The Psychology of a Hero
By Patricia Pronovost
When the nurse arrived for her night shift, she had no idea what the night would hold. Nurses rarely do. But it certainly came as a surprise when a patient who seemed stable suddenly coded. The patient had tested positive for COVID-19, which made performing chest compression riskier because of potential exposure. Nevertheless, she jumped in…
Ask nearly any medical professional working in a hospital setting and they will tell you they’re just doing their jobs. Ask those on outside the hospital walls, and they are considered heroes.
But what is a hero?
Maria Jasinskas, MD, a CCHC Behavioral Health psychiatrist, served five years in the U.S. Army Combat Operational Stress Control (COSC) unit. Her role was to treat front-line soldiers who needed to defuse the stress of combat and were showing the signs of fatigue. Today, she treats geriatric patients, has also treated children and has led clinical education on avoiding burnout as a medical professional.
Her experience gives her unique insight into heroism from the point of view of combat veterans and everyday people. Common traits among those who are called heroes include altruism, a disregard for personal safety, a sense of community and personal resilience. Sound familiar?
“Our profession as medical providers, nurses, phlebotomists, techs, is to care for those who can’t care for themselves,” she said. “We’re taught to look out for the person who can’t care for themselves.
There are common traits among those who “run toward the battle,” including confidence, courage, integrity and selflessness; but Dr. Jasinskas indicates that heroism on a scale like that which we’ve seen during the COVID-19 pandemic is a communal effort, with no one individual claiming credit for the heroic acts.
“A strong attribute for a heroism – pre-COVID, post-COVID or any other time, is the altruistic component; but more specifically a hero is someone who deflects the credit to those who made things happen – who made the victory possible.”
“It’s like that in the military. A general, a true leader, will bear the brunt of what went wrong, but when there’s a success, will point to the people around them,” Jasinskas said. “The hero is whoever packed my parachute, whoever packed my lunch, whoever set me up for the mission.”
Keeping up the pace in an extended crisis like a pandemic is a challenge to the front-line heroes, however.
“That is why self-care is so important. If you don’t get adequate rest, you crash. We’re not machines. You’ll be able to better remember the instructions to put on PPE if you get a good night’s rest,” she said, noting that even the military has requirements for sleep.
Brain and body take action
The toll of heroism is both physical and psychological.
“During times of stress, you get into this adrenaline mode and you lose track of your own weakness for the greater good,” she said.
In a stress response, three areas of the brain are highlighted, according to the National Institutes of Health (NIH), the amygdala, hippocampus and prefrontal cortex. The function of these areas plays an “integrated role in cognitive, emotional and visceral control processes” in a crisis.
The amygdala processes the ‘fight-or-flight’ response as well as fear, but it also affects the ability to perceive emotions in others and plays a role in empathy. The hippocampus affects learning and long-term memory. It also affects the down-regulation of the stress response. The prefrontal cortex is central in decision-making and working memory. It also regulates impulse control and the down-regulation of the stress response, according to the NIH.
A chemical response pushes the hero forward in the form of cortisol, which has physiological effects that focus the body’s energy stores into the stress response. Once the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system are engaged, insulin is suppressed, heart rate and blood pressure increase. It’s a heightened autonomic response.
The burnout effect
Over time, a sustained heightened response leads to burnout. Jasinskas recently led a clinical education unit on the topic for Cape Cod Healthcare.
Being mindful of your own needs is critical to maintain your health – and your heroic behavior, she said. Taking regular breaks away from the action, reconnecting with family and friends and enjoying nature or music is a necessary step to maintain high-level performance.
Taking a break can be a challenge when working together as a team during a crisis, however. Many front-line workers struggle and are plagued by guilt for stepping away.
“You don’t want to let your colleagues down... if you take a break and step down from the line, who’s going to take your place?” she said.
Taking part in aspects of life outside of the front-line are credited with success for a team, she said.
“The doctors who often burnout the most aren’t the ones with five kids. It’s the single person with no children.”
She guides those on the front lines to “find their inner hero” and to direct that energy into saving themselves.
Can heroism be learned?
Jasinskas also directs others to think carefully about their definition of the word “hero” and consider that this type of behavior can be cultivated.
Heroism is part nature, part nurture, she said. One can be born with heroic traits and epigenetics will play a role in whether those attributes are activated. That said, someone not necessarily born hero-like can develop the sense of altruism and resilience through observing others in their everyday lives.
The study of the cultivation of heroes became a topic of national interest following a 1971 study about its mirror quality, evil.
In 1971, Stanford professor Philip Zimbardo conducted a famous psychological study known as the Stanford Prison Experiment. In it, he gathered 24 young men who were assigned the roles of prisoners and guards in a simulated jail setting. The experiment replicated prison conditions, and the participants got so caught up in their roles that abuse became obvious within days. The experiment became a landmark study in the psychology of evil – how otherwise average people could transform into those who embrace evil practices.
Years after this study, Zimbardo turned his work on its head in the hope of affecting positive change: the transformation of otherwise average people into heroes.
The Heroic Imagination Project (HIP) teaches others how to recognize, emulate and learn heroic behavior. His curriculum was originally geared toward children but has grown to engage adults who participate social movements.
Zimbardo’s recent work has shown that those who engage in altruistic behavior – helping a neighbor or volunteering – have a natural gateway to be a hero in training. Helping others in the day-to-day can make people more likely to help in higher-stake situations.
Jasinskas believes that in addition to being able to develop the hero inside each of us, we should look carefully at the ways we define a hero and points to the COVID-19 pandemic for examples.
During the pandemic, she said, it’s been interesting to see how the term “essential” has made its way into the conversation about heroes.
“Which heroes are considered essential and which are not is not the point – we’re all essential,” she said.
Those who are older and part of the high-risk population and are staying at home, wearing a mask, thinking critically about medical care that could wait until after the surge are heroes in their own right, she said.
“Even the kids who are sitting in front of the TV, waiting patiently for lunch are helping,” she said. “Heroism is a collective action.”
“One little movement, one decision by someone who is acting heroically matters in the battle,” she said.