Most of us don’t get through our careers in medicine without the occasional dust-up with shame. The performance expectations on us, from others and usually from ourselves often have us snagged in the habit of perfectionism. And the habit of perfectionism is all about avoiding shame. There is healthy-striving, which is about wanting to do better. And then there is perfectionism, which is about having it all “just so,” in order to avoid criticism and negative judgment of any kind, which are common shame-triggers.
The filters through which we proceeded to become attendings sifted out a lot of people. Organic chemistry, MCATs, long admissions processes, Step exams, etc; all of these “took people out,” and we saw this happen as we moved through. And when people were removed through these filters, we saw them being “not good enough” to get through by that particular standard, whether we agreed with it or not. And we might have sat there wondering, “when will I be weeded out?”
But here we are. Made it. And all those perfectionist habits that got you here? Most of us hang on to them to cope with the ongoing high standards of expectations not only for our clinical knowledge, but also for superhuman performance fueled by too little sleep and rest.
But inevitably, all humans fall at times. We all hit challenges we aren’t ready for, fail to get a promotion, give a talk that duds, face liability or injury or divorce or discipline for a bad attitude. Turns out, we are human after all, despite learning to systematically ignore our needs in school and residency.
And when we fall, how do we stand up? One of the difficulties of shame that we may experience with these circumstances is that shame makes us want to hide. It’s a nearly universal experience with the human emotion we call “shame.” We fear that we are unworthy of love and connection, and we don’t want to be seen.
But responding to shame in this way, by hiding, by not sharing your pain, makes it worse, and it makes it more difficult to process, rather than less. Brené Brown, PhD LMSW, teaches us that shame needs 3 things to grow: secrecy, silence, and judgment. So when we respond to shame with these, hiding, avoiding talking about it, and believing our stories that what we did/what’s happened proves that we are awful human beings, we allow shame to grow. And if you understand that our actions come from our emotions, what do you think happens when we feel more shame? It’s not good. In fact, this shame, and it’s secrecy and hidden pain is, sadly, likely a key component of Physician suicide.
Shame resilience requires that we connect, share our pain, and get out of judgment. When we lean into other humans that we trust, and share our stories, we heal. And when we heal, and cultivate more shame resilience, we grow in our self-compassion and connection with ourselves and others.
I don’t want to minimize the work involved here. Or the need to identify safe people in our lives with whom we can share our stories. Brené literally has written the books on all of this, and there are many reasons why they are best-sellers (Daring Greatly and Rising Strong are two of them that I highly recommend). Getting clear on what’s real and what’s not real in your story takes self-reflection, and both time and space to really feel your feelings. But this work is literally life-saving, and its transformative.
So if you are here, and experiencing shame, know that you are normal. All humans experience shame. But cultivating ways in which we can understand and heal the shame are skills that not all humans learn. And you can too.
I help Physicians and Allied Health Professionals who are experiencing difficult emotions, including shame, overwhelm, and burnout to name a few. Usually people find me when they want to feel better, learn boundaries, when they have been disciplined in some way, they are tired of feeling overwhelmed, or considering a job change. If that sounds like you, click here to set up an initial call with me.
There are important resources available for anyone experiencing an urgent mental health crisis related to these emotions, which are posted below. Your health and safety always come first, and you are too important to lose, regardless of your circumstances, so please, get help.
If you are feeling unsafe in anyway, please reach out for immediate assistance to 1.800.273.8255. The National Suicide Prevention Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources and best practices for professionals in English and Spanish. You are too important to lose, simply because you are human.