DTD 176
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[00:00:00] This is the Drive time debrief, episode 176.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. I'm Kendra. And today we are diving into something that's both tender and important, codependence and doctors. So let's start with a story. Imagine walking into work one morning [00:01:00] after just two hours of sleep, triple booked on patients, but then saying yes to a colleague when asked to pick up an extra shift that weekend.
Colleagues like this do it all of the time thinking that they're a team player. But the truth is it might be coming from a fear of letting people down, and that can be a deep pattern that slowly drains us. And so we're gonna talk about when and if this could be a pattern of codependence. I was listening to another podcast sometime in the last few months and the podcast host was talking about something she termed high functioning codependence. And when she was describing it, I was like, oh boy, this is, oh no. It's like all the women doctors I know and a lot of the men doctors too. Yeah, it was, it was wild. And so it made me wanna investigate a little further.
I did grow up in a [00:02:00] home with substance use. So I was a little bit familiar with the idea of codependence, but codependence doesn't necessarily mean substance use is involved. It means that there is a dysfunctional system and people are over-functioning in the system, and other people are under-functioning, and it's not healthy really for either.
Pia Melody - she was an expert in codependence. She recently passed away but she was a pioneering therapist, author and educator, and she did a lot of groundbreaking work on codependence, trauma and relational healing. I believe she was originally a nurse and she worked at The Meadows, which is a renowned treatment center in Arizona.
She defined codependence as a disorder of immaturity rooted in childhood trauma. And remember, childhood trauma does not have to mean we were beaten. Childhood trauma is pretty ubiquitous. We all [00:03:00] have some of it and have developed some adaptations to it.
But she says codependence is this disorder of immaturity rooted in childhood trauma, particularly in families where emotional needs were unmet or inconsistently met. Well, I think that's pretty much all of them. I think some families did better than others, but certainly those of us who maybe grew up more than 20 years ago, it was a lot of suck it up buttercup and maybe our emotional needs were not completely met or inconsistently met. Her framework includes five core symptoms of codependence and she emphasizes the importance of reparenting the self, setting healthy boundaries, and reclaiming one's emotional reality.
Her work has influenced countless therapists and recovery programs worldwide. And I'll say learning boundaries is a big part of her work about recovering from codependence. And I saw a meme the other day that just summed up medicine. How did you get into [00:04:00] medical school?
Well, I was good at school and bad at boundaries. I was like, ouch. Yeah, there's some truth there.
Yeah. That, that stings a bit. But I identify that I chose the right career based on those qualifications. I'm in the right place. But anyways, we'll get into what is codependence. According to Pia Melody, it's a disorder of immaturity, so, it means that our development got stuck somewhere along the way, usually because of the childhood relational trauma.
Like Laura was saying, it's not necessarily that we were physically or sexually abused or anything like that. It's just that somewhere along the way our emotional needs were either unmet completely or inconsistently met. And so we came up with some sort of way to power through if you wanna use that term.
But basically it's surviving and she describes five core symptoms of codependence. Difficulty with self-esteem is number one. [00:05:00] Number two, boundaries. Difficulty setting boundaries, difficulty owning reality, difficulty acknowledging needs, and difficulty with moderate emotional expression, which I just think I checked off all those boxes.
Dang. It's not just in romantic relationships either. It's really how we relate to everyone, including ourselves. And I think if this didn't give you a different perspective on what that self-critic and self-compassion - I know we've recently done a few podcasts on the self-critic and having self-compassion.
This may give you a little bit different perspective in order to understand that a little bit better. But in medicine, it's basically a masterclass in codependence. We're trained to silence our needs, measure our worth by external approval and over function until we collapse. Many of us were drawn to medicine because we were already wired to take care of others.
Mostly, I wouldn't even say sometimes, mostly at our own expense. We're going to explore how this shows up and what we can do about it. Okay, so let's walk through those five core symptoms [00:06:00] and see how they show up in medicine. You just heard 'em and we're all like, oh yeah. Oh boy. So low self-esteem, and this doesn't always look like what you'd expect.
It's not always like, I hate myself. Although we do hear that from doctors. We hear doctors have terrible internal dialogues, so mean to ourselves. But it's more like I am only good if my attending praises me, or I'm only good if my Press Ganey scores are high, or I'm only good if I meet my RVU marks or I'm only good if I never mess up, or I only feel okay if my patients like me.
It's outsourcing our worth to someone else's opinion, and it's so interesting hearing it. There's definitely a time I would've been like, well, how is there another way to be really? Like that's how deep I was in that. And it's trained, it's trained into us, and especially those of us who are employed [00:07:00] by systems, our worth continues to be measured in these ways.
Number two, difficulty setting functional boundaries. So saying yes to extra shifts, extra committee appointments, extra reteaching of people, extra volunteering, extra anything that is not something we really want to do and that really aligns with us and who we want to be - it's not healthy and it's not setting good boundaries. Not speaking up when a consultant or another colleague says something rude or treats you inappropriately.
You know, in training it feels like death if we speak up sometimes. We're trained not to have good boundaries. We have to learn those to escape this codependence trap. Taking on emotional burdens that aren't yours to carry because you don't wanna be seen as difficult. You know, we find ourselves, if we look at really [00:08:00] what we're doing, sometimes propping up individuals and systems that are not fully functioning.
You'll have to let us know, you know, for people out there working in other specialties, I'm sure that your boundaries are getting pushed one way or another.
The third one is difficulty owning one's own reality. And this shows up when we disconnect from our feelings, which many doctors do. There has been some research on emotional intelligence in doctors like before medical training, after medical training.
We're less emotionally intelligent, less able to name emotions and manage them than we were before medical training. So that's a problem. We deny feelings, you know, we're exposed to a lot of traumatic information like every time we go to work, odds are there's going to be some kind of traumatic either thing we see or story we hear, [00:09:00] and we just say, I'm fine. I'm fine. But without really acknowledging that and processing it, we find ourselves having symptoms like we can't sleep for three nights, or we haven't paid attention to our feelings or our body in so long that we completely burn out and don't even realize it until we completely collapse from it.
So that dissociation can be adaptive as a child. When you're in an environment where bad things are happening and you have no control, it's kind of easy to go to la la land. As an adult, it's going to further drive all kinds of health issues and emotional burnout.
And then, you know, continuing on this lovely list, difficulty acknowledging and meeting needs and wants. So this is just furthermore disconnecting, and this time it's basic physiologic needs. So skipping meals, not eating during a shift, not even [00:10:00] snacking, not trying to give your brain the glucose it needs to function at baseline and not drinking water.
And so therefore not going to the bathroom, maybe not taking time off or scheduling a vacation, but then somebody needs a shift covered so you come back a day early or wait to leave another day or whatever. You know, or telling yourself things like, well, if I ask for help, it's a weakness.
Or you know, this is a big one that we often - if we're wearing it as a badge of honor, somehow that gets in there in our brain. Like, oh, I worked seven out of nine and, you know, and I carried this person's extra shift and this person's extra shift. I don't know, it's just like the wrong version of being a team player because what we would offer up is that you take care of yourself first so that you can show up and be the best team player. Meaning you can show up, you know, full of life taking care of yourself so you can take care of others.
And then the next thing is difficulty experiencing reality moderately. So this is like when we have those bad cases or quote unquote bad shifts or [00:11:00] maybe a bad day with super stressful, complicated patients, that we come home and we might buffer and numb out. We just don't really wanna feel that, we don't really wanna go there and so we drink a bottle of wine or watch six episodes on Netflix or you know, sometimes that even can be dysregulation, like if we get called in before our next shift 'cause we want to review a case or troubleshoot maybe an outcome that we just can't even sit with that or receive that. We just completely are dysregulated. Even if it's like minor, somehow we are just not able to stay in a level playing field. We are just completely one extreme or the other.
And most of the time it's avoidance. It's trying to avoid sitting in whatever discomfort that might be. But we've talked about this before, that actually sitting in that discomfort, naming it and allowing it not only allows for growth, but then it does allow you to experience the emotions or the feelings you actually get.
You know, some dopamine and [00:12:00] serotonin from like pleasure and joy and happiness and everything. So it's super important that we feel all the feels. Okay. So to summarize again, 'cause sometimes I get lost in our list, Pia Melody's five core symptoms of codependence are low self-esteem, difficulty setting functional boundaries, difficulty owning one's own reality, difficulty acknowledging and meeting needs and wants and difficulty experiencing reality moderately. Each one of these can be masked as professionalism, but when we're helping others at our own expense, that's not sustainable. So take a moment and consider if any of these patterns are recognizable in yourself or not, but why?
Codependence might feel normal to doctors. Pia Melody says that codependents often come from families where emotional needs were ignored, punished, or inconsistently met, or, you know, maybe you had super busy parents that weren't trying to maliciously do [00:13:00] anything, but the needs that you had weren't a match with your parents.
As kids, we can learn to be hyper attuned to others and ignore ourselves, which makes sense, especially if there was like some sort of danger. I mean, when you're a kid, it is danger to not be able to depend on your parent. Maybe you've had to take care of parents' feelings for whatever reason, or maybe you only got praise when you performed.
And then we enter medical training, da, da, da. And that system often mirrors this exact dysfunction. So if you just think about it for a moment, long hours, emotional suppression - I feel like the emotional suppression part is almost a learned defense mechanism because we do see some terrible stuff across the board.
And we're in a high stress environment, and so really feeling like we've gotta armor up or you know, have that personal defense mechanism. 'Cause if we did take in everything that we saw in the moment, it would probably be too much to bear. We'd probably [00:14:00] walk off shift. But also harsh criticism, perfectionism, all of these really contribute to that mechanism of codependence or feeling like it's actually normal because these are actually the things that we need to make it through medical school, through residency and into attendinghood. And we are taught that needing rest or reassurance is actually a weakness. Even though it seems counterintuitive because we look for so much validation externally, but yet we're taught that if we need reassurance, even if it's not coming from an external source, but even reassuring ourselves is a weakness - it just doesn't make sense in our brains.
And so if you're already codependent, medicine just might feel familiar and kind of comfortable. Yeah. Brené Brown puts it this way. When you say yes to others, make sure you are not saying no to yourself, but how many of us were trained to believe that saying no is selfish or to look down on people who were taking care of themselves, that [00:15:00] boundaries, I don't know.
We learned nothing about boundaries. I mean, and that worth is something you earn 100%. That was, that was the story in, in training, at least for sure.
Yeah, and I think if you did pick up some of these messages it's probably not abnormal. It's not your fault. And there's a good chance that these traits were adaptive at one time.
I mean, you're doing the best that you can with what you have at that time. It makes total sense why you might have picked up some behaviors like this. They helped you to survive, but as adults it is important to start noticing if some of these traits are keeping you stuck. Yeah. So let's get into maybe sharing one thing or two that we wish we'd known earlier in our careers that we can reflect back on and yeah.
One of the hallmarks that the podcast I had listened to about the high functioning codependence was [00:16:00] she said, if you overhear someone's conversation and they're, you know, stressed about something and you have an urge to go fix it for them, that that's a sign you're codependent.
And I was like, what? Well, I know what could help them. Why would I not say, you know, have you tried this or this? That's something that was really eye-opening to me about my own boundarylessness is that yes, I have overcome a whole lot in my life and I've learned a whole lot, and it's not my responsibility to fix everyone else's problems, even if I know the answer.
If they don't ask me, it's really none of my business. And so that's been super eye-opening. It's not my business to try to help other people function normally. That's not what makes me a good, worthy human. I'm good and worthy just because I'm here and because I'm doing my best.
I don't need to [00:17:00] be super woman and go save the day for everyone. So that would've saved me. That would've saved me some hassle and angst because it's annoying when people don't take your advice, even when they didn't ask for it. That's, oh, like don't just give unsolicited advice. Yeah. One thing that I think is important is to realize - Kristin Neff talks about common humanity. You don't earn worthiness with your flawlessness. You don't have to earn the right to eat during shift or go to the bathroom. You don't have to earn the right to rest.
You are worthy. You get to be cared for and respected as a human being just because you exist.
I think one thing that I wish I would've known was that boundaries aren't selfish. They're actually essential. And in my recovering people pleasing anonymous group - I'm the one and only member, but [00:18:00] I don't think I'm the only member, but I'm a former club member.
But that was part of my people pleasing, like, boundaries didn't even enter the equation because I was so focused on people pleasing that I couldn't even hear that or it didn't make sense to me. 'Cause I'm like, that doesn't align with what I do, I people please. So yeah, I had to check myself.
But that is one of the things that I probably implemented first in my journey to come back from burnout, was when I came back to the shop that I work at now, that was the same place that I walked away from and quit because of the first boundary that I set. I named it, you know, in the name of patient safety, but it really was a boundary. If this happened, I will do this. Or if these two things happened I would walk and so they happened. But it still took me a couple of months because I was so connected to my partners. We had an amazingly strong, reliable bunch of amazing doctors who are super smart and just [00:19:00] awesome to work with every single day. So even when I had set the boundary, I didn't realize I set it and it happened and I still took time. I battled so much with it just like feeling I was leaving the group, letting my group down because that's really what meant the most to me outside of direct patient care. But I honored that boundary and then where it served me was coming back, the contract I signed, the way I negotiated the measures for which I would return to this place was on my terms.
And I was very confident and clear as to what I was willing to do. Even coming back in a leadership position, I was very firm as to, okay let me see the job description, what does it entail? And then this is what I will and won't do, and this is how much I'll, you know, blah, blah, blah, blah, blah. And so that actually did serve me retrospectively in that I realized what that was and how to get clear on what was most important and how [00:20:00] far I was willing to go and staying in alignment coming back on my terms.
And so that was definitely one of the things I felt like was essential on my return. Yeah, it's interesting. I had a client who's looking at maybe changing jobs and had looked at a place and they basically gave her a letter of intent that she had to sign before they would even give her what any job terms were.
Like what? That's how boundaryless these places expect us to be. Like, no, you, you get to work with us. We will tell you what that means after you sign the paper. It's like, it's creepy. Doesn't seem unreasonable to know what you're signing up for. No. Maybe I'm crazy. Apparently. Yeah.
All right, so reflection prompt. Dear listener, does any of this sound familiar? Do you notice where you're over-functioning? Do you know what that means? That means are you doing what's your responsibility plus a bunch of other people's responsibilities. [00:21:00] Are you doing things for people that they can do for themselves? Sometimes that shows up in our relationships with kids. Where do you deny your own needs? And like, just notice it. There's no judgment. I mean the term codependence, you know, you can take that or leave it. It is interesting. It does show up so much prominently in families of substance use, but it is really present in I'd say more than half of family systems would be my guess, definitely to one degree or another. There is just a way of being where some people just identify in that way as someone who is an over-functioner, someone who makes things happen even if someone else is saying they can't or doesn't want to, but really would be best for them to do it. Just notice where that happens for you. And no need to judge it. Just decide [00:22:00] what you wanna do with it. And how well do you know what boundaries are and how to set one and keep it.
And the reason we wanna keep boundaries is that's what keeps us full and healthy. If not, we leak out all over the place and wind up completely depleted and resentful. So super important for us to know and understand how to establish and hold boundaries and just, just some things to ponder.
Yeah. So we will continue this conversation and next time we'll talk about how to start untangling from these patterns. So it's not so much about anything in yourself that needs to be fixed or we need to remedy or diagnose and treat, but it's really just about finding your way back to who you are.
So if this episode has resonated with you, as always, we'd love to hear from you. Leave us a review, share with a friend. Message us about your experience [00:23:00] with codependence. We'd love to hear it. Email us at [email protected] and always follow us on the socials. We love to talk about all of these things, but plus we always put up our favorite memes about these things, so it's always enjoyable and we're excited to announce that we are back this year.
If you're planning on attending ASEP Scientific Assembly 2025 in Salt Lake City. We will be honored to have you be part of our third annual event called the Happier Hours. So join us, we're gonna launch - we're gonna launch the website really soon. So stay tuned for details and see where you can be a part of where physicians meet up and create community and connection.
So until next time, you are whole. You are a gift to medicine and the work you do matters.
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