you have to be a model citizen. And so, I spent years trying to be a model citizen.
Now, I always got along with people at work and all these other things. But I was even more careful in my documentation, careful in my interactions. But that rage had to go somewhere. And I started getting very isolated within my personal relationships. I quit opening up to my wife and kids. I found that at work it seemed like everything was going really, really well. And I obviously was involved in a lot of things.
But that downward spiral of rage just didn't have a place for it to come out because I couldn't talk to anybody about it, because I was so afraid of what would happen if I told anyone and then it circled back to the reporting system and they're like, "Oh, this person can't be trusted."
Once the CBC News exposé came out and the ministerial investigation ended up happening, I realized for the first time all these things that had been happening in the background. So, one of the things that occurred that really shed a lot of light on it is they released the report unredacted, which I don't know how you do that as a government, but they released the ministerial report without blacking out anything. So, I got to read in real time what was going on immediately after I reported and the narrative that was shaped after that.
And so, that gave me a lot of context for why I wasn't reached out to. The reporting was suppressed. It was moved out. I was relabelled as self-reporting. There's a thing in bylaws for physicians that if you self-report harm that you caused, the system is obligated to actually give you less of a punishment. I found out that there was a piece of documentation that said that I had said that I was going to support the person in fixing everything. I obviously hadn't talked to anybody over the period of time that this whole thing had been going on for years, so that led to a cascade of other types of events.
But it was really instructive for me to go through that downward spiral myself, realize the impact that it had on me personally, realize the system and how it reacted to things, and that whole suppression of outrage. All those things that I listed are things that I personally experienced in the course of going through that harm reporting.
And then to now be here in a position of influence, in a position where I'm still very aware that things can happen, but I at least have different optionality than I had before. And to be able to help people walk through the same sort of thing.
When I have someone talk about reporting harm, that's in the same sort of vein as reporting the news, I think the person that I am today gives very, very different advice than the person that I was when I first went through that harm reporting.
And for folks who have been going through outrage, like maybe some of you are raging right now, but just expressing it in different sorts of ways. I'll say as somebody who's walked down that path and kind of unwound it, it gives you a different type of empathy to go through those experiences. It does actually make you into a better leader, if you let it.
Vanessa Vermette: Yes, I was about to say this experience, I'm sure, has made you a more trusted, more credible, and more effective advocate and leader for people who may be going through something similar. It's really incredible.
I'm just going to check in on the room. Yes, Darlene, please go ahead.
Audience member: This is like therapy. No, thank you very much for the session today.
Now, you talked a lot, even just a second ago, about suppression, and I'm just thinking about the mental and physical health impacts that rage has on you, as a person. And you've given us a great framework, and even within those frameworks, there's a little bit of suppression in some of those solutions there.
Just wondering if you can speak to some of the coping mechanisms from a mental and physical health perspective, because I'm sure there are repercussions from high blood pressure, and heart disease, other different things that can come about as a result of these things. Would you be able to speak to some of that?
Dr. Alika Lafontaine: Yes, and I do talk about this in more detail in the book, but there's a lot of hormonal surges that then end up happening, like chronic stress.
My personal opinion on it, and I think this is supported in the literature, chronic stress is probably the largest killer out of everything. It increases your risk of cancer, it increases your risk of uncontrolled high blood pressure, increases your risk of stroke, heart attack, development of diabetes, all these things.
I went through all of those physical changes. I had sleep disruption. I actually ended up developing an arrhythmia for a little while, where I was pretty sure I was in atrial fibrillation. Luckily, I could just do hallway consults, so I'd run into an internist friend. I'd be like, "Hey, can you hook me up to the ECG and tell me what's going on?" So, I was well supported in that way, but it wasn't until I actually unwound the churning emotions that I had, that it started to get on a path of getting fixed.
And I think that that's a message that I'd share to folks in the room who are dealing with these emotions right now. If you don't unwind them, you can run as much as you want, you can have that glass of wine after work and stuff, but you are going to experience severe physical changes as a result of that chronic stress.
One of the most important things that I did was actually opening up to talk about things. I talk about it in one of the chapters, but I reached peak outrage around the time that I had a family member almost die from a pulmonary embolism. And I remember flying to see that family member, and I'm sitting around with the rest of my family, and I'm just thinking to myself, "Geez, what's going on? I'm going to lose this person. And what have I been doing with my life?"
And there's things that can happen in your life that disrupt the downward spiral of outrage. I list them in the chapter, but this was one of them where I started to think about whether or not what I was focusing on was really useful to me.
And one of the things about outrage is it is a powerful force. I do think it's a part of human behaviour because you do need reform at times. You do need people to kind of rage and get people out of power positions in certain circumstances because that's the only thing that breaks down systems of power. But at some point, outrage tips from being something that's useful, to something being super harmful.
And when I came home from visiting that family member – who, thank goodness, recovered. I didn't actually think that they were going to recover, but they ended up recovering – I sat down, and I talked to my wife. Well, to be honest, my wife actually sat down and talked with me, and she's like, "You're going to have to figure this out." And at that point, I decided in that moment, I just can't feel like this anymore. It's not worth it.
And, going back to the question about the Second Horizon, this is the interesting thing about individual and shared experiences. You get to a point where you finally start to think about the important questions, the noise starts to disappear. And I think if you're caught in the downward spiral of outrage, if you're lucky enough, you end up having one of those disruptions.
But in the absence of having those disruptions, it's very, very hard on your body in ways that are probably even more severe than I've communicated.
Vanessa Vermette: So, we're coming, unfortunately, towards the end of our time together. I'm going to give you the floor to leave us with some advice, some parting words of wisdom for the leaders in the room and the leaders that are going to be joining us online around how they can apply this framework, in a very concrete way, tomorrow in their lives, in their work lives.
Dr. Alika Lafontaine: Yes, I think one of the things I've appreciated since sharing the book – so the book came out on the 28th, and I've had a week to sit down and hear from people –
Vanessa Vermette: Congratulations, by the way. It's amazing.
[01:08:56 Vanessa Vermette and the audience applaud.]
Dr. Alika Lafontaine: Yes, thank you very much. Thank you. And to hear from people about what they take away from the book. It's always interesting when you write because one of the things my wife always reminded me, because I'd write a chapter and then I'd send it off to her to read and then we'd have a chat about it. She'd always ask me the question, "Are you writing this for yourself, or are you writing it for a reader?"
Yes, and the book was a lot of therapy. It forced me to confront a lot of things that I'd superficially discussed. Obviously, in 2017 when I talked about being labelled as developmentally delayed, that was a really low point in my life. But in unpacking it, I think I leaned into it in a way that I hadn't before, even though I had, kind of.
And I think the message to folks in the Public Service is what you bring to your job, it's as important as what you do in your job. And just acknowledging you've really gone through a lot of trauma. I can't imagine what it's like to be trying to solve problems 24/7 and be told in a lot of situations, you're just not doing your job.
And I experienced that to some degree when it comes to being a doctor. I, of course, can put people to sleep if they're yelling at me.
Vanessa Vermette: Literally.
Dr. Alika Lafontaine: Yes, Yes. So, I always have that in my pocket, literally. But I think working through these emotions will turn you into a better leader and really turn you into a better person, I think. I really hope, as people read through the book and go through the insights that I myself had to walk through, [that] you kind of walk through your own.
And at the end of the book, you'll find out what happened to me and Tom. And I would say that you can't undo the effects that anger, outrage, and indifference have. There's no way to reclaim the physical effects that happened to you, or the emotional impact of breaking up relationships and having these ruptures occur. But you can rebuild something different. And I think if I'm being completely honest, that building back different is not always better, but it is building back something that you can then be proud of as you walk forward.
The problems that you guys are dealing with are bigger than I think anyone – and I don't think this is hyperbole – but they're bigger than any group of folks within the Public Service have had to deal with. Maybe if you went back to the aftermath of World War II, maybe you're talking about the same thing. Maybe the 1970s when there are huge disruptions. But this is a once in a generation crisis, or polycrisis, a collection of different crises. And what you do day-to-day is going to have reverberations across the next few generations of Canadians.
And being in touch with how you feel, and your own experiences as you go through them, I really hope you do take time to figure that out. I think it's become kind of matter of fact for people to say that they're in therapy. But I think the effectiveness of talking to someone, that's really shaped by what we bring to the conversation. And the more that you seek out trying to understand yourself, and where you're at, and the more that you are able to be empathetic and pick up on where people's emotions are at, I think the more you'll feel full and complete, as you go throughout your day-to-day.
I know that it's transformed the way that I provide medicine, it changes the way that I work with patients. And I always know [that] the person yelling at me in that hospital bed is probably experiencing the very worst day in their life. But I think the missing piece for me and what's made me a better doctor is I now know how to respond to it. Not just to make space and listen but actually give people what they're asking for.
Vanessa Vermette: Dr. Lafontaine, thank you for your candour, for your courage, and for your generosity being with us here today. Please join me in thanking Dr. Lafontaine for the session.
[01:13:30 Vanessa Vermette and the audience applaud.]
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