Improving Tactical Performance with Science

My guest today is Dr. Nathalie Pattyn. She's an MD, PhD, with two master's degrees and a mixed clinical, research, and operational background. Dr. Pattyn has been deployed with Special Forces teams as a medical officer in the Middle East and the Sahel, and on numerous occasions as a sole physician to Antarctic stations. The longest of these Antarctic deployments lasted for 15 months, during which she served as a physician at the Halley VI Station, part of the British Antarctic Survey, while setting up a new life sciences lab for the European Space Agency. In all of her deployments, she combined clinical work with research on human performance. In 2010, she founded the first multidisciplinary research unit in the Royal Military Academy in Belgium called “V.I.P.E.R” with Professor Xavier Neyt to promote a 360-degree approach to human performance by combining engineering, psychology, and biomedical science. Their main research included remote healthcare, sleep and fatigue, and human performance in extreme environments. She's the author of “The Handbook of Mental Performance”, released in 2024. She's currently an invited researcher at the University of Montreal, the Centre for Advanced Research in Sleep Medicine at Hôpital du Sacré-Cœur de Montréal. In addition, she's an associate professor in human performance at the Royal Military Academy, all while still being a practicing emergency physician and flight surgeon and also serving as a lieutenant colonel in the Belgian Defense Medical Component.

I'm excited to have Nathalie on The Debrief because perhaps no one has a more well-rounded perspective on human performance in extreme situations than she does. While it's not unusual to find somebody with experience in the field or with academic experience, it is extremely rare to find one person with academic research and operational experience.

One special thank you to my friend Fredrik Granholm, who runs the Tactical Trauma Conference in Sweden. Fredrik was the one who first made me aware of Nathalie's work and recommended her for The Debrief.

I hope you enjoy my conversation with Dr. Nathalie Pattyn.

My name is Jon Becker. For the past four decades, I've dedicated my life to protecting tactical operators. During this time, I've worked with many of the world's top law enforcement and military units. As a result, I've had the privilege of working with the amazing leaders who take teams into the world's most dangerous situations.

The goal of this podcast is to share their stories in hopes of making us all better leaders, better thinkers, and better people.

Welcome to The Debrief!

Jon Becker: Nathalie, thanks so much for being here with me.

Dr. Nathalie Pattyn: Hi, Jon.

Jon Becker: I'm excited to have you. This has been a long time in the making, so I'm glad you're on finally.

Dr. Nathalie Pattyn: Yeah, I'm glad it worked out.

Jon Becker: So, why don't we start? You have possibly the most impressive resume I've ever seen. I would love to just kind of walk through the elevator speech of your career path. I talked about it in the intro, but let's start with your background because I think you have a very unique background that is academic, research, and operational. And usually, like I said in the intro, you see one of those. You don't see all three. So maybe you just kind of give us a little history, Nathalie.

Dr. Nathalie Pattyn: Well, first let me say that you can always frame things either positively or negatively. So if you look at my resume and you want to describe it kindly, you would say I'm versatile and I have broad-ranging expertise. If you want to frame it negatively, you would say, "I have issues with choosing one path and sticking to it." So, there's always two sides to a coin. My career choices were never made, let's say, as part of a grand plan where the direction was decided and kept for years. It was more a question of pursuing what I find interesting, what I find challenging, and following opportunities that arose.

I chose to study psychology during medical school because that's a gap in the medical curriculum. We learn a lot about how the brain functions from a biochemical perspective, but we don't learn how people think, how they feel, or how they make decisions.

I pursued clinical training as an emergency physician because that allowed me to do research on the side, and it had the element of unpredictability, which I really enjoyed. That research focused on how people think in different environments. It started in the space age, in astronauts, because when I was a kid, I wanted to be an astronaut, and I was discarded from the military pilot selection because of my eyesight. In hindsight, that was a smart decision, not only because of my eyesight, but because I'm really happy with the path I took. So I took a lot of detours. I think it's a testimony to the fact that if you pursue what you like, and you put as much effort and work into it to do a decent job, things will always work out.

Jon Becker: Yeah, I mean, I agree. But you definitely pursued really challenging things. No one has ever invited me to go to Antarctica. So you definitely went looking for hard stuff and then tried to conquer it.

Dr. Nathalie Pattyn: Yeah. I can assure you nobody invited me to Antarctica either. I kind of invited myself. The secret to being able to pursue these opportunities is to be willing to give up a bit of your life for it, to put in work and effort, and to be willing to step away from life as you know it for a couple of months or even more than a year. When you're willing to do that, it pays off.

Jon Becker: Talk to me a little bit about this. So, obviously you go to medical school, you do an MD, PhD, and you do two master's degrees. Let's start with military experience. Why did you decide to go into the military, and what were you hoping to accomplish there?

Dr. Nathalie Pattyn: So, we're talking about the early '90s, and remember, I wanted to be an astronaut. I had looked up the resumes of astronauts, and the most likely path to succeed was becoming a military pilot with an engineering degree. So that was my plan, which didn't work out because I didn't get through the medical selection. Then, all of a sudden, the engineering degree without being a pilot sounded kind of dull. The summer before, I had done several qualifications in scuba diving, which involved quite a bit of physiology theory, and I thought, "Hang on, that was cool, learning about the heart and the lungs and how the body reacts in this weird environment. Yeah, I'm going to go to medical school." That is honestly how I decided to go for medical school. I was already on track for a preparatory year for the military academy. That's why I chose the military, because I thought if I go to medical school in the military, I can do aviation medicine in the military and still work in that field.

I grew up in a family where both my parents were elite athletes in skydiving, and so I grew up on airfields. I did my first tandem jump when I was 12. I started solo jumping when I was 15. And so the aviation environment was really home to me.

Jon Becker: Very interesting. Yeah, it makes more sense now. Your parents jumped out of airplanes.

Dr. Nathalie Pattyn: Yes. Perfectly normal.

Jon Becker: So it makes sense that you're willing to. Yeah. Perfectly functioning airplanes. Exactly. So it makes perfect sense that you're willing to just join the military. We'll just jump into this. So talk to me about the military career. You went in hoping to do aviation medicine, but you went kind of beyond that.

Dr. Nathalie Pattyn: Yes, because I went into aviation medicine. My first posting was in the training base, the flight school, and then I realized how frustrating it can be for a military flight surgeon because you are the person who is best trained to support aviators. However, you are one of the last people they will ever talk to about their issues because there's this conflict of interest. Yes, you're there as their physician, but you're also the person holding the key to fitness to fly. So, whether they can continue to fly or not, and as I learned later on working with all kinds of elite professionals, whenever there's a medical qualification at stake, which can make people lose their job, which is also their passion and in which they have invested a lot, they will never, ever talk about any issue whatsoever, be it physical, mental, or preventive medicine.

So there I was, as a young physician, realizing that I couldn't help. I couldn't support the population I was aiming to support because of this flaw in the system.

Jon Becker: Which is still a flaw in every system, right? I mean, part of the problem with psychology in the tactical environment.

Dr. Nathalie Pattyn: Absolutely.

Jon Becker: Is that the psychologist is just viewed as the person that's going to say you're unfit for duty and pull you out. So, you are perversely incentivized to be totally fine all the time.

Dr. Nathalie Pattyn: And I completely understand. I mean, if I were in that position, I would do exactly the same. And there's a joke among flight surgeons that goes, "How do you know a pilot is lying during your medical exam? His lips are moving."

Jon Becker: Yeah.

Dr. Nathalie Pattyn: You can't expect people to give away information that may jeopardize what they have spent so much time, energy, and effort to build up.

Jon Becker: Yeah, which is going to be a recurring theme here as we move forward, I think, in our conversation. So, okay. You do the flight surgeon thing. You get tired of that. Then what happens?

Dr. Nathalie Pattyn: So I continued the research in aviation medicine, and more specifically in the psychophysiological measurements of performance in astronauts and jet fighter pilots. The idea was this: this population, even apart from the clinical side, if you're doing research about how well they perform, they also don't want you to measure when they underperform. That's something that was very apparent in the astronaut population as well because some participants were actually rigging our baseline measurements by consciously performing worse to make sure that this baseline would not reflect their peak performance. So, if we were to measure some suboptimal performance in operational conditions, in this instance on board the International Space Station, the delta wouldn't be significant because the baseline performance had been botched.

When I saw that, of course, you can't point that out to people because it's subjective. You don't have any hard evidence to tell people, "You're rigging the test," but you know it when you see it. And so I thought, "Hm, this is interesting." So basically, the challenge here is to measure how people perform without actually asking the question, and that's where this idea of coupling physiological recordings and the outcomes of performance came in. And that's something that I've continued doing in research throughout my whole career.

Jon Becker: Yeah, it's interesting. You can see why they would sandbag the tests, right? Because they don't want to underperform. Simply the act of measuring something changes it, right?

Dr. Nathalie Pattyn: Absolutely.

Jon Becker: Simply telling them that you're testing them is going to change their behavior on the test. Why did you start to get interested in the tactical side of it?

Dr. Nathalie Pattyn: Well, working with jet fighter pilots and telling them about operational challenges. So in the astronaut community, you have the operational pace, but it's like top athletes; it's predictable. You know the schedule of flights. People prepare long in advance. They have recovery time after a mission, and it's all very formalized. Whereas in tactical populations, I thought, "Hm, this is actually interesting," because there is a lack of predictability. Basically, these people train, but they train to be ready for an assignment, and you never know when the assignment comes. It can come at a suboptimal time, and basically, you have to be ready all the time. Of course, if you think about it in a sustainable way, it means you have to have enough personnel for this readiness to be there without draining people, without exhausting people. Again, then we touch upon a caveat, a pain point that has been there ever since I started this career because this is something I noticed already in the beginning of my research, which was 2001/2002, and it has only become worse in tactical populations. Whether we talk about pilots or Special Forces operators, it's really something. It's like the operational pace has picked up but never stopped picking up. People were already not employed in a sustainable way 22 years ago, and it has only gotten worse.

Jon Becker: Yeah, it is a huge problem, and it's a huge problem in military special operations. It's a huge problem in civilian law enforcement special operations. Units are overtasked and underresourced. It's interesting, as you're talking about jet pilots. I'm thinking a jet pilot is almost preparing like a professional athlete for peak performance. He knows on this day we're going to do this, and he has a long prep cycle. And there's a lot of analogy that takes place between professional sports and tactical. That analogy has always bothered me because professional athletes are preparing for peak performance on a known date. The mindset that we're going to train like athletes doesn't make sense. Nobody shows up at the rugby pitch on a Tuesday and says, "Today's the game," right? They know it's going to be Sunday, and they know which Sunday, and they know who they're going to play.

Dr. Nathalie Pattyn: Yeah.

Jon Becker: Whereas with the tactical community, especially in a state and local, or civilian tactical population, the start of the game is whenever the suspect says the game starts. And so the preparation is really trying to build and maintain an optimal level of performance over time. I think we've prepped our teams incorrectly, and because we are underutilizing or underresourcing them, we're trying to keep them in this state of optimal performance for a ridiculously long level of sustainment. There isn't enough time to recover.

Dr. Nathalie Pattyn: And it doesn't work, and that's why you break.

Jon Becker: Yeah. And you're seeing that. I mean, you're seeing that in suicide rates. You're seeing that in alcoholism rates. You're seeing that in attrition. You're seeing that in the difficulty of units just keeping staffing levels. Recruiting has become impossible. Couple that with moral injury from the community defunding police and doing other things, and we've created this environment where it is very difficult for a team to even maintain an adequate level of performance.

Dr. Nathalie Pattyn: Absolutely. And I think that is really what bothers me the most in my professional environment. My job as a scientist is to generate knowledge, and I feel like there's no point in generating more knowledge because the knowledge we already have about human performance and human functioning is not being applied. So why would we bother investigating new techniques to enhance performance when we don't even cover the basics? The analogy I always use is stop asking me about icing on the cake. We have no cake. If people don't sleep well, if they don't train well physically, if they are not well-fed, if they don't rest, there's no point investigating some fancy headband that will trigger specific brain waves to enhance recovery because your basics aren't there.

Jon Becker: Well, I think that it's funny because you see this in everyone's health, right? You see this, you know, people don't eat, they don't sleep, they drink too much, they don't exercise, but they're looking at their heart rate variability or they're trying to figure out the perfect supplement for them to take. Yeah, it's almost like we're trying to pick out the perfect sprinkle for the top of the frosting that we don't have for the cake that we haven't built. I think that's a good kickoff point for us because I think one of the things that I love about your work, and about prior interviews that I've heard and the articles that you've written, is there is a blunt practicalness to the way that you look at this problem that you don't see in other places. Everybody is talking about which sprinkle to put on, and you're like, hold on a minute. No, we don't even have freaking cake. Let's start there.

Dr. Nathalie Pattyn: So it's the whole marginal gain thing that you see in sports science. If you look at the behavior of scientists, it's logical. I mean, as a scientist, I am hardwired to go get the next bit of knowledge, to go investigate something we don't know yet. Yes, intellectually, that can be very satisfying to me. But as an operational physician, having worked with operational populations and knowing what the challenges in the field are, I'm like, "No, this is not relevant to people right now." What is relevant to people right now is not new knowledge. It's building robust systems. We have to stop wanting to make people very fancy Formula 1 cars that need massive pit stop crews and that drive 0.01% of the time, if you look at the whole year. What you need in a tactical operator is not a Formula 1 race car because it's not possible to sustain the operational pace of a Formula 1 race car. What you need is a versatile, super robust Hummer-type vehicle that will go through any terrain, carry whatever you need to carry at that time, and never fail. That is robustness. People keep thinking about elite populations, tactical or otherwise, as the Formula 1 race car. And it's like, yeah, a Formula 1 race car is very nice if you can afford it, but we can't afford it. There's no way on earth.

As an emergency physician, I have to work both intra-hospitally and extra-hospitally. So in Belgium, we have medical teams going out of the hospital for certain emergency calls. At that time, I really wish I could describe myself as a Formula 1 race car. I can't, because those calls come in at any time of the day, and maybe I haven't eaten because I haven't had time because I've had a backlog of patients when I was in the emergency department. I haven't had time to drink. I haven't had time to pee before I left. I am not a Formula 1 race car. I am rushing out to maybe resuscitate your infant that is choking and that is in cardiac arrest, and you would want me to be that Formula 1 race car, but I'm not.

Jon Becker: Yeah. I think one of the things that I've seen in this community is the focus on elite tier one units, right? There are thousands of tier one operators worldwide in all of the services, in all of the countries, and it's kind of like you see teams and they're very focused on what is Delta doing, or what is DEVGRU doing, or, in Belgium's case, what is DSU doing? The question is not what are they doing. The question is, how is your mission aligned with theirs? The way that Lewis Hamilton prepares for a race is not the way you should prepare, and the way that elite teams that operate for three months and are down for six prepare for a mission is not frequently relevant to somebody who has to be working five days a week and beyond those five days a week.

Dr. Nathalie Pattyn: Yeah. I think organizations carry a responsibility there because the way we recruit people, there's always a bit of marketing that is aspirational. If I take the example of military physicians, the way people are recruited now, defense advertises the job of military physician as something adventurous, where you get to do medicine in extreme environments, in the field, in unusual settings. For me, I always laugh about it because I'm like, "Yeah, plant a blue light on your head, stick that chest tube between your teeth, and run, Forrest, run." The reality of the job is you will go more often than not on low-intensity deployments because, as physicians, we are high-value assets, and it's very rare that we get really deployed to the core of the action because there's just not enough of us to risk it in such an exposed setting. You don't see that much action, but you have to be there for the people who are deployed. It means you have to listen to a lot of just venting. You have to be a stabilizing influence in the detachment, be it 25 people or 400. You have to be well-versed in all kinds of minor, let's say, general practice pathologies. If you think you're too good for that, then you're not serving the community. You forgot that this job is about serving and not aspiring to be the cowboy who puts in the chest tube in the field. But that is organizations not being totally honest about what the job entails.

If you make a parallel with tactical personnel, if you think of law enforcement in rural areas, remote areas, there is seldom, let's say, kinetic action. It's more of a proximity job where you have to know the people, know the area, and then once in a while something violent will happen. But that's not the core of your job. It's this balance between, and that's also the difference. That's also one more reason I really don't like the analogy with athletes and the so-called tactical athlete concept. When you're in a tactical job, one of the biggest challenges no one talks about is you have to be able to deal very flexibly with very low workload and still stay in tune, and very high workload and suddenly having to prioritize. That is a very difficult switch to make because people either hope for the high action, but when they get it, they burn out really quick, or they get bored and frustrated with a low workload that doesn't seem interesting enough. It's a very difficult balance to keep in those jobs where you have this high-intensity potential, to keep people interested and motivated and functioning well, even in the low-workload instances.

Jon Becker: Yeah. I see that in the units that I work with. There is this balance between teams that are either not busy enough to maintain their skills or so busy that they can't maintain their skills.

Dr. Nathalie Pattyn: Yep. It is exactly the same in medicine.

Jon Becker: Yeah, I can see that. Yeah, I can totally see that. So I think what I would like to do is just kind of walk through with you. I appoint you the team physician for a tactical team, and I kind of want to go through Nathalie's greatest hits. Instead of looking at that 1% solution in that supplement, here's the stuff we need to think about, boys. The first thing I'd like to talk about is a difference that I've heard you make, and I have not heard anybody else in this space make, which is the difference between resilience and robustness. You differentiate that in a way that I had not heard before that I love. So, can you walk me through it? We talk a lot about resilience and this idea that we're going to make you more resilient, but that's not the way you look at it.

Dr. Nathalie Pattyn: No, because that's the second part of the story. Resilience is how fast you get back on your feet after having been knocked down. And it's very important. But the first question is, how come you were knocked down? Was this preventable? And that's where robustness comes in because robustness is how many punches you can take before you're knocked down. If you don't pay attention to robustness, there's no point looking at resilience. Because if people, organizations, systems, or societies are vulnerable or knocked down easily, you can't work on resilience alone. You have to work on robustness first. Robustness will be the foundation layer for your resilience because you will have a stronger basis to come back to.

Jon Becker: Yeah. I think in terms of going back to your Formula 1 analogy, a Formula 1 car is not robust.

Dr. Nathalie Pattyn: No, not at all. It's ridiculously fragile.

Jon Becker: A pickup truck is robust, right? A big truck or an armored vehicle is robust.

Dr. Nathalie Pattyn: Yes, and especially the pre-electronics version, where people could still tinker on the engine and get things going. If you think of the French writer, who was also a military pilot, Saint-Exupéry, who crashed in the desert and then repaired his own plane. I mean, this is something from a bygone era. This doesn't exist anymore because you can't do this anymore in this digital age. But that is robustness.

I'm going to give you a simple example of robustness. The way I designed my house, I have zero domotic systems. I open my door with a key, period. I close it with a key, a mechanical key. There's zero digital interference with opening or closing my door because I only want the people with the key to be able to enter my house. And it's not performant. When I drive home, I cannot talk to an app on my phone and tell the app to open my door and to heat up the house. But it also means that if the power goes down, I can still get into my house. And you can see the wood stove behind me. I can still heat the house. That's robustness. It's not performant. It's not sexy. It's not new, but it will keep working no matter what happens.

Jon Becker: So, we want to build a tactical unit of 1972 Chevy pickup trucks.

Dr. Nathalie Pattyn: That's a good summary.

Jon Becker: Not 2025 Ferraris.

Dr. Nathalie Pattyn: Exactly. Because you have to look at the weaknesses of the system and what is sustainable. When you look at the way something functions, you have to keep in mind: what is my optimal level of functioning? If I really want to reach absolute peak performance, throwing everything in, what does it take? What can I reach? What is my nominal level of functioning? Things are going well. No hiccups. Business as usual. What is my degraded level of functioning? Things are not going well. Hiccups. People being on sick leave, no replacement, not enough resources, not enough ammunition to train properly. And then the absolute emergency scenario, where shit has hit the fan. If everything goes awry, what is left? The problem is that we design normal operations with peak performance in mind. But that is not sustainable because you can compare it to your physiological stress reaction. The stress reaction is a super efficient mechanism to ensure our survival.

There's an American researcher, Robert Sapolsky, who is one of the main names in stress research, and he has written a beautiful book targeting the lay population called Why Zebras Don't Get Ulcers. He describes a stress reaction really well in how much it actually serves our survival. If you think of the zebra in the title, if a zebra gets attacked by a lion, it runs for its life. And the zebra's survival will be determined in a half-hour time frame. That's how you have to think of the stress reaction. The stress reaction is your body throwing everything in for survival. It's an all-or-nothing game in the time frame of half an hour, which means it makes sense to inhibit all the processes that can be useful, but on a longer time frame: digestion, reproduction, anything that is useful to your body but not relevant in the time frame of 30 minutes.

What is relevant in those 30 minutes? It's to get blood to your brain, to your heart, and to your muscles to run. It's to get more oxygen in that blood. So, you're going to breathe faster, and your heart is going to pump faster, and your blood pressure is going to increase to ensure that the organs that determine your immediate survival have the optimal supply of fuel at that time, fuel being oxygen and sugar. And that's for half an hour. It makes perfect sense for that zebra. Either it outruns the lion, happy days, or it gets eaten. If it has outrun the lion, then the zebra, not being a human being, doesn't suffer PTSD and just goes back to its nominal state of functioning. And so the stress reaction deactivates, and the body can rebuild its storage of resources. So it can eat again, digest food, store energy, and happily go on being a zebra until the next time it has to run for its life. That is peak performance. It's throwing everything in and sacrificing everything else that doesn't matter in the next half hour. By definition, it is unsustainable.

If you take lab animals and you submit them to that kind of stress reaction repeatedly without deactivating, they die very quickly because it's unsustainable for the body. That's one of the issues of modern life as a whole, that we don't deactivate that reaction anymore. We are a society that is constantly surfing on that stress reaction. Just look at the news. Everything is an emergency. Everything is crisis management. But that's not sustainable in terms of resources. You cannot run your body. You cannot run your unit. You cannot run your society only managing crises. At some point, you have to put money in the bank. You have to rest. You have to restore. You have to rebuild storage. That's what we don't do.

Jon Becker: Yeah. It's so true. I've never heard it put quite that way, but it really does make perfect sense. Between being constantly overstimulated, and our brain doesn't really make a big difference between TikTok and a tiger, and a news cycle that is constantly feeding us breaking news and emergency, you end up overactivated all the time, and then you can't sleep, which begins to erode you. We all end up in this kind of downward spiral unless we're consciously attacking the parts of that that we need to keep us alive. Absolutely. And combined with that, working terrible hours and being on call and being short-handed and knowing that you're one of three guys in a unit that should be 12 guys and are going to get called out five times this week.

Dr. Nathalie Pattyn: Exactly.

Jon Becker: So, let's kind of walk through. I've heard you say that there is a difference between knowledge and behavioral change.

Dr. Nathalie Pattyn: I don't have a picture to show you, but I like to show a picture when I talk about that. I've worked in sleep research for 25 years now, so I am a sleep expert. I really know a lot about sleep, about why we sleep, what happens in our body and our brains, and what effects it has when we don't sleep enough, be it acute sleep deprivation or chronic partial sleep deprivation; people who think they get by with six hours per night but are actually chronically sleep deprived. So, I don't lack knowledge on the subject, really not. And yet, in 2020, during the first lockdown of the pandemic, I was driving home from a shift in the hospital. It had been a longer shift than usual because we were short-staffed, because there were too many patients, and because I had had a call for an extra-hospital intervention just before the end of my shift and it had taken a long time. So it had been a long shift. I was tired. I had a two-hour drive home. My colleague who took over from me told me, "You're not going to drive two hours now, are you?" It was, I think, 10:00 p.m. And I was like, "Yeah, you know, I don't want to sleep here." We had rooms available at the hospital, but hospitals were not very happy places back then. You could argue they never are, but especially back then. I really wanted to get out, and I wanted to leave it behind me and be in my home environment. I decided to drive home. And because it was lockdown and there was no one on the road, I fell asleep, but no one honked. I very gently swayed and went to kiss the middle rail of the highway. No one there. So, I didn't harm anybody else, luckily, but the car was badly maimed and I had a severe concussion. I prize myself very lucky. It was only that. And that shows that knowledge doesn't impact your behavior because I should have known better, really. If, with all that knowledge and expertise, you still make those dumb mistakes, it goes to show that knowledge is not enough.

If you want to impact people's behavior, you need carrots and sticks. You need coercive measures to actually protect people from themselves. And especially when we're talking fatigue, we are not accurate judges of how fatigue impairs our performance. Because in jobs where fatigue is part of the setting, we get used to the feeling. That's what we mistakenly call training, because nobody can train for the effects of fatigue. And that is a scientific fact. You cannot train to have a more robust performance for fatigue.

Jon Becker: Wait, let's just reinforce that. You cannot train to resist the effects of fatigue.

Dr. Nathalie Pattyn: Nope.

Jon Becker: So, no matter how many times I've worked the graveyard shift, I'm still just as impaired cognitively.

Dr. Nathalie Pattyn: Yep.

Jon Becker: As anybody else would be.

Dr. Nathalie Pattyn: Yes. The difference is that you get used to the feeling, and you mistake that familiarity for training. But it's not. Your performance is still as impaired. I'm sure you know the analogy of the blood alcohol level versus one sleepless night. Nobody would dream of having a surgeon operating on them above the legal limit in terms of blood alcohol level. But nobody bats an eyelid at the fact that we don't regulate medical professionals' duty times. For example, we regulate aviation professionals' duty times, and aviation is the most regulated profession when it comes to crew duty time. We don't do it for medical professionals, and we don't do it for tactical professionals either. So we give people the means and the mandate to end other people's lives knowing they are in an impaired state, and that should be illegal.

Jon Becker: Yeah. One of the questions I ask, I teach this class called Lessons Learned from The Debrief. It kind of changes every year, but it's, you know, here are the top issues that I see right now in the debriefs that we're doing and the people that I'm talking to. One of the questions I ask in that class is how many of you would put a guy with a 0.1 blood alcohol concentration in a stack for a high-risk entry? Nobody's ever raised their hand for that.

Dr. Nathalie Pattyn: Luckily.

Jon Becker: But then I follow it up with, how many of you would put a guy in who hadn't slept last night? And everybody kind of gets a wry smile. I think that's a good place for us to talk about sleep. We talked about how we're good at the really pointy part. I'm taking this special supplement that's going to augment my nicotinamide riboside levels in my body, but I slept four hours last night. So let's go through sleep as a concept. Talk to me a little bit about that.

Dr. Nathalie Pattyn: Sleep is fascinating because in our efficiency-obsessed society, it is the last frontier. You cannot go around it, and there is no substitute for it. You can meditate all you want. You can swallow supplements. You can have a very healthy lifestyle when it comes to physical activity and nutrition. If you don't sleep well and enough, both are important, quantity and quality, it won't work.

Jon Becker: How do you advise the teams that you've worked with, the units you've worked with, to handle sleep?

Dr. Nathalie Pattyn: It depends. When we talk about sleep, it depends how big your target audience is. If your target audience is 200 people and you're alone, let's say as the team physician or coach or whatever, it's a bit much to do a tailored assessment of each and every member and issue customized recommendations. But you can start with what I call the low-hanging fruit, which is to look at how many hours per night people sleep, how they rate the quality of their sleep, and, that's possibly the most important question, how they rate the quality of their wakefulness or their vigilance during the day. A very good example and a very common example are sleep apnea patients who sleep a solid eight hours per night and who are still waking up feeling tired and not rested, and who still have vigilance issues, which means they fall asleep quite easily.

You see that often in tactical populations when people brag to me about, "Oh, I can fall asleep whenever, wherever, whatever is happening around me." I'm like, "You're not a good sleeper. You're just sleep deprived." Because that is a clinical sign of sleep deprivation. Being able to fall asleep no matter when, where, or how is sleep deprivation. And if you have sleep apnea or any other condition disturbing the quality of your sleep, you can be sleep deprived with your nights.

Jon Becker: Yeah. You're stopping breathing and getting startled and everything else. What do you use, or do you advocate any sleep tracking devices?

Dr. Nathalie Pattyn: No. So you will notice that I don't wear self-quantifying devices. There is a new disorder now with all these tracking devices. It's the equivalent of orthorexia is for food, people who are obsessed with eating the right food and eating healthily. Now we see narcorexia, people who are obsessed about tracking their sleep, getting good quality sleep, getting enough sleep. The problem with those tracking devices and the apps is they are not scientific tools. They are a one-size-fits-all solution. They are not accurate enough to track, let's say, on a night-to-night basis, the quality of your sleep. The most accurate way to track your sleep is just to answer the question when you wake up in the morning: do I feel like I slept enough, and do I feel like I slept well? That is the most accurate information that you can gather.

Jon Becker: Very interesting. Yeah. You said narcorexia is a sleep obsession? I know orthorexia is a dietary obsession. It's interesting we've taken technology that is intended to make us healthier, like sleep trackers, and I have friends that are this way, that are obsessed with their sleep scores and are so obsessed with their sleep scores that it disrupts their sleep.

Dr. Nathalie Pattyn: Yes, because it becomes a source of anxiety. And it is actually, when you look at the clinical models for insomnia, primary insomnia, one of the precipitating factors is the anxiety about your sleep. When you become anxious about falling asleep and sleeping well, that is one of the building blocks of insomnia.

Jon Becker: That's fascinating. What kind of big-picture advice do you give to people to improve their sleep?

Dr. Nathalie Pattyn: It is to rest. And that may sound weird, but sleep is a very active physiological process. It's not a shutdown of our brain and body. To enable that process, we need rest. So we cannot function 16 hours a day, let's say 14 hours a day, chasing maximum efficiency in every area of our life, being the perfect partner, the perfect parent, the perfect friend, the perfect housekeeper, the perfect professional, and then all of a sudden, bang, go to bed and expect to sleep well. No. Remember, you can't be a Formula 1 race car. One thing, when you look at people with sleep disturbances, one thing that is often missing in their life is rest because there has to be something between being busy and being asleep. You need moments to rest. And if during the day your system never deactivates enough to just be at ease, and if at night you go from 100 to zero, your sleep will be poor. So the main thing to keep in mind if you want to improve your sleep is to factor in rest in your wake time.

Jon Becker: How do you advise me to do that? What do you mean by rest?

Dr. Nathalie Pattyn: It's many different forms for different people. I would advocate not only me to go out because a lot of our lives happen indoors nowadays, and so people don't get enough exposure to natural daylight, which is an issue for a lot of physiological processes. But definitely go outside, and have mild to moderate physical activity, with the emphasis on mild to moderate, because physical activity used to be either a hobby or downtime to relax, but not anymore. It's become something we track with those devices that we can then post online, and basically it has become just another area of performance. So it's not downtime. Whatever you do with rest, it shouldn't be something you measure. If you're measuring it, if you are goal-setting about it, then it's not rest by definition. Whether it is going for a walk, reading, reading for pleasure, not reading because you want to cram a book about content that is related to your job.

An excellent example of what is not rest is listening to podcasts. I'm not going to advocate against podcasts, but before podcasts, people would step in their car if they had a daily commute and either not intently listen to the radio or just not think about anything. I see a lot of people who describe this as their downtime. It's their time in the car. You know, it's this bubble. Nobody can get to you, and you just have to mildly focus on the road if it's a way you know. This downtime has been colonized by efficiency, like, "Oh no, I'm going to use this to make phone calls, which I can do because my phone talks to my car and even allows me, and I do this too, to have work meetings in my car because of this efficient digital environment I'm in. I can listen either to audiobooks or to podcasts to use this time well to actually use this to absorb new information." But then it's not downtime anymore. It used to be downtime if you would half-absently listen to music or call a friend just to have a chat. But if you use it to have work calls and meetings and listen to content that is related to your job, then that's not rest. Rest is being idle, and it's something we don't do anymore because it's very much frowned upon.

Jon Becker: Yeah, I hadn't really thought of it that way. I mean, we are every minute of the day trying to maximize what we're doing, and in the process, we don't spend a lot of time just doing nothing.

Dr. Nathalie Pattyn: No, indeed. Just think about eating. How many people still eat, sat on a chair doing nothing else, apart from conversation with the people who sit with you at the table, but no reading, no watching digital content, no sitting in front of your computer, definitely not running around doing errands while eating a sandwich. When you stand up versus when you sit sends a signal to your autonomic nervous system. When you sit, your autonomic nervous system knows, "Okay, we're at rest. We're at ease." When you stand up, you're not at ease. It's fighting gravity to sustain your blood pressure. Why is this important? Because your digestive system depends on the parasympathetic branch of your autonomic nervous system, which is the part of your nervous system that deals with restoring storage, restoring energy, and digesting. It's the opposite of the stress reaction.

So if you eat while you activate your autonomic nervous system, then your digestive system doesn't get the signal that we're at ease and the digestion can take place. People wonder why they feel bloated, they don't digest well, they feel heavy and tired after their meal. Even apart from what they eat, there's a question of how they eat.

Jon Becker: So it's almost like there's a fight or flight.

Dr. Nathalie Pattyn: Absolutely. Yeah.

Jon Becker: I've heard it described as fight or flight and rest and digest.

Dr. Nathalie Pattyn: Yes. Absolutely right.

Jon Becker: So if we're constantly activating our fight-or-flight system, then the resting-and-digesting part never gets an opportunity to work its magic.

Dr. Nathalie Pattyn: No. And if you don't activate the rest and digest during the day, you cannot sleep well at night.

Jon Becker: Interesting. I hadn't thought about that. So then where does physical activity play into this?

Dr. Nathalie Pattyn: Physical activity is one of the pillars of health. If you ask me about the cake, if you give me carte blanche to support a tactical team, I will start with what I call the Four Pillars of Health. So you have food and nutrition, sleep, physical activity, and mental health. Physical activity is necessary. A lot of the diseases we now have in our society are just because of sedentariness, lack of physical activity. What is problematic is if people do it too much or train in the wrong way, and then it becomes a source of injuries. That's what we see in Belgium. The paramount example is the Sunday morning soccer players who don't do any other physical activity, who drink heavily on Saturday night because it's the night they go out with friends, and then who show up on the soccer pitch on Sunday morning dehydrated, not rested, not trained because the only physical activity they do is the Sunday morning soccer game. Then they go into the game, and after 10 minutes or so, bam, the knee goes or the ankle goes because that is a recipe for injury.

Physical activity is like the maintenance of your vehicle. It's like your body. You can't change it. You can change cars. You can't change your body. So the basic maintenance of it is to move it. But you have to move it in a balanced way, not only working quads or pecs. You have to pay attention to mobility, to agility, to flexibility of joints. That's one of the areas where, I think, on both sides of the Atlantic, our education system fails catastrophically because this should be part of basic education for every citizen. It shouldn't depend on whether you got it from home or not. Sadly, it does because I don't know what happened to PE in our educational system, but it's definitely not where it should be.

Jon Becker: Yeah. No, that's a really valid point. It is going. I look at the PE we did when we were little kids versus what kids are doing today. And it makes sense why when you look at my fourth-grade pictures, there were no fat kids, and now 60% of the kids are fat. We're catastrophically failing our kids and ourselves in the way we're caring for each other. So, give me the four pillars again. Diet, nutrition...

Dr. Nathalie Pattyn: Nutrition, sleep, physical activity, and mental health.

Jon Becker: So, if you are czar of the universe now running LAPD SWAT, you're focused on those four pillars.

Dr. Nathalie Pattyn: No, because I've learned my lesson. I'm old and ugly enough to know that before I try to implement whatever it is regarding those four on an individual or team level, I have to make sure that I have a system in place, that I'm working in an organization that supports its people. Because there's no point telling people to sleep enough if their work regimen implies 80-hour work weeks because they're understaffed.

Jon Becker: So your first line of attack is to solve the staff management.

Dr. Nathalie Pattyn: Yeah. Interesting. Because I think it's my assumption that people generally, when given the opportunity, want to do a good job and want to feel good about themselves and about their job. First you have to create the boundary conditions for this to be possible, and then you can work on their individual responsibility. What I see in a lot of operational communities right now is that they're getting more and more understaffed, and they're getting more and more pressure on the individual level, telling them it's their responsibility to function well. It's their responsibility to make the right nutritional choices. It's their responsibility to sleep enough and to train properly. The question is, do we give them the basic tools and the most basic resource regarding that, which is time? You cannot expect people to take care of their health and performance if they don't have the time to live.

Jon Becker: Which is a huge problem in the tactical community. Huge problem, right? Like, I expect you to work 60, 70 hours a week and be on call all the time, but oh, by the way, I notice you're getting a little fat, and you need to look really tired. Solve that in your free time that you don't have.

Dr. Nathalie Pattyn: Exactly. And we're going to give you this phone number for the shrink because your wife left you. Surprise, because you were never available. You get tired and grumpy all the time, and you're never there for her or the kids. But here's the number of the shrink.

Jon Becker: Yeah. Well, I think there's a lot of systemic shortcomings right now, right? Organizations are underfunded. They're underled. If you're a type A personality who cares about their job and cares about the guys that they work with in the unit, how do you not take that on, though?

Dr. Nathalie Pattyn: That's a tough one because I think everybody who has what we call an internal locus of control, which is normally the case if you end up in this type of work, it's because you fundamentally believe that you can make a difference, which is a very useful personality trait but also one that puts you at risk because you believe that by putting in more work, better work, more resources, you can actually tackle these issues. I think everybody at some point hits the wall. The question is, how hard? If it's a full crash and burn, you don't come back from that. But if it's a minor concussion, then you're like, "Oh, hang on. I'm not doing this right. I need to change something." I think it is very sad that we allow the people who are willing to serve the community, because this is not a self-serving job. We allow these people to damage themselves, and we don't put everything in place to prevent that. I think that is a massive failure as a society.

Jon Becker: Oh, I agree. Yeah, we are taking advantage of their dedication.

Dr. Nathalie Pattyn: Absolutely.

Jon Becker: We are allowing you to work yourself to death, and then when you do have drug and alcohol problems, we're going to get rid of you because you have drugs and alcohol and divorce.

Dr. Nathalie Pattyn: Because now you're a liability.

Jon Becker: Because now you're a liability. It's funny. I have a friend who's a tactical commander, and he was complaining about his leadership. He said, "You know, my guys are working 70 hours a week. They're exhausted all the time, and they keep giving us more missions, and we're struggling to keep up. I just don't understand what to do." And I said, "Let them fail." And he said, "I don't understand." I said, "Don't make the guys work 70 hours a week." He goes, "Yeah, but we have all these missions." And I said, "As long as you're solving the problem, it's not a problem to your leadership. The leadership doesn't have a problem. They have you solving it."

Dr. Nathalie Pattyn: Yeah. And that's the hardest part when you reach a certain level of responsibility. That's what I teach when I talk at leadership level. I say, you're stuck between a rock and a hard place. We all agree we have a systemic problem, and it's your personal choice and responsibility to be either part of the problem or part of the solution. But there's no middle way. It's either one or the other. If you're not part of the solution, you're part of the problem. So just maintaining the status quo is being part of the problem. If you never say no, you're part of the problem.

Jon Becker: Let's say that one more time. If you never say no, you're part of the problem.

Dr. Nathalie Pattyn: You're part of the problem.

Jon Becker: So if I'm a leader, and I have the luxury of having worked for myself since I was 17 years old, it's very easy for me to be able to say no to things, and I don't have downward pressure. If anything, the pressure on me is my wife and kids and people around me making sure that I don't overwork myself. But if I'm a leader, if I'm a middle leader in an organization, and I'm adopting Nathalie's philosophy, I have a responsibility to tell my leadership no.

Dr. Nathalie Pattyn: Yep. And that's why it's a hard job, and that's why you get a bigger paycheck.

Jon Becker: It's a very good way to put it. So, if I am a leader, and I mean, let's kind of walk through your counsel for people that are leading tactical units. One says no. Do you say no and protect the people that work for you?

Dr. Nathalie Pattyn: Yes.

Jon Becker: What else?

Dr. Nathalie Pattyn: Well, that's already a big one because that will make your life very difficult, honestly. But you will be able to live with yourself, and you will earn unlimited respect from the people who work for you by putting your neck out to protect them.

Jon Becker: So if I'm in an environment, and I've heard you say be the whistleblower, right? If I'm in an environment where they're not listening, then what do I do?

Dr. Nathalie Pattyn: So basically, I wrote a handbook of mental performance, but I could write a handbook of being a pain in the neck because I have been confronted with this issue of working in an organization, being the senior medical responsible for a high-stakes deployment, where you very strongly feel that absolutely not subtle pressure to go do it and you realize we are taking huge risks. So I'm perfectly happy with risk taking, but it has to be acknowledged. We cannot take risks and tell ourselves, "Oh, we have everything covered." No, we take risks, we analyze them, and we say, "Okay, we are at risk for this, but it's worth it for this and this and that reason that I can perfectly live with," but not with telling the people we care for, "We have you covered," and knowing perfectly well, we haven't. And so if people don't listen, one thing that is very compelling is putting things in writing and escalating: escalating vertically, one level up of command, and escalating horizontally outside of your pillar of command. I don't recommend this as a career strategy. Definitely not.

Jon Becker: Yeah. Yeah. It's interesting because when you're in a large organization, you do have a responsibility to the people that you lead, and that is frequently at odds with what the organization wants. I think you raise a really valid point. We're kind of in the find-out stage. The fuck-around-and-find-out life strategy. We're starting to get into the find-out stage here, right? We've been underfunding, understaffing, undertraining, and overworking tactical law enforcement to a point of absurdity, and we're starting to see this system cracking. People are not, you know, SWAT teams. I can remember when some of the teams that I've worked with for 40 years would go out, hey, we have three spots available, and they would get 300 people from the organization. A recurring theme I'm hearing now is that we're not even getting enough people to pick from. We're trying to get five people, and we get three that try out, and two of them don't make it.

Dr. Nathalie Pattyn: Yeah.

Jon Becker: I think we are in the find-out stage of this thing, and the question is, how do we right the ship? How do we get it going in the right direction as leaders?

Dr. Nathalie Pattyn: It's a habit that has grown with the 21st century, with the shift in our societies, with the war on terror, and with the culmination of abundance in the 20th century. We have lost the habit of managing resources economically. So tactical teams, be it civilian, law enforcement, or military, it's the same thing in medicine, basically. We get the bazooka out to kill a fly because we can. But guess what? We can't anymore. It's true in medicine. We can't run the full battery of tests for anybody who comes in with a benign cough and complains of chest pain. We can't send in a top tactical team for every alleged threat that we think of, which means we have to become better at selecting the responses. One of the symptoms of this canary in the mine is the fact that these teams are burning out. We are exhausting them because they have been, as you said, overcommitted.

So maybe it's time to think, well, this instance you don't need a SWAT team for. You can send in a regular team. It comes back to what we were saying earlier about everybody wanting to be a tier one, but you don't need a tier one for everything. You don't need to bring every patient to a trauma level one center. We need to be better at staging our responses to threats and crises because our crisis response system, it's not crumbling. It's sinking.

Jon Becker: Yeah. I think that's right. I think that we've lost our ability to triage.

Dr. Nathalie Pattyn: Yep.

Jon Becker: How serious something is, what kind of resources we have. I think we've also taken advantage of the drive and sense of duty of a lot of our operators. I have friends that have been, for the last three, four years, 70 hours a week because their unit is down by 20%. There's kind of this, oh yeah, it'll be all right. We'll get more guys, guys, we'll get more guys, but it's been three, four, five, six years. They're not getting more guys. The organization is making do with fewer resources and is not taking responsibilities away. They're not adding resources. So, we're just taking advantage of the guys that are willing to put in the work.

Dr. Nathalie Pattyn: Yeah. That's where, as a leader, and it's a discussion I even have in my own hospital where we are understaffed in senior physicians that are able to do extra-hospital work. Every month, there's this discussion about the shift role and how there are empty slots. Sometimes you have an acute issue, like a colleague has had a serious accident, is out for two months, and everybody pitches in to fill in those slots. But that is an acute problem. You can't run your normal operations like this. My argument to our head of department is always, "Well, put us on red for emergency extra-hospital interventions." "Oh, I can't do this." "Yes, you can. It is your prerogative as a head of department. If you don't have the resources to staff your service, you put us on red. We are not available." "Oh no, I can't do that." "Yes, you can. You don't want to. That's a different thing. But you can." And how do you want any political leverage if there's never an issue? If you keep solving these, if you work yourself into the ground to fill the holes, then we're never going to get additional physicians because there's no problem.

Jon Becker: It's almost like I had a friend recently who died, and his spouse had Alzheimer's, and the family didn't really know that she had Alzheimer's because everything that she needed he just solved for her. So you didn't realize that she could no longer balance a checkbook. She could no longer do math. She could no longer cook. She wasn't really caring for herself because he was doing everything for her. Then as soon as he was gone, now you realize there's this catastrophic problem. With these tactical units, it's almost better for them to fail in a controlled way, turn down mission sets, refuse to do things because guys need to sleep, which takes courageous leadership.

Dr. Nathalie Pattyn: Yes, because it's a difficult choice. But it's easier to turn down a mission and to be a pain in the neck than to have to be at a teammate's house announcing to their family that he died because there was a screwup during an operation. And nobody will ever know how much of it is due to bad circumstances and maybe faulty decision making from the team because people are overworked, overcommitted, and don't sleep enough. When you have those difficult choices to make, I always tell people, yes, it's difficult, but imagine if you don't. It can be a lot worse. Really a lot.

Jon Becker: I think one of the hidden costs that people don't talk about is when you are overstressed and overworked and fatigued, complacency is the result.

Dr. Nathalie Pattyn: Yes.

Jon Becker: At some point, if the zebra is constantly being chased by the lion, at some point the zebra no longer reacts when somebody says, "I think that's a lion."

Dr. Nathalie Pattyn: Yeah. And that's just human because your nervous system will seek to adapt. If crisis management is your new normal, then your crisis response will blunt. Because what your body aims for is survival. If your way of running is not compatible with survival, it will adapt. It will downgrade its response to make it survivable.

Jon Becker: Then you're going to lose your, you know what, but you and I've talked about contingency margin. It's having that ability, if you're constantly jogging, you will lose the ability to run really fast when you need to.

Dr. Nathalie Pattyn: Yeah. It's really, and it's described in mental health issues as well. If you lose your flexibility, if you're constantly rigidifying in that emergency mode, then that is the beginning of the end for your mental health and for your physical health.

Jon Becker: Well, and we see that when guys come back. You think about it, I'm sure you've seen it in the units that you work with, when you take units and you deploy them into a theater of operations that's a high threat, and you work them really hard. When they come back, it takes those guys a long time to be able to go to the mall or to be in a concert or to deal with any kind of loud noise, multiple-person environment because their nervous systems have just been turned up so freaking high.

Dr. Nathalie Pattyn: Yeah. The risk there is that individuals, if the organization doesn't channel this and force recovery strategies, people will feel uncomfortable in this downtime of their life. They will feel uncomfortable in their home situation, and they will quickly volunteer for another deployment because then they will feel comfortable again. This is something I have experienced myself in previous years. It's years where you are really doing high-intensity jobs, and at some point you can't relax anymore because when you relax, you feel like this is not normal. It feels like wearing too-small shoes, like you feel out of place. This is not how you function. Then you go back to some high-intensity role again. Then you relax because this is normal. This I can handle. That's when you have to really, because that is a massive red flag. If you feel comfortable in situations that are normally highly stressful, then by all means get help.

Jon Becker: Well, and you see that with guys, especially in the tier one units, who have, you know, eight, nine, 10, 12, 15 deployments in the Global War on Terror, and they'll come home for a month or two months, and they're volunteering to take additional assignments. It's almost like the autonomic nervous system has to be set on stress all the time.

Dr. Nathalie Pattyn: So that's this rigidification, and as soon as you notice that either in yourself or in a colleague or in someone from your team, then you have to take action because that is a really bad sign. It means that your system cannot deactivate anymore, which means your resources, both mental and physical, are crumbling.

Jon Becker: So, organizationally, like we've talked about individually, leadership-wise, organizationally, how do organizations start to address some of these systemic health-driven problems?

Dr. Nathalie Pattyn: Quite poorly because that's always the conundrum you face. When you're working as a caregiver in an organization where the primary goal is performance on a mission, at some point the interests of the organization and the interest of the individual will clash. I will give you an example because you talked about the people who got deployed repeatedly during the War on Terror years. The French government has acknowledged responsibility for not only the health issues for their deployed personnel, but also for the families and, more specifically, when it comes to domestic violence. If you think of the operator deploying repeatedly and not feeling comfortable at home anymore in a family situation, and not coping with it well, be it with substance abuse or violence or behavioral changes and issues, and then choosing to deploy again. Well, the conflict of interest is very clear because for the organization, and that's the difference we have to make between performance and health, there's this area where people can be unhealthy because they are suffering, their environment is suffering, but they still perform because it's, let's say, the last straw where their identity hangs. Organizations have a responsibility in encouraging this type of behavior because as an organization, if you have a guy who is willing to do three three-month tours per year, well, of course, that's easy for you because it solves your scheduling issues, but it puts that person at risk both personally and in terms of their domestic environments.

The French government launched an initiative to support families and to have a fast track to get help, both in terms of mental health and in terms of legal and practical issues, like finding housing for spouses that wanted to escape domestic violence and stuff like that.

I don't think organizations deal with it well because of this constant crisis management mindset. Sapolsky, whom I mentioned earlier, the stress researcher, in his book Zebras Don't Get Ulcers, has this beautiful phrase to describe the stress reaction. He says, when there's a tornado tearing down the house, it's not the day to repaint the kitchen. When you think of all the things that are being defunded in our society right now when it comes to health and care and education, it's exactly that. There's a tornado tearing down the kitchen. So people think, "Well, let's not care about housing for domestic violence victims because it's all very sad, but that won't change our future as a country."

I think that this crisis management mindset is really dooming our future as human organizations and societies that were aiming for the greatest progress for the greatest number of people, because that ship has sailed.

Jon Becker: You see it, you know, we see it in the United States, right, where it's, you know, we're the best healthcare in the world, and we have the highest rates of obesity and the highest rates of stress-related illnesses and cardiovascular disease. I think to some degree we've Maslow-triangled our way into trouble here. Like we've gotten so comfortable and so safe that we've allowed ourselves to give up on the things that are keeping us alive and keeping us safe.

Dr. Nathalie Pattyn: Yeah. I think that's a problem in all industrialized countries. It's certainly the same for us in Belgium. Earlier this year, our foreign secretary issued a warning to the general public about keeping basic supplies at home in case of power outage or whatever. But, you know, having a minimum amount of potable water, having a flashlight on batteries, having a basic supply of medication if you take chronic medication. So it's basically really common sense. You think, in what kind of country do we live that we need a formal message from the government to get people to do that? The reaction to that message being issued was, to me, really shocking because it was being mocked. Not only mocked but also criticized as being fearmongering, trying to rule and justify government decisions with fear. Whereas last winter, we saw these overall power outages in large regions of Spain, and it showed how dependent we have become.

I know a lot of people who shop every day or every other day for food, and they don't keep food in their house. It's like, "Okay, but just remember the COVID lockdown. What if all of a sudden you can't go shopping anymore? What are you going to eat?" I don't know. When I have those conversations with people, I feel like we come from different planets.

Jon Becker: I feel the same way. It's interesting because there is this mindset of, "Oh, the government's going to take care of us, right? Food and power and water and all these things are going to always be available." What I find paradoxical about that is we are two years out of the pandemic, where worldwide governments failed catastrophically at protecting us. I always use the example of N95 masks. The U.S. government, despite how many hundreds of predictions of H5N1 pandemic and all of these things, they didn't have masks, much less respirators and food and everything else, basic things that are durable and can be kept for long periods of time. It was like, "Oh no, we didn't really think about that." We have this kind of paradoxical time where, on the one hand, we are so comfortable that we're not scared anymore.

Dr. Nathalie Pattyn: Yeah.

Jon Becker: At the other time, we have a government that has become so comfortable that it's not going to protect us anymore.

Dr. Nathalie Pattyn: That goes back to this distinction between robustness and performance. Nobody wants to stock supplies that have no intrinsic value, like masks, which you have to destroy after a certain amount of time because they don't resist well. You have to be willing to sacrifice the storage place. It's the same thing as keeping money in the bank. You know, people who invest all their money because money in a bank account just sits there and actually doesn't work for you and is devaluating because of inflation. All very well. But if you lose your job and all your cash is stuck in investments, you can be very rich on paper, but how are you going to buy food and put gas in your car, if you still run a thermic car? It's that idea of robustness. We are not willing, neither as individuals nor as governments, to lose money, space, resources, to lose performance. We have rationalized and optimized everything, and we have forgotten that this quest for performance comes at a cost, and that cost is robustness. We are not robust as societies. We have demonstrated it with the pandemic. And the sad thing is we haven't applied the lessons that were obvious from it.

Jon Becker: No, if anything, we seem to have gone the opposite direction. You know, it's interesting they talk about the Roaring '20s being a reaction to the stock market crash and how, after something terrible, we go the exact opposite direction. It feels to some degree that we've done that. We are exceptionally safe. Western Europe and the United States have ridiculously high levels of physical security. Although all the news media tells us everything is a war zone and we're all having these problems, that's not true in our lives. But I think that that comfort has come at a price.

Dr. Nathalie Pattyn: Yes.

Jon Becker: The price is preparedness. The price is contingency margin.

Dr. Nathalie Pattyn: Yeah. And one thing that scares me related to that is how now in Europe, I mean, people have seen the light. They have underfunded defense and national resiliency for decades, and now all of a sudden, we're going to pump massive amounts of money into defense. But it's not something you can solve by buying equipment. It's having a robust healthcare system that can function even with a denial of service because conflict doesn't mean you have tanks in your capital city. It can mean even only that your network and digital capacity is under threat. We have seen this in the past week/month in Belgium. It's like we're watching it like frozen rabbits in the headlights of a car, and we're watching the car, and we're staying on the road and not moving.

Jon Becker: So if you were Nathalie the czar of the universe, what would you do organizationally? What would you advise law enforcement leaders, SWAT team leaders to do at this point to restore robustness?

Dr. Nathalie Pattyn: It's very difficult because it implies you need political support because it's a matter of resource allocation. But within your margin of movement, because every leader, whether it's top, middle, or tactical level, has a margin of movement. Within that margin, it's being prepared to make the difficult choices. The good way to lead is being tough on the upper level and being welcoming towards your lower level. Sadly, lots of people do the opposite. They are tough on their lower level, and they are welcoming and give a good news show to the upper level. That's where it starts to go wrong, and it's true throughout the chain.

Another thing is to gain, let's say, the trust of the people you are leading. We are often told in leadership courses that we need to show loyalty to the organization because if, as a leader, you criticize the organization and your leaders above you, it will undermine the confidence of the people you lead. However, if everybody in the organization knows that a decision is plain bullshit, defending that decision will actually undermine your credibility as the leader because the people working for you, the people you are leading, they are not stupid. If you pretend to adhere to bullshit, well, then you will get associated with it. So there's a fine line between actually showing loyalty, but not to the point of absurdity. We all have to enforce absurd decisions at all levels. But it helps a lot if you tell your team, "This is absurd. I have zero leverage to change this, so we're going to do this." Or, "This is absurd. I have zero leverage to change this. But this puts us in danger, so I will refuse for us to execute this." It will not make your life easier because you will create tension and friction with your upper level, but at least you will be able to live with yourself, and you will be respected for your honesty by the people you lead.

Jon Becker: Yeah, I think that's a really valid point. One last thing I want to talk to you about, and we talked about this in one of our conversations leading up to this, was the Maslow triangle and how comfortable society is in preparedness for mass casualty, for terrorism, for pandemic, for all of these things. I wrote in my notes, "We are debating rules that will not be relevant in a crisis."

Dr. Nathalie Pattyn: Absolutely. Again, we are rigid in how we function. Our nominal mode of operation has become peace with enough resources, enough time, and how lucky we are, really. I'm 49, and I can say that I have lived in a country that has known peace for all my life, which is an exception when you look at the history of mankind. But because of that, we are like, we are frozen in this mindset, and we are unable to make the switch. The switch entails, for example, knowing, okay, this is how we practice medicine now in peacetime with all the resources we have. However, when we go into degraded mode, this is how we will practice.

I had a conversation related to preparedness for this kind of conflict situation, degraded operations at national level. We had a meeting with all the heads of departments of emergency medicine. I was struck because emergency medicine, I mean, come on, this is normally the specialty where you expect shit to hit the fan, and one of these guys told me, "We're never going to let registrars, so physicians who are already physicians but who are training for specialization, work without supervision." I was like, "Dude, we're going to send medical students to the front line, and that will be the medical support, just so you know." I don't know. People either don't want to see it, maybe it's too big a cognitive dissonance between the way we operate and all the quality we are able to formalize in everything we do, which is a good thing, but it shouldn't make us forget it's not because I can have the finest food in a very fancy restaurant that I don't know that if I have to survive, I will have to go sleep in the woods and hunt for food. I know I sound like a paranoid hillbilly saying that, but it's true.

Jon Becker: I think that's also informed by the fact that you have, just in the time that I've known you, put yourself in environments where there's no recourse. There's no fallback. There's no, you know, we've talked about you being in Antarctica for 15 months, and if the weather's bad enough, there's no food coming. There's no medevacing somebody from Antarctica, which is why I thought you were crazy for taking the Antarctic assignment as the doctor because whatever happens, you're not going to reach out and get a specialist.

Dr. Nathalie Pattyn: No, but that also, what doesn't kill us makes us stronger.

Jon Becker: Oh, yeah.

Dr. Nathalie Pattyn: Or gives us heavy mental health issues after.

Jon Becker: That's a fine balance.

Dr. Nathalie Pattyn: Yes. But that also, to me, makes these experiences valuable because I think being in very safe and pampered societies is also linked to the catastrophic surge we see in mental health issues. Because if your life becomes too comfortable, then you get a lot of time and opportunity to wonder, but what is the point? And the big secret is there is no point. But being able to face that truth, your own insignificance, and to go on living with it implies that you have been confronted to an environment that made that hard truth mandatory to absorb. This is not something we have in our current societies.

Jon Becker: No, we got a taste of it with the pandemic, but I think it was a really bad taste, and we just washed our mouth out with mouthwash and called it good. We saw that human beings can kind of turn against each other, and we took all of the negative lessons of the pandemic and turned it into us making political war on one another and none of the value of aligning ourselves with other people. There were a lot of amazing things that happened in the pandemic, right? I mean, a vaccine was synthesized in less than a week, and there were a lot of things like that that happened that demonstrated that we have this incredible ability to cooperate and be robust. But instead, we took the mental illness side of that and scaled it. It feels like we're kind of doing that with our tactical units. We're kind of overworking them and under-resting them. I jokingly call it the pussification of the American male. We are in such a comfortable society and so well fed and so understressed physically that we're turning into the guys on the scooters from the Wall-E movie, where we're just floating around in space eating. On the other hand, the guys that are willing to push themselves, we're pushing them until we grind them up.

Dr. Nathalie Pattyn: Yeah.

Jon Becker: It just feels like there needs to be a better balance on both sides.

Dr. Nathalie Pattyn: Absolutely. It reminds me of a poster that was hanging in the office of the former RSM, which is like the senior non-commissioned officer of our Special Forces unit. It said, "Don't hope for an easy life. Train to endure a hard one." It's very cheesy, but it's very true because basically, you know, life is never easy. No matter how safe you are, it will always throw curveballs at you. Plus, your own references shift. If you never deal with threats to your physical integrity, with really worrying about your physical security, basic needs like food and shelter, well, then you put all that worrying energy in non-basic needs. The thing is to just remember. I think that's why I chose those difficult deployment environments and those professional challenges because somehow it taught me that we can do hard things. And yes, we can do it if you put yourself in that situation and you work hard, you can count on people around you, and you have a bit of luck. Then you can come out stronger for it. But we don't live in a society that encourages this. We have deconditioned ourselves from hardship. Just like physiologically when astronauts are in space, their nervous system forgets how to deal with gravity, and then they come back to Earth, and then you have the pull of gravity again, and their vascular system is not used to this anymore, so they faint and they really have to reaccustom to this, let's say, permanent stress. Well, it's the same thing with us and hardship. We don't know hardship anymore. It's a good thing because it means we have grown as a very peaceful society, but somehow we're seeing the downside of it as well.

Jon Becker: Yeah. I think I can equate it to triathlon. I had a triathlon coach that told me, "The problem with most triathletes is that they train at seven all the time." What they do is they exhaust their bodies and gradually lose fitness. He said, "You need to spend most of your time training at five, and every once in a while you need to train at nine."

Dr. Nathalie Pattyn: Yes.

Jon Becker: "And never train at a seven."

Dr. Nathalie Pattyn: Nope.

Jon Becker: I think that we have made ourselves physically. Food is abundant. We're physically comfortable. We're not under great physical threat. And it has allowed us to mentally shift to, well, it's not really that dangerous. We don't really need to fund our police department. We don't need to be robust. We don't need to be prepared because we're totally safe. At the same time, we have put ourselves in a situation where we are constantly stressed about dumb shit, and we never rest. We've lost both resilience and robustness as a society. It just feels like, in the tactical environment, the right answer here is, yeah, push the unit really hard for a very short period of time, and then let them recover.

Dr. Nathalie Pattyn: Yeah, absolutely. It's all about that flexibility. And what you say is very correct. We have rigidified at a very limited scale of the spectrum, which is not healthy.

Jon Becker: And we're just kind of gradually grinding ourselves up in the process. Yeah, it's fascinating. Nathalie, thank you so much for doing this. If people want to learn more about your work, what's the best way for them to find you?

Dr. Nathalie Pattyn: I don't have a very strong outreach or social media presence. For people interested about the performance improvement and the basics behind that, we wrote the Handbook of Mental Performance, which is open access for the digital content. So it's completely free. For the broader part of our research work at VIPER, we regularly publish scientific articles. And then, thanks to you, I can advertise these ideas and make them known to a wider community in podcasts.

Jon Becker: I love it. Well, I will link to the book. I love the fact that you spent all this time and wrote this amazing book and then gave it away. So I will link to the book and link to some of the articles, and then hopefully have you on again in the future and hear more about your research.

Dr. Nathalie Pattyn: Thank you very much.

Jon Becker: Thanks, Nathalie.