How to address the feeling known as “imposter syndrome”
I spent this past Easter weekend doing a hospital shift. For psychiatrists in private practice, doing a weekend hospital shift is like voluntarily fighting in war. For example, my friend Pooja Lakshmin MD literally says, “I’m so sorry,” sends a “did you survive?” text both Sat/Sun, and expects radio silence on Monday. From 5 p.m. on a Friday until 9 a.m. on Monday I could be asked to forcibly hospitalize someone who doesn’t think they need it or decide whether to medicate someone who seems like a sweet grandma until 6 p.m. when they start deliriously cursing out nursing staff.
Over the course of the weekend, I expect to meet at least 10 to 20 new people who need my help to make decisions about their care. I do about six of these shifts a year in exchange to be a fancy smartypants “Assistant Professor” at Johns Hopkins.
Unlike in my personal practice where I can choose who I see, and where and for how long I choose to see them, I have little control over these details while working in the hospital. As a special snowflake who prioritizes comfort (a more acceptable way of saying a workspace that minimizes anxiety, sleepiness, hunger, annoyance, distraction), I start mentally preparing for these weekends five days in advance.
But I was not mentally prepared for this particular shift. Come Day 1, my first shift of 2023, it’s chaos: I have already failed my goal of getting to the hospital by 9 a.m. (I haven’t been able to get anywhere by 9 a.m. since age 30), I’m throwing shit all over the floor because I can’t find my hospital ID, I’m yelling at my partner, she’s yelling at me, the hospital was calling. Total shit show.
On the drive, I’m on the verge of tears, frantically texting friends for a pep talk. If I can't manage my own affairs, how can I manage others’ health? (Fyi, my ID. was in the glove compartment of my car where I would OBVIOUSLY look for it.) I get to the hospital at 10 a.m. and in my high school basketball coach’s voice tell myself: “You aren’t bleeding so you’re fine! Get over it and move on.” That pep talk didn't work – big surprise! I entered the hospital thinking that everyone would know I was a terrible, disorganized doctor like they would expect of someone who looks like me: one of the few Black, genderqueer-looking, who was obviously an affirmative action hire.
From 10 a.m. to 7 p.m, I saw all the patients with their trauma-filled stories. I answered all the questions from family members who expected me to know every detail from the past seven days about their loved one. I decided who was in their right mind to refuse unnecessary tests that were indeed, unnecessary. I did my job and I did it well.
Yet, at the end of the day, I still went to bed thinking of myself as a terrible doctor. I stayed up until 1 a.m. writing notes that sounded “smart” so doctors reading wouldn’t know I was bad. This was my sign that I needed to get it together for tomorrow or else I’d be a hot angry mess.
The next morning, after reassessing my expectations of myself and accepting that I would not leave the house by 9 a.m., an old memory came to mind. Early in residency while rotating on internal medicine, a senior (white lady) doctor nitpicked the shit out of me, questioning my every decision. It destroyed my self-esteem. She did not criticize any other trainees as much as me and made me feel like I was only smart enough to be a “psych” doctor. Also, she commented on my word choices, presentation style, monitored my notes only, and explicitly expressed doubt of my medical knowledge. This might seem normal to Scrubs or Grey's Anatomy viewers, but her criticism was only directed towards me, the different one. I remember asking friends for advice and pumping myself up to give her a piece of my mind for our final feedback session. At the session, I gave her a piece/politely shared how her actions made me feel. Then she admitted (after denying it twice) that she feared my ability to care for patients because, when she asked for our goals the first day of residency, I said “I want to work on details because I am a big picture thinker.”
To her, this admission meant DANGER! RED ALERT! THIS IS A DOCTOR WHO DOESN’T PAY ATTENTION TO DETAIL! SHE COULD KILL SOMEONE ON MY WATCH SO I CAN’T LET ANYTHING SLIP! I was inherently incompetent due to admitting an intelligence style discordant with how doctors are “supposed to think.” Plus, my mere existence as a lighthearted Black person with flashy Floridian style was obviously a danger to patients.
Sternly, I reminded her that I completed med school like everyone else and WAS CHOSEN BY A TOP 3 PROGRAM (better ranked than hers). She apologized. I remember feeling relief, like I was no longer holding her anxiety.
Years later, on that weekend shift at Johns Hopkins, THAT SAME ANXIETY was what I was feeling! It was an old feeling of inadequacy, triggered by losing my ID. After realizing this, I felt a similar relief. So when I went back the next day, I didn’t watch the clock like the day before — I was truly present even though I was assigned more patients. I felt grateful, even though I was up until 1 a.m. again.
Your Therapy Takeaway
Stop calling it “imposter syndrome”
My biggest issue with the term is that it suggests your feelings of inadequacy aren’t normal. But that’s incorrect: It is normal to feel inadequate. It is normal to have self-doubt. It is normal to feel othered. (By “normal” I mean, you are not the only one who experiences it). Yeah, it feels like shit, especially when your environment, people in your environment, and your own freakin’ body add more shit to the pile by reinforcing your inadequacy.
We know the stats: If you take up space in society as a woman with whatever number of marginalized intersectional identities, you are treated like you don’t belong, you don’t look like the expert is “supposed” to look, and you are most likely quite literally the definition of “one of these things is not like the other.” Society makes it certain that you will have feelings of inadequacy. (For more on this, check out Ruchika Tulshyan and Jodi-Ann Burey’s 2021 essay Stop Telling Women They Have Imposter Syndrome.)
For example, it was totally normal for me to feel inadequate or incompetent as a doctor because I was already sensitive to feeling this way, because society told me that I don’t look like George Clooney or Meredith Gray. So not only do I look like an imposter doctor, but because I have ADHD, society implies that I am inherently disorganized, absent minded, and terrible with details. My emotional brain believed this, but my rational brain eventually took over and called bullshit.
Remember that feelings are temporary and can change any second.
Our brains have us thinking some crazy, irrational shit that we would never do. One moment you might feel like punching a dog owner in the face to disarm them while you steal their adorable Cavapoo. A minute later, you might see a cute person crossing the street and wonder if you’ll be single forever or whether you’d leave your current partner for this random stranger. These thoughts are fleeting and it’s best not to take them too seriously, UNLESS they repeatedly show up and won’t go away. This might be a sign that your emotional brain is holding on to the feelings of insecurity for some reason. In this case, be curious (and nice) to your emotional brain to explore why that insecurity is there, and engage your rational brain to confirm why it is BS (or what you need to do to be more confident that it is BS).
Try not to give those self defeating feelings more attention than they deserve.
For example, in the case of my lost ID, I could say: Kali, you’re feeling insecure RIGHT NOW because this triggers your fear that ADHD makes you incompetent. It is okay. Losing an ID doesn’t have anything to do with your expertise as a psychiatrist, or as a Black psychiatrist. You are human for feeling this way, but now let’s play some French pop, call a friend, and tap into that bad ass you know you are.
Ask yourself: “Do I have evidence to prove it?”
Just because you think/feel you did something bad, it doesn’t mean you ACTUALLY did something bad. If you aren’t sure, asking yourself this crucial question can help bring you back to reality. We can’t choose the feelings/thoughts that come to us, but we can choose what we do, or how we act in response to those feelings/thoughts.
I can think I’m inadequate all day every day in my head, when in reality there is little or inconsistent evidence of not completing what needed to be done in a satisfactory manner. Nor is there evidence that I consistently made decisions or performed behaviors uncharacteristic of a person with qualifications required to be a psychiatrist. Just because I think about punching the Cavapoo owner and stealing their dog, it doesn’t mean I will! If I have never punched somebody randomly in the face and attempted to steal a living being that belongs to someone else, why spend time convincing myself I am a sociopath?
These are the questions I ask myself, and I suggest you do the same.
You got this,
Kali
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