10/23/2014 09:59 pm ET Updated Dec 06, 2017

Listening to Your Marshmallow

Carolyn Taylor Photography via Getty Images

Listening To Your Marshmallow
Succeeding in work by knowing and playing the endgame before the end
Lloyd I. Sederer, MD

The six-minute TED talk, "Build a tower, build a team," by Tom Wujec, has been viewed well over 2 million times. In the video, we see small teams, from CEOs to recent kindergarten graduates, given 20 sticks of spaghetti, a yard of string, a yard of tape, one marshmallow, and 18 minutes to build the tallest, free standing tower they can with the marshmallow on top -- typically in competition with other teams.


This exercise has been used for team building around the world by organizations and management gurus. Teams that do the best found ways not to get locked into one idea or to wait until mounting the marshmallow until the very end because, untested, it was very apt to collapse the structure so laboriously built (and then time's up!). By the way, the kids did better than the CEOS.

Recently, in a day-long team building meeting of some 60 of my clinical colleagues, doctors and hospital administrators from 24 New York State public psychiatric hospitals, we used the tower building exercise to warm the group to problem solving about the challenges facing our hospitals and clinics (and to promote their leadership capabilities). After declaring the winner among the teams, and having a good time with the exercise, we talked about what we experienced and learned.

One hospital medical director, Dr. Page Burkholder, made a statement that took the conversation to a different place. She said, "We need to listen to the marshmallow." She was asking, figuratively, what were the 'marshmallows' our hospitals needed to put at the top of their work? She had given the group a metaphor for thinking about how mental health care might be reconsidered -- that is, by listening to the marshmallow!

For example, let's say that one goal of services for a person with serious mental illness is to live in safe, affordable housing. Adding the housing placement at the end of a hospital stay or after time spent on getting someone to be compliant with medications or to stop using alcohol or drugs is adding the marshmallow at the very end of an effort, where it may likely topple the work done. Housing is the marshmallow and the treatment team needs to be thinking about and trying to achieve that goal throughout a person's care. Indeed, in recent years, a policy of "housing first" has been shown to work for highly vulnerable and ill people, even those homeless and living on the streets for years (U.S. Interagency Council on Homelessness).

For example, most people with serious mental illness have different goals from their doctors and other mental health clinicians. While the doctors may want to relieve them of their symptoms (even disturbing hallucinations or delusions) patients generally want something different (in fact, what we all want) -- to function well and have a life of relationships and contribution. We hear, in their voice, "I want a job, a home, and a date on the weekend." If we listen to their marshmallow(s), we hear that what they want atop the construct of their lives often is different from conventional medical goals.

Only by appreciating their respective marshmallows can we form true partnerships with patients -- only then can health care professionals construct a treatment that supports what their patients want, and thus enable them to achieve the free standing life they seek.

In A Secret Garden Frances Hodgson Burnett wrote: "At first people refuse to believe that a strange thing can be done, Then they see it can be done, Then it is done, And all the world wonders why it was not done centuries ago."

She must have been listening to the marshmallow.


Dr. Sederer's book for families who have a member with a mental illness is The Family Guide to Mental Health Care (Foreword by Glenn Close).


Dr. Sederer is a psychiatrist and public health physician. The views expressed here are entirely his own. He takes no support from any pharmaceutical or device company. -- Follow Lloyd I. Sederer, MD on Twitter: