SUNDAY, OCTOBER 20 , 2019. THE WASHINGTON POST EZ BD B3
what we observe every day in our work at the
Energy Project. Facing threats to their busi-
nesses and uncertainty about the future,
leaders instinctively double down on what’s
worked best for them in the past. The
problem is that any strength overused even-
tually becomes a liability: Confidence turns
into arrogance. Courage becomes reckless-
ness. Certainty congeals into rigidity. Author-
ity moves toward authoritarianism. Feeling
attacked and aggrieved, Trump becomes
more Trumpian.
The prerequisite to growth is the capacity
to self-regulate, which frays under stress. As
an antidote, we encourage our clients to
practice something we call the “Golden Rule
of Triggers”: Whatever you’re compelled to
do, don’t. Compulsion means we’re no longer
in control of how we respond, which is so
often the case for Trump. But it is possible to
better manage our triggers. Even a brief
period of deep breathing, for example, can
clear the bloodstream of the stress hormone
cortisol and return control to the prefrontal
cortex.
To grow, we need an inner observer — the
ability to stand back from our emotions
rather than simply acting them out. Trump is
a prisoner of his poor self-control, his
inability to observe himself and his limited
perspective. Refusing to accept blame or
admit uncertainty is a habit he developed
early in life to protect himself from a brutal
father, whose withering criticism he had
watched drive his older brother, Fred Jr., to
alcoholism and an early death. In Trump’s
mind, if he is not seen as all good, then he is
all bad. If he’s not viewed as 100 percent
right, then he is 100 percent wrong.
Growth is possible only when we can see
ourselves not as right or wrong, good or bad,
strong or weak, but as all of who we are. We
won’t change Trump, and he won’t change
himself, but w e can grow ourselves. The more
we see and acknowledge — our best, our
worst and all the shades in between — the
less we feel compelled to defend our own
value, and the more value we can add in the
world.
Twitter: @tonyschwartzTony Schwartz is chief executive of the Energy
Project. He is the author of several books,
including the forthcoming “The War Between My
Selves.”realistically, to his future as president. Any
capacity Trump ever had to think clearly or
calmly has evaporated. Instead, he’s de-
volved into anger, blame, aggression and
sadistic attacks.
When people enter this “fight or flight”
state, the amygdala — the lower part of our
brain known colloquially as “fear central” —
takes over from our prefrontal cortex. This
wasn’t much of an issue when I worked with
Trump because he was riding high. Now, like
a drowning man, all that matters to him is
survival, no matter how much collateral
damage his behaviors cause.T
he only wall Trump has built is around
himself, to keep his own insecurity and
vulnerability at bay. Ironically, his de-
fense consistently produces precisely what
it’s m eant to p rotect against. That i s just w hat
happened when the Wall Street Journal
broke the story of his attempt to pressureUkrainian President Volodymyr Zelensky to
investigate Hunter Biden. In an impulsive
attempt to defend himself, Trump released
the transcript of their conversation, which
substantiated the very point he was seeking
to undercut and led to the current impeach-
ment inquiry in Congress.
The same thing happened when Trump
suddenly decided to withdraw U.S. troops
from Syria. After even h is most loyal R epubli-
can supporters condemned the action, he
reacted with anger, singling out Sen. Lindsey
Graham, one of his most vociferous defend-
ers. Once it became clear that the withdrawal
was a terrible mistake, Trump reacted by
writing a crude, bullying letter to Turkey’s
President Recep Tayyip Erdogan, threatening
to destroy Turkey’s economy.
Trump’s behavior is an extreme version ofworld.
Those theories teach us that humility
enables learning and growth — but Trump
confuses humility with humiliation and
defaults instead to hubris and grandiosity. “I
alone can fix it,” he told us when he was
nominated for president. On multiple occa-
sions since, describing virtually any subject,
he has begun with “Nobody knows more
about ____ than I do.”
In reality, Trump’s worldview remains
remarkably narrow, shallow and short-term.
It’s narrow because he is so singularly
self-absorbed, which has been true through-
out his life. In the 18 months I worked with
him, I can’t remember a single time Trump
asked me a question about myself. I never
saw him engage for more than a cursory
couple of minutes with a ny o f his three young
children.
Trump’s knowledge and understanding
remain shallow because he resists reflection
and introspection and struggles mightily to
focus. When I set out to interview him for
“The Art of the Deal” i n 1986, he was unable
to keep his attention on any subject for more
than a few minutes. “I don’t like talking
about the past,” he would tell me. “It’s over.”
After a dozen interview attempts, I finally
gave up and settled instead for piecing the
book together by sitting in Trump’s office
listening in on his constant stream of brief
phone calls.
His need for instant gratification prevents
him from considering the longer-term conse-
quences of his actions. Instead, he simply
reacts in the moment. This helps to explain
why he moves into overdrive whenever he
feels attacked. On Wednesday alone, as the
furor around him grew, Trump tweeted
furiously, more than 20 times in all. “Nancy
Pelosi needs help fast!” he declared in one
post, after the House speaker walked out of a
meeting with Trump that Democrats de-
scribed as a presidential meltdown. “Pray for
her, she is a very sick person!”
The negative qualities we ascribe to
others are often those we find it most
intolerable to see in ourselves. Throughout
his adult life, Trump has viewed the world as
a dark, dangerous place teeming with en-
emies out to get him. In the face of potential
impeachment, this fear has escalated expo-
nentially. The threat he imagines is no
longer just to his fragile sense of self but,is essentially the same person today that he
was at age 7. He has his story, and he’s
sticking to it.
Growth and development are about seeing
more. The wider, deeper and longer our
perspective, the more variables we can
consider — and the more capable we become.
Likewise, the more responsibility we take for
our behaviors, and the less we blame others
for our shortcomings, the more power we
have to influence our destiny.
None of this is possible for Trump.
I got to know Trump three decades ago
when he hired me to write “The Art of the
Deal.” Although the book became a bestseller,
working with him was deeply dispiriting,
given his almost complete self-absorption,
the shortness of his attention span and the
fact that he lied as a matter of course, without
apparent guilt.
After that, I tried to steer my life in a
direction as far from Trump as possible, and
the next book I wrote was titled “What Really
Matters: Searching for Wisdom in Ameri-
ca,” an exploration of people who had found
success and satisfaction in ways vastly differ-
ent than Trump’s focus on wealth, power and
fame. In 2003, I founded the Energy Project
to help leaders and their employees pursue
healthier, happier, more productive and
more meaningful lives. We’ve helped organi-
zations ranging from Google and Pfizer to
Save the Children and the Los Angeles Police
Department.
As part of our work, we encourage clients
to ask themselves two key questions in every
challenging situation: “What am I not seeing
here?” and “What’s my responsibility in
this?” These questions emerged from study-
ing developmental psychology. Jean Piaget’s
theory of cognitive development describes
four increasingly complex stages of thinking
that we move through in childhood. As we
grow up and become less self-centered, our
perspective gets progressively bigger and
more complex. Thinkers such as Robert
Kegan, William To rbert and Susanne Cook-
Greuter have described the potential for
further growth as adults. Cook-Greuter’s
framework, for example, refers to “nine
stages of increasing embrace,” characterized
both by deeper and deeper self-awareness
and the capacity to take into account a wider
BEHAVIOR FROM B1
MYTH NO. 1
E-cigarettes are not regulated.
Experts and activists urging government
action on vaping sometimes imply that the
industry has completely eluded oversight.
“We must not stand by while e-cigarettes
continue to go unregulated,” s aid the
president of the American Medical
Association. “E-cigarettes are unregulated,
which means that we don’t know what’s in
them,” a Kansas state health official stated in
a news release.
E-cigarettes are, in fact, regulated by the
Food and Drug Administration. In 2016, a
“deeming rule” granted the FDA regulatory
authority over the products, and the agency
immediately prohibited selling e-cigarettes to
people under 18. E-cigarettes currently on the
market are required to display a warning label
stating that they contain nicotine, and their
makers must submit ingredient lists to the
FDA (though these lists are not available
publicly).
It’s true that e-cigarettes are not well-
regulated: Unauthorized products regularly
enter the market, and underage sales too
frequently occur in stores and online.
Moreover, the government treats e-cigarettes
like tobacco products, not pharmaceutical
devices, so they escape the FDA’s “safe and
effective” s tandard. The products containing
THC thought to be responsible for the lung
injury outbreak are not regulated by federal
agencies, since marijuana is considered a
Schedule I drug.
MYTH NO. 2
Vaping is as harmful as
smoking cigarettes.
A growing number of Americans believe
that vaping is as unhealthy as smoking,
according to a Reuters poll last month. This
impression is probably reinforced by the
actions of retailers like Rite Aid, Walgreens,
Walmart and Kroger, which have halted sales
of e-cigarettes while continuing to sell
traditional cigarettes and other tobacco
products. And the New York Post warned
that “Vaping might be more dangerous than
smoking” while reporting on a 2018 study in
the American Journal of Physiology.
That study’s investigators, though,
concluded that their data “aligned with the
evidence of the less toxic effect of e-cig vapor
compared with tobacco smoke.” E-cigarettes
are undeniably harmful, exposing users to
numerous toxic and carcinogenic substances
that may lead to adverse health effects. But
they virtually eliminate exposure to carbon
monoxide, tar and many of the 7,000 chemicals
that contribute to cigarettes’ lethality. In the
most comprehensive review of the health
effects of e-cigarettes to date, the National
Academies of Sciences, Engineering and
Medicine found that completely switching
from cigarettes to e-cigarettes lessens exposure
to numerous toxins and carcinogens and
probably reduces adverse health outcomes in
several organ systems. This evidence was
supported by a large national study finding
that exclusive e-cigarette users had
substantially fewer biomarkers of toxicant
exposure, compared with smokers and users of
both types of products. In short, e-cigarettes are
less harmful than smoking, but they are by no
means safe.
In the recent THC-linked outbreak, every
state but Alaska reported cases of acute
injuries and even deaths from vaping. But
smoking and exposure to secondhand smoke
still cause 480,000 deaths in the United
States each year, and according to the World
Health Organization, tobacco kills almost
half of all long-term users.
Housekeeping to the New York Times. A
former chair of the American Academy of
Pediatrics To bacco Consortium told the
New Yorker that vaping can cause the
disease.
Inhaled diacetyl and other chemical
flavorants may certainly pose respiratory
risks to e-cigarette users, but to date, vaping
has not been linked to popcorn lung.
Moreover, diacetyl is present in cigarette
smoke at levels substantially higher than
those measured in the Harvard study, but
smoking has never been considered a risk
factor for popcorn lung, making it extremely
unlikely that e-cigarettes cause the disease.MYTH NO. 4E-cigarettes do not help
people quit smoking.American public health organizations
generally discourage smokers from using e-
cigarettes to help them quit. Smokefree.gov,run by the National Cancer Institute, nudges
visitors toward other, FDA-approved
methods for quitting smoking. California’s
smoking-cessation website puts it more
directly: “E-Cigarettes: Not a Quit To ol!” In
March, a team of economists wrote in
Barron’s that there was no evidence that “e-
cigarettes were any better than self-help
pamphlets” in helping people quit
conventional cigarettes.
In Britain, however, nearly 900 smokers
who wanted to quit participated in a recent
randomized trial to determine the
effectiveness of e-cigarettes compared with
other nicotine replacement products, such as
patches and gum. One year later, 18 percent
of the e-cigarette users were not smoking,
compared with 10 percent of the other
nicotine replacement group. It is true that
most smokers who try e-cigarettes continue
to smoke, but that does not mean that e-
cigarettes are an ineffective cessation aid:
Most smokers who try FDA-approved
nicotine replacement therapies also continue
to smoke, but such products are still officially
deemed “effective.”
We are still learning about the product
features and behavioral factors that may
contribute to successfully quitting with e-
cigarettes. One national study found that
more than 50 percent of adult, daily e-
cigarette users had quit smoking within the
past five years, suggesting that the frequency
of e-cigarette use may play a role in
cessation.MYTH NO. 5E-cigarettes are a gateway
to youth smoking.After several longitudinal studies
documented that youth who first used e-
cigarettes were more likely to try cigarettes,
publications such as Fortune claimed that
there was a “gateway” effect. The FDA
recently released a promotional video
featuring magician Julius Dein
transforming a vaping device into a
cigarette and saying: “It’s not magic. It’s
statistics.”
Despite their rigor, studies cannot fully
account for “common liability” — the idea
that certain people are simply more likely
than others to engage in risky behaviors.
Some youth may have tried smoking
anyway; they just happened to use e-
cigarettes first. It’s possible that e-cigarette
addiction may cause some young people to
migrate to cigarettes, but the order of
product use does not alone prove cause. In
ascertaining whether vaping has a
“gateway effect,” it’s also important to
consider magnitude: If e-cigarettes are
strongly associated with subsequent
smoking among youth, we might expect to
see an uptick in smoking at the national
level. But despite a 78 percent increase in
e-cigarette use among U.S. high school
students between 2017 and 2018, there was
no statistically significant increase in the
high school smoking rate, which this year
has dropped to a projected historic low of
5.8 percent. One BMJ study that examined
multiple sets of data on American youth
tobacco use demonstrated that the decline
in youth smoking rates actually accelerated
as vaping became more widespread. Make
no mistake, though: While E-cigarettes do
not seem to be leading large numbers of
youth into smoking, the strikingly high
rates of teenage vaping alone are alarming.
Twitter: @dannygiovencoDaniel Giovenco is an assistant professor at
Columbia University’s Mailman School of Public
Health.By Daniel Giovenco
Authorities have blamed vaping for a rash of recent lung injuries and deaths thought to be linked to
products that contain tetrahydrocannabinol (THC), the primary psychoactive ingredient in mari
juana. At the same time, use of nicotinebased ecigarettes, such as Juul, has skyrocketed among
middle and high school students, placing them at risk of addiction and potential health harms. In
response, states including Michigan, Massachusetts, Oregon and Montana have initiated bans on
flavored vaping products or all ecigarettes. These distinct public health issues are often conflated,
causing widespread confusion about ecigarettes and their risks.FIVE MYTHSVa ping
TONY DEJAK/ASSOCIATED PRESSVaping’s public
health risks have
been in the news
recently, from an
outbreak of lung
illnesses to a leap in
use among
teenagers. But are
e-cigarettes any
more dangerous
than traditional
tobacco products?Tr ump tries to compensate for his insecurities. That just makes them worse.
Humility enables learning and
growth, but Tr ump confuses
humility with humiliation and
defaults instead to hubris and
grandiosity.
MYTH NO. 3Vaping causes ‘popcorn lung.’
The myth that e-cigarettes cause
“popcorn lung” — a rare condition that can
cause irreversible airway obstruction,
resulting from severe damage to the
bronchioles — originates from a 2016
Harvard study in which researchers
detected the chemical diacetyl in a sample
of vaping products. (The nickname stems
from an outbreak among workers in a
microwave-popcorn factory who were
exposed to high levels of vaporized
diacetyl, which is sometimes used to create
butter-like flavors and is a known cause of
the disease.) The authors did not explicitly
link e-cigarette use to popcorn lung, but
the possible connection has been
highlighted by health organizations such
as the American Lung Association (which
published an article titled “Popcorn Lung:
A Dangerous Risk of Flavored E-
Cigarettes”) and by outlets from Good