During the current COVID-19 pandemic and with staffing shortages, you’ve probably heard the phrase “stay positive.”

Perhaps this message comes from well-intended institutional leadership, mentors, colleagues, family members, friends or even yourself.

On the surface, the mantra of “staying positive” sounds appealing. Of course, I want to be positive for my family, patients, colleagues, learners, or people whom I lead, right? But what does “staying positive” really mean? And what might be the drawback of telling us ourselves and others this?

What does being “positive” even mean?

Typically, it refers to minimizing or overlooking the negative aspects of a person or situation (e.g., pain, frustration, anxiety, loss). Common adages exemplifying this concept include “make lemonades out of lemons” or “grin and bear it.” The presumption is focusing on the pleasant and comfortable and good — whether they exist yet or not — will enable us to overcome the situation at hand. As physicians, we want to fix problems and end suffering, right?

What are the unintended consequences of staying positive?

Suppressing negative emotions can be a short-term adaptive strategy. For example, as a physician or parent, it is not appropriate to impulsively and violently act out with raw anger every time you feel upset.

The problem is research from the psychology literature suggests long-term and systematic emotional suppression is potentially harmful to individuals and those around them. A study by Lacey and Lacey found that emotional suppression is associated with sympathetic activation and, in turn, impaired cognitive performance. Suppressed unconscious negative thoughts are screaming for attention, like a frustrated kid who is vying for more attention. It takes energy to constantly suppress those thoughts and feelings.

Counterintuitively, overemphasizing happiness was also paradoxically found to lead to disappointment and less happiness in two studies.

According to psychologists Drs. Jim Knickerbocker and Susan David, emotions — including “negative” ones — serve important purposes. They might provide information to ourselves about our values, perceived needs, and concerns. What makes us feel “negative”? Working with “negative” emotions might prompt us to think more carefully or improve perseverance. Examples of insights might include:

My values are not being honored, and I feel angry.

I am unsure I have the resources needed to do something, and I feel anxious.

Perhaps upon further reflection, the “negative” emotion stems from an erroneous inference or a primal self-protective measure of the unknown.

Negative emotional expression can provide data to others in certain contexts. For example, expressing feelings of frustration to a colleague or partner could demonstrate trust in your relationship and marshal assistance and resources. It might also help set healthy boundaries with others.

What is a different perspective?

I am not advocating always ignoring positive feelings and feeling depressed, neurotic, and anxious. Negative thoughts and emotions can also hijack our brains and be contagious to others. Wallowing in self-pity, resignation, and helplessness is not constructive.

My point is focusing just on positive or negative emotions misses the whole picture.

Rather than jumping immediately into reflexive reassurance or shutting down negative thoughts or feelings, try acknowledging or even embracing them — in yourself and others. It’s not easy if you’ve defaulted to be the go-to problem-solver or “rescuer of others.” But think about this unintended consequence. If you act as if everything is positive, how honest are you being with yourself? With others? How might this incongruence impact you, your trustworthiness as a leader, and the psychological safety of your work environment? How might a different approach resonate with others?

Invitation for reflection

What new possibilities and outcomes might occur if you could momentarily feel and accept all emotions: positive and negative?

Justin Endo is a dermatologist.

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