The cost of accomplishing anything great is willingness to be misunderstood. Internalization of the idea “This problem matters enough that an unreasonable attempt is justified” is the bedrock of any monumental accomplishment. The hard part of trying to do anything big is that it always seems from the outside like you’re doing it for yourself. But nothing big was ever accomplished by someone who thought they couldn’t do it. A goal can be wildly improbable, socially audacious and far beyond a person’s present resources without being a delusion and without implying a lack of humility.
People who can achieve big goals while remaining humble and realistic have to become psychologically organized around their own evidence-based capability of increasingly difficult contributions. Failure is a learning win, but success can expand their perceived agency. “I accomplished A” can be used as evidence that B may now be modestly more tractable than it used to seem, then C once B is achieved. Incremental evidence-based probability adjustment isn’t false confidence.
When the frame is wrong, large-scale purpose in an individual making a risky move can seem pathological, narcissistic and delusional to outside observers. This misinterpretation can generate resistance by those observers in spite of goal-alignment unless they understand that you can attempt to make large changes, and not be selfish, by focusing on the meaning assigned to an objective instead of the person doing the thing.
A more useful term may be “prosocial grand ambition” or “self-transcendent ambition”: having an unusually large discrepancy between present reality and desired future reality, coupled with a motive directed substantially beyond self. One person says, “I am going to transform this institution.” Another says, “I am going to change how an entire field handles this problem.” Both statements sound grandiose but may not be selfish.
It’s easy to mistake “prosocial ambition” with pathological ambition. Pathological grandiosity occurs as part of a constellation with traits like excessive self-centeredness, superiority, dependence upon admiration, exploitative relationships, emotional shallowness, and impaired empathy. But a psychologically healthy person can still hold enormous aspiration while assigning it a modest probability. “I intend to accomplish X” does not logically require “I am certain X will happen.” Pathological grandiosity would suggest, “The probability cannot be that terrible simply because I am the person attempting it.”
A healthy grand goal may look more like this:
Probability of complete success: 15%
Probability of meaningful partial Success: 60%
Expected value of attempting it: Very high
Cost of never attempting it: Unacceptable
Most enormous goals often require probabilistic asymmetry. The expected value can justify pursuing an outcome whose modal result is failure.
David M. Bennett, MD, FAOA, FAAOS, FPOSNA, is an ABOS board-certified pediatric orthopedic spine surgeon at Phoenix Children’s, with academic appointments at Mayo Clinic, the University of Arizona, Creighton University and Barrow Neurological Institute. His clinical and scholarly work focuses on pediatric spinal deformity, trauma, fracture remodeling, surgical planning, artificial intelligence, and emerging technologies. He is a member of the American Orthopaedic Association and serves as current president of the Arizona Orthopaedic Society.
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