In her book Daring Greatly, Brené Brown says, “If we want to be fully engaged, to be connected, we have to be vulnerable. In order to be vulnerable, we need to develop resilience to shame.” If you’re a physician who is “not good at being vulnerable,” then it’s likely you’re steeped in shame, but you’ll never admit it. Given the social capital that comes with being a doctor, it may surprise you to learn that we’re masters of shame. Having spent most of your adult life in medicine, you may be unaware of the insidious but ever-present shame since no one talks about it. That’s because people have shame about their shame. This is precisely why shame thrives in medical culture. To be fair, most people deny they have shame. When I gave the book Daring Greatly to my mom, she said, “Oh, I loved it! But it’s not like I have shame or anything.” Brené herself has admitted that shame is never a useful emotion, except in medicine, where it’s often used as a motivator. The demand for perfection keeps us numb to our own feelings, blinded by the illusion that all our struggles are temporary or justified. It’s easy to believe you’re resilient to shame if you’re still showing up for work. But if you struggle with feeling you’re not enough, know that what you’re actually experiencing is shame. Brené defines shame as the intensely painful feeling or experience of believing that we are flawed and unworthy of love and belonging. Medical culture depends on shame to keep us in line, to keep us showing up no matter how we’re treated or how we’re suffering. (A sizeable paycheck does not cure shame.) We don’t feel like we’re enough because we don’t really know ourselves. If you knew what mattered most to you before medical training, you may have slowly and subtly betrayed yourself and your own needs when you made the tacit agreement to put medicine first. It might not have occurred to you that you’d lose your identity when you became a doctor, though some willingly accept this risk for the rewards. As humans, we armor up against our own suffering as a means of survival. My dearest friend from medical school, now a community OB/GYN who still takes in-house call every third night, describes it this way: I remember sobbing on a park bench in Manhattan, miserable in my Wall Street job, having just learned I’d been accepted to medical school. I knew I wanted to be a doctor. I also knew I’d have to armor up to protect myself from the self-harm medicine would inflict upon me. I cried because I knew I’d lose myself, that I’d never again be the person I once was. I put that armor on and 30 years later, I’m still wearing it. Outside of medicine, we set up boundaries, or personal limits, around what’s okay and what’s not okay for us. Boundaries function to keep us safe to meet our authentic wants and needs. The problem is: we don’t create our own boundaries in medicine. Medical culture creates boundaries for us. Even if we know who we are and what we value, the expectations and demands of our careers repeatedly trespass over our personal boundaries, requiring us to act in opposition to our own wants and needs. When this happens, our behaviors aren’t in alignment with what we really value. When our behavior doesn’t match our values, we lose our integrity. Did I just imply that physicians don’t have integrity? Stay with me. People who lack integrity and don’t respect boundaries aren’t trustworthy. So, despite our ability to seamlessly navigate life and death circumstances daily, we don’t actually trust ourselves or the people around us. This lack of trust makes us feel perpetually unsafe. No matter what we do, we can’t overcome our anxiety that we’re not enough because we don’t feel safe. We’re traumatized by self-betrayal and powerlessness against a near-constant fight-or-flight state which manifests as nervous system dysregulation and, ultimately, dissociation. Sadly, learning to manage shame in a healthy way isn’t taught in school, and it’s unlikely you learned it at home. It’s not your fault you don’t have these skills. It’s not your fault you’re hurting. But it’s absolutely your responsibility to learn to stand up for yourself, set boundaries to maintain your integrity, and be willing to be vulnerable to save your self. I like Abby Wambach’s definition of vulnerability best: “Vulnerability is the opportunity to get really honest with yourself on the inside and let people on the outside see it.” We don’t want to feel pain. We want to be liked and win approval. We want to be perceived as “right” even when we don’t know what the hell we’re doing. We don’t want to be honest with ourselves about our imperfections because we haven’t developed the skills to cope with feeling bad about ourselves. So, we just keep lying about and denying what we really need and how we really feel. It’s exhausting. I believe this inability to be our authentic selves is a major source of burnout in any arena. People can’t keep so many balls in the air and still appear like they have their shit together. It’s too much for any human to handle. We can’t escape shame but don’t despair, dear reader, because shame resilience can be cultivated. There are mental fitness skills that can be learned which are self-perpetuating. I taught myself these skills and healed my own wounds. You can, too. Once you have the skills to recognize and manage shame in a healthy way, you’ll no longer be held hostage by the perceived need to betray yourself by pretending to be someone other than who you are, imperfections and all. An enormous weight is lifted, and the world feels safer when viewed through a lens of self-trust. There’s no better investment you can make in yourself. Source
