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What are you curious about?
I'm Dr. Marie Claire Bourque, Dr. MCB. I'm a psychiatrist, and I ask a lot of questions. My favourite ones are the ones I don't know the answers to.
That's where Dr. MCB’s Curiosities starts. We take a question about neuroscience, human behaviour, clinical medicine, or something else entirely, and build a podcast episode or series to explore the answer.
I read the research and look at different explanations. What do we know? How do we know it? And what haven't we figured out yet?
You get to follow that search with me, without having to work through all the papers yourself. We'll make sense of the science in plain language, including where the evidence is uncertain or the answer is still taking shape.
You might leave with a clearer answer, a different understanding of something you thought you knew, or another question worth asking.
And if you've got a question I can't answer, send it my way. That's the engine.
Dr. MCB’s Curiosities is produced by PIPACO Tech. Dr. MCB is a Clinical Instructor at the University of British Columbia and a Clinical Assistant Professor at the University of Calgary's Cumming School of Medicine. The views expressed are her own and are not endorsed by either university. This podcast is general education, not medical advice, and does not create a doctor–patient relationship.
Let me tell you about Nadia. She's a composite: a made-up person built out of patterns I've seen many times.
Nadia is a video coordinator. Five seasons with the same team. She's outlasted 2 general managers and 2 head coaches. Apart from the equipment staff, she's one of the longest-serving people in the building.
A new head coach arrives in July. In his first week, he tells her the clip packages she's been building overnight for four years aren't what he's looking for. He doesn't say what he is looking for, but his own analytics lead starts quietly redoing her work. She raises it with the director of operations, who tells her not to step on anyone's toes.
So Nadia does what people do. She stops sending her packages to the whole staff. She stops staying past midnight. And she stops flagging the patterns that only five years of watching one division will show you.
They lose a game, late. In that review, the coaches talk about adjustments nobody saw coming. Nadia is in the back of the room. Her contract is up in April. She says nothing.
In the off-season, the team decides it needs to get better at tracking opponents. The analytics lead gets more staff, and Nadia's contract isn't renewed. Five years of knowing how that division plays leaves the building in a cardboard box.
Now, if you only saw the end of that story, you'd say Nadia checked out.
I want to show you that she did exactly what the building taught her to do.
And to see that, we have to stop looking at the people for a minute and look at the building.
That's where this whole series starts. This series is about elite sport, and we're answering one big question: what makes a high-performance culture? Each episode takes one smaller question on the way there. This is episode one of seven, and today's question is the one you have to ask before any of the others: what are we actually dealing with?
Welcome to Dr. MCB’s Curiosities. I ask a lot of questions, and my favourite ones are the ones I don't know the answers to. So, let's find the answers!
I built this series around seven questions, in a fixed order, because each one depends on the one before it. Here they are. These are the 7 questions that we must ask ourselves when we are working in or trying to understand the Psychology of High Performance Sports Culture. For ease, we built the HPCOS (High Performance Culture Operating System).
One: what are we actually dealing with? That's today. We look at the pressure landscape.
Two: can anyone here tell the truth? Is the culture and environment one where people feel safe enough to tell the truth?
Three: what is actually broken? That's the diagnosis.
Four: how do we decide what matters? As culture, how do we make decisions?
Five: are we listening, and using what we hear? Are the people included in the culture?
Six: how do we stay grounded when everyone is screaming? When the noise is loud, does the culture remain grounded?
And seven: will this survive us? When the leader leaves, what changes? If it's a good and profound culture, the answer should be nothing.
The first three are about understanding the place before you touch anything. The next two are about how the work actually gets done: decisions, and people. The last two are about protecting what you've built, from the outside, and from time. And they stack, because when a culture goes wrong, it almost always traces back to a question that got skipped, not to a person who was deficient. Today's question is the one that gets skipped most, because everyone thinks they already know the answer.
So, what are we actually dealing with?
Here's the first thing I want you to notice, and most people in sport have never said it out loud.
Elite sport is not a harder version of a normal workplace, it's a different kind of organization.
Think about the actual conditions. The main asset is a human body, and it wears out with every use. A career lasts years, not decades, and it ends on a schedule the person doesn't choose. The work is done in public, judged live by millions of people with slow-motion replay and no context. People come and go at a rate that would alarm a hospital. In one dressing room, the pay runs from the league minimum to more than the whole support staff earns put together. And the roster can change overnight.
This is where we have to pause, because almost every piece of management advice you've ever read assumes a stable job, slow and private evaluation, and decisions that take weeks. None of that holds here. Drop an office culture program into a sports organization and you're building for a place that doesn't exist.
That's why the first job isn't to fix anything. It's to make a map. The way I map it, there are eight pressures, and for each one I'll give you one thing to watch in your own building, because by the end of this I want you reading your own landscape. Here we map the (non-exhaustive) pressure landscape of professional sports:
The first pressure: everyone is on a different clock. The athlete's clock is biological: ten or fifteen good years, and it never stops ticking. The coach is being judged on this season and the next couple. The owner thinks in decades, unless they haven't won in decades... The agent thinks from one deal to the next. Everybody behaves sensibly inside their own window. But the windows don't line up. James March, who spent his career studying how organizations learn, much of it at Stanford, described the pattern in a 1991 paper: under pressure, organizations take the sure thing now over the better thing later. Come playoff time, the coach's clock is the loudest voice in the room. The athlete's ticks underneath until something breaks. When you're reading this pressure in your own building, watch the next time a quick roster decision cuts across the long-term plan, and notice whether somebody says so in the room that day or whether everybody says so three months later, because the difference between those two buildings is the difference between a plan and a story.
The second pressure that exists in elite and pro sport: there are always more people than places. That one fact reshapes every relationship in a dressing room. Your teammates are also your competitors, and if what you know is the reason you still have a job, you hold on to it. And it's worse because every career ends early, and the ending changes everything at once: the income, the daily structure, who you are. Athletes know that, and it shapes every contract year and every injury decision long before the end comes. When you're assessing this type of pressure, watch for how somebody with four years left versus six months left treats an injury.
The third is the one people outside sport miss most. In most jobs you use tools, but in sport you are the tool: the body is the workplace. So pain stops being a simple warning light and becomes one more number in a calculation about availability, contract and position. Howard Nixon, a sociologist who studied why athletes play through pain, showed this in the early nineties, and Zachary Kerr and Emily Kroshus, researchers who study why athletes hide concussions, have shown it since: before an athlete says what hurts, they weigh what it might cost them and how they expect the coach, the teammates, even the fans, to react.
Kroshus and her colleagues put a shape on that in a study published in 2015. They surveyed college athletes and asked them two kinds of question. First, how much pressure did they feel from their coaches, from their teammates, from their parents and from the fans to keep playing after a hit to the head? And second, if they had concussion symptoms in a game, would they report them? The two answers moved together: the more pressure an athlete felt from all of those people put together, the less likely they were to say they'd report. What strikes me about it is the kind of pressure they were measuring, which was the pressure the athletes themselves felt from each of those groups, and the fans counted too, people who will never set foot in a medical room. Translate that into a dressing room and it means the decision about what hurts is made before the trainer ever asks, and it's made with the whole building in mind.
And under all of that sits a tension nobody designed and everybody lives with: the doctor who decides whether you're fit to play is usually paid by the team that needs you to play. Most of those doctors are careful, honest people. The problem isn't their judgment, it's the seat they're making the call from. The tell is who clears your athletes to come back and who evaluates that person's job, because a doctor whose review is written by the people who need the player back on the ice is making the call from a different seat than one whose review isn't, however honest both of them are, and if it's the same chain of command, this pressure is live.
The fourth: the evaluation never stops, and it started long before anyone got paid. The pipeline that produces elite athletes sorts children from their first tryout, and at every stage, staying selected meant fitting what the institution wanted. By the time someone reaches a professional dressing room, they've had a decade of being rewarded for going along rather than pushing back. The people who might have said something different mostly didn't advance. And it's the question parents ask me more than any other: how do I make sure I don't mess up my kid? My honest answer: put the kid ahead of the performance. High standards and honest feedback don't damage children. The damage starts when the message becomes "you're worth something here if you win," when feedback turns into humiliation, and when managing the coach's moods becomes the child's job. And notice where that leaves a parent. Raise a concern, and you risk your child's place. Stay quiet, and you risk your child. Notice whether what your training staff can see on the floor matches what your athletes say when asked, especially in the weeks around camp cuts and contract windows: a player who favours one leg through every drill and reports nothing is the pipeline's lesson, learned at twelve, still being obeyed at twenty-six.
The fifth is power, and it's the plainest of the eight: a coach decides who plays, how much, in what role, and often whether a contract gets recommended. That reaches past the job into your livelihood and into who you are. The research here is about as steady as anything in this field. Elizabeth Morrison, a management professor at New York University who studies why people speak up or stay quiet at work, went through that whole body of research in a 2014 review, and the finding that keeps coming back is that the bigger the power gap, the more likely people are to stay silent. That's a tendency, not a law about any one person, but it's a strong one. And it runs in more than one direction now: a star athlete can hold more leverage than the staff around him, and the staff know it. Then above the team sit the league and the federation, and some of the worst failures in sport have happened there, because the only place to report a problem was the organization with the most to lose from hearing it. Watch how a concern from your trainers, your video people or your psychologist travels: in one building it goes straight to the person who can act on it, and in another it goes to a veteran player first, who carries it in because the direct channel doesn't feel safe, and that second route tells you the gap is live even when nobody has complained.
The sixth is inheritance, and it works like this: today's head coach came up under somebody, who came up under somebody else. Practices that would get you reported in an ordinary workplace can live on as tradition, because the people handing them down went through them and came out believing that's what made them. "Back when I played, we didn't have any of this, and we turned out fine." Well, the people still in the room are the ones it worked for. The ones it didn't work for left, and they're not there to tell the other half of the story. There's a name for that: survivorship bias.
The clearest example is hazing, and the best evidence on it comes from a national survey of American college athletes run by Alfred University, a small university in New York State, in the late nineties. The researchers did something clever with the questions. Instead of asking "were you hazed", which lets everyone answer no, they listed the things that happen to new players one at a time, from being yelled at and acting as a personal servant to the veterans off the field, through drinking contests, to the things nobody puts in a team handbook, and asked which of those had happened to them. Then, separately, they asked whether they had been hazed. About eighty percent ticked at least one thing that met the definition. Twelve percent said yes, I was hazed. That gap, eighty to twelve, is the finding, and it's what normal looks like from the inside: the people who went through it mostly didn't name it as harm, which is exactly how a tradition protects itself. Walk into a dressing room and ask whether there's hazing here, and you'll get the twelve percent answer. Ask what happens to rookies in their first month, and you'll get the eighty.
Notice, when a coach leaves, which of their habits are still running a year later, and then ask whether anyone in the building can tell you which of those are written policy and which are simply how it's been done, because a rookie and a fifteen-year veteran will give you two different answers, and the gap between them is your inheritance.
The seventh is that nobody stays: players move on, coaches get fired, owners sell. Head coaches are often hired on three-year contracts, and plenty are fired before the end of them; in English football, the typical manager lasts three years or less. Every bit of trust you build has an expiry date, and a building that churns this fast gets stuck at the first stage of trust, where nobody's had time to prove they're reliable. When a new coach brings in their own people, which makes perfect sense from where they sit, the trust clock resets for everyone. That's exactly when Nadia's five years walk out the door. You'll see it in the last departure from your building: compare how much effort went into bringing the replacement up to speed with how much went into writing down what the person leaving knew before they walked out, and in most buildings the first number is large and the second is zero.
And the eighth is the one that gets inside people. Sustained pressure changes the brain that's trying to handle it. Amy Arnsten, a neuroscientist at Yale who studies what stress does to the front of the brain, laid this out in a 2009 review: when stress hits, the brain pulls resources away from the prefrontal cortex, the front part that does the careful reasoning and holds several points of view at once, and hands them to faster, older systems built for an immediate threat. That's perfect if a car is coming at you, and a problem if what's in front of you is a contract that needs a careful read. Attention narrows, and the ability to weigh conflicting information goes first. Keep that up for months, and there's evidence from Arnsten and her colleagues that those circuits are weakened as a baseline. So a coach fourteen months into a losing run is not using the same brain he had at training camp, and the part that would notice is the part that's impaired. This is why I keep insisting on structure rather than insight: the safeguards have to be built into the routine, to catch what the people under pressure can no longer see. Watch for who in your building has been under sustained pressure for more than a year, and then ask whether anyone is looking at how they're deciding rather than only at what the results say, because a coach whose record is holding up and a coach whose record is slipping can both be running on a narrowed brain, and the standings won't tell you which.
So that's eight pressures, and the point of listing them, rather than just saying "sport is hard", is this: they stack, and they're loaded differently in every building. One place is dominated by the clocks, another by a power gap nobody's named, another by traditions nobody's examined. So you can't read your landscape off somebody else's map, including mine. You have to read your own.
Now go back to Nadia, because now you can see what she did.
Put the pressures on one side of a scale: her contract, her standing in the room, the new coach's people, the fact that she'd already raised it once and been told to stay in her lane. On the other side, one question: if I speak, what are the odds anything changes? She'd already been given that answer. I call this the silence calculus. Calculus is just a fancy word for a calculation. When the cost is high and the odds are low, people go quiet, not because they're cowards, but because they can count.
And the thing a leader has to hear: the building is the variable in that calculation, not the person's courage.
The reframe I'd ask you to hold on to comes in three words:
dysfunction is adaptation. The silence, the injury nobody mentions, the decision that only makes sense until next week: they aren't character flaws. They're sensible ways of coping with the conditions people are in. Work out the conditions before you decide what's wrong with the person.
And notice which way the calculation runs: the athlete knows what hurts, the trainer knows the mood in the room, and the player from abroad knows who's being left out. So the information is there, but it tends to sit with the people who have the most of it and the least power to do anything with it. So the useful question is never "why don't people speak up here?" It's "what about this place makes staying quiet the smart choice?"
Not all silence is fear, by the way. I separate three kinds, and I'll only name them today, because next episode is about them. Fear-based silence: the person could speak and did the math. Architecture-based silence: they were never in the room; the psychologist learns about the trade from the news. And network-based silence: the real information moves through the back channels, the people who played together or came up together, and some people can't get in. Each one is a different problem, and each one needs a different fix. Run a "speak up" campaign in a building whose problem is who's in the room, and you've spent your money on the wrong silence.
And the building itself has a say. The training room is the real information hub of most organizations, not by design, but because having an ankle taped happens every day. You're sitting still, the conversation is expected, and talking costs nothing. That's where athletes open up. Meanwhile the sport psychologist's office is often next to the coaching suite, so walking in is a visible choice in a place where being seen carries weight. The floor plan decides what gets said and to whom. And the people who hear it, the trainers, the equipment manager who sees a player quit looking after his gear, the video coordinator: low in the hierarchy, high in what they know, and almost never asked about the culture. When they start leaving, the organization is telling you something about itself.
The calculation isn't the same for everyone, either. It's loaded, by race, by gender, by who the room was built for. For women working inside men's sport, I can tell you from the inside: you learn the codes fast. There's a narrow range of volume you can use and still be heard. Certain hallway conversations stop when you walk up, not out of dislike; the room just hasn't updated to include you. And most of the men are decent people, great people, working inside a system built before you arrived. The system isn't hostile. It's habit. And habit is harder to shift than hostility, because nobody thinks they need to.
So why doesn't somebody just fix all this? Here's the uncomfortable part: the rewards are real, and I mean belonging, mastery, identity, money that can change a family for generations. The system meets those needs at an intensity nothing else does, and that's exactly what makes people put up with conditions they'd walk out of anywhere else. It's also why the people best placed to see the problems are the ones with the most invested in keeping things as they are. And the costs are measurable. Vincent Gouttebarge and colleagues, sports medicine researchers who in 2019 pooled the studies on mental health in elite athletes, found that about a third of athletes competing right now report symptoms of anxiety or depression, and coaches and support staff run at similar rates. Nobody in those numbers is being weak, because the handcuffs are golden. And a weak signal, like Nadia's, sits in a building where catching it is nobody's job until it turns into a crisis. Aviation and healthcare built their catch-nets for exactly that reason. Sport is still building its own.
Now, the objection, and it usually comes in these words: "pressure is the job, and people need thicker skin." That's half right, because pressure is inevitable in elite sport, but pressure shouldn't change what's true. When bad news gets punished, truth slows down. Those aren't personality problems, they're predictable effects of a system, and no amount of personal grit fixes a system.
So what do you do with this on a Tuesday morning? That's the standard I hold every idea to, by the way: it has to earn its place on an ordinary weekday.
The honest answer for this layer is: nothing yet, because you're not intervening, you're learning to read. Before the next pressure point on your calendar, a selection, a trade window, a playoff push, ask yourself: which truth is likeliest to get stuck here, and where?
I ask questions like that for each of the eight pressures, and the trick of it is that the answers aren't the point. Where you can answer straight away, you can see. Where you hesitate, or realize nobody's tracking that signal, you've found a gap. The gaps are the map. And three questions sharpen it.
The first is where truth is slowest: which decision or piece of bad news takes the longest trip from whoever knows it to whoever needs it?
The second is whose silence math is steepest: which role, which contract status, which group pays the highest price for speaking relative to what they'd gain? Those people are your canary.
And the third is what you usually do when something goes wrong: do you treat the symptom, or do you ask what produced it? Your answer tells you whether the same crisis is coming back.
And there are five signals you can watch without a survey: support staff leaving faster than coaches, injury reports dropping in contract years, new hires repeating the mistakes of the people they replaced, athletes bringing the trainer problems that have nothing to do with their ankle, and reviews that name the symptom and miss the cause, every time. Each one is the building telling you something about itself.
Where does the research stop? Most of what I've described is borrowed from fields other than sport: workplaces, hospitals, aviation, neuroscience labs. There's a lot less research done directly on elite sport than people assume. A review published in 2025, by Bernier and colleagues, sport psychology researchers, found eleven studies in twelve years that met its standard for psychological interventions with elite athletes, and eleven is not much to build a field on. So we borrow carefully, we say so, and we check whether it holds in the room we're in. The eight pressures, the silence calculus, the questions I just gave you: those are a practitioner's tools. They produce a map, not a score.
Madeline Antony and I wrote the full framework up in a book, The Psychology of High-Performance Sports Organizations: Culture, Safety, and Leadership. The link is in the episode notes.
So, what are we actually dealing with? Here's the answer: a different kind of organization, under eight pressures that stack, which make silence, hidden injuries and short-term decisions the smart move for the people inside it, and which leave the most information with the people who have the least power to use it. The first job isn't to fix any of that. It's to make an honest map of your own building: which pressures are loaded, whose silence math is steepest, and where truth travels slowest. Skip the map, and you'll build a safety program for a culture you never diagnosed, open a channel that misses the quietest people, and mistake sensible adaptation for defiance.
Nadia wasn't defiant. She was reading her landscape correctly. The building told her to shrink.
So here's what that adds to our big question: a high-performance culture starts by looking honestly at the conditions people are actually working in, the clocks, the competition for places, the power gaps and the pressures that make silence rational, before trying to change anyone.
Next time, question two: can anyone here tell the truth?
That's Dr. MCB’s Curiosities. I hope you learned something. I sure did. Can't wait to ask more questions with you. See you next time! Dr. MCB’s Curiosities is produced by PIPACO Tech. I'm a Clinical Instructor at the University of British Columbia and a Clinical Assistant Professor at the University of Calgary's Cumming School of Medicine. The views here are my own and aren't endorsed by either university, and this podcast is general education, not medical advice.