This is the Drive time debrief, episode 177.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. I'm Kendra. And we have been talking about codependence in medicine. Today we're going to ground this conversation in a shared understanding of what we mean by codependence and why it matters so deeply for those of us in medicine.
And we're gonna talk a little bit about why it might be showing up for us. We mentioned in previous episodes that codependence, while this is a term I've identified with since childhood, 'cause I grew up in a home with substance use disorder, it doesn't necessarily mean that that is what's going on with us or that even happened in our childhood home.
These are patterns of behavior. Maybe someone had alcoholism generations before that started these patterns in motion. It doesn't have to be, and honestly, just working in medical culture, a lot of times the medical culture, the medical system or the healthcare system or hospital can act like someone would act who has a substance use disorder, and we find ourselves over-functioning to help keep it going.
So it doesn't mean that we're in a relationship with someone that has a dependence, just a system of behaviors that we engage in. And we're drawing primarily from the work of Pia Mellody, who, as we've talked about in prior podcasts, was a leading voice in the field of trauma, relationships and codependence.
She was a nurse who became an addiction counselor, and she developed this framework on codependence while she was working at the Meadows Treatment Center in Arizona, world renowned treatment facility. Her work really has shaped how we understand boundaries, emotional maturity and identity in adult relationships, and she defines codependence as this.
Codependence is a result of childhood relational trauma that leads to difficulty with self-esteem, setting boundaries, owning your reality, meeting your needs, and expressing yourself appropriately. We see all of this in doctors who are experiencing burnout and most of us are not aware that codependence could even have any relationship to what we're experiencing.
So in simpler terms, it's when we lose connection to ourselves in the effort to stay connected to others, we override our needs to meet theirs. We feel responsible for other people's feelings and, you know, we've said this in prior podcasts as well. Arguably, our jobs ask us to be responsible for other people's feelings through Press Ganey scores.
Like seriously, we get rated on other people's feelings about their interaction with the healthcare system, whether it had anything to do with us or not. We say yes when we want to say no, and we often feel like we have to earn love through service, perfection, or self-sacrifice. And does this sound familiar?
It does to me. If you're a physician who's praised for being the rock, the helper, the one who always comes through and yet you feel exhausted, resentful, or invisible, you're not alone and you're not broken. You might just be codependent. And the good news is that you can heal. One of Pia's core teachings can be summed up this way, and this is kind of the heart of this particular podcast episode.
Children who are not allowed to have boundaries grow into adults who don't know how to protect themselves. I'm gonna say that again. Children who are not allowed to have boundaries grow into adults who don't know how to protect themselves. So sometimes these boundary issues did originate in childhood.
What does it look like for a child to not be allowed to have boundaries? This is such an important question and central to understanding how codependence forms. And even if this didn't happen in our childhood, you're going to hear these things and you're gonna say, oh, well that happened to me during medical school or that happened to me during residency training.
We were not allowed to have boundaries when a child is not allowed to have boundaries, or when a medical student or a resident is not allowed to have boundaries, it means they're not permitted to have ownership over their body, emotions, time, thoughts or preferences. Here's what that can look like in everyday experiences.
We're just gonna talk about a variety of different scenarios that illustrate what it looks like to not be allowed to have boundaries.
So what does it actually look like when a child isn't allowed to have boundaries? Because codependence isn't just about being too nice or overly helpful. It's actually what happens when a child's developing their sense of self, their body, their feelings, their preferences, and this can be constantly overridden by the adults around them, almost like they're not allowed. And so that's crucial to understand because that's when you're really kind of developing and figuring it out and like, this is what I like, this is what I don't like. This makes me uncomfortable. This doesn't, I can do this. I'm not so comfortable doing this. So let's talk about a few examples.
So when a child isn't allowed to have physical boundaries, it sounds like this. Go give grandma a hug. Don't be rude to grandma. She just wants a hug. But grandma smells, that's what I used to say, like the creepy uncle gives you a tickle, you know, just trying to be playful, but you say stop and it just keeps happening.
Or maybe by choice you don't, or not by choice, you didn't have your own room, but even just your own space in the room isn't respected. Or even if you did have a room, you always had to keep the door open or people would barge in and out without knocking or asking for permission to enter. Or maybe you had a journal growing up where you were able to write stuff down in processing and that gets read or worse, it gets shared with the family at the dinner table, right?
Or your body isn't treated like it belongs to you. So I mean, this could be something as easy as, you know, not even getting to choose. I mean, obviously I went to public school so I didn't have a uniform, but like I wasn't really allowed to choose what I was wearing. My mom was concerned with the appearance on the outside.
So, it was like, you know, you're not wearing that, are you, you know, just those subtle comments. Then I personally later on felt the rebellious spirit came out like, well, yeah, I'm gonna wear this. But it is trying to figure out what, as a child, what you're developing into and what you like and what you don't like.
But what happens in the process is the message that gets internalized is, my body isn't mine, or my space isn't mine, and I'm not allowed to say no or worse. I just don't have a say so at all. When a child's emotional boundaries aren't honored, it might sound like, don't cry. You're fine. You're just being too sensitive.
Why are you making such a big deal out of this or out of what seems to be nothing? So instead of just allowing to have feelings, we're told these feelings are wrong, inconvenient, or too much. So what does the child learn? Well, my emotions aren't valid or I'm too much. And so to avoid being too much they shut down or hide them.
And I think I can relate mostly with that. Growing up they just weren't allowed and to credit, my parents probably weren't allowed either, you know? So it's like, yeah, you passed down what you weren't aware of, but it's interesting to see how those things later now manifest as going through med school or being the physician and basically.
I mean, I can remember, I think I've told this story before in residency, having a very bad case where the outcome was one that I did not choose, and my soul just feeling completely crushed and that I wasn't allowed to experience sadness at the bedside. So I went outside, but then I was told, get yourself together.
You have the rest of your shift. Like basically suck it up. Let's go. And so further discrediting or stepping down my humanity that you're not allowed to have. Right. Well, you know, like, I just would like to say too, because as we go through this, these are gonna be nearly universal experiences because our parents just didn't know.
I mean, I've done some of these things to my own kids and I'm like, oh, it's so cringey. Mm-hmm. We can give credit where credit is due in that most of our parents did better than their parents did, and their parents did better than their parents, so, oh, for sure. We're just learning, this is just information to help us understand why we got in this situation to begin with, and so no blame.
It's just like, oh, okay. Yeah, that wasn't the most beneficial thing that happened there, and I can, I can learn from it and do better for my kids in the future. Yeah, for sure. And then the last category is cognitive boundaries. So the right to have their own thoughts. So if a child says something and gets laughed at or constantly corrected with, don't be ridiculous.
They start to doubt their reality and they stop really trusting their own mind. So the internalized thought is, my ideas are dumb or maybe unacceptable, and I probably just shouldn't speak up. So Laura, I thought it was interesting that you said it could have been previous generations 'cause there wasn't any substance abuse in my nuclear family, but there was in previous generations.
And I can see in that affected parent a lot of those behaviors that then I built huge boundaries against because it was too much. But I don't know. This is all very fascinating to me. And again, I love that you said that everybody was doing the best that they could, probably better than previous generations, but this is just interesting to know.
And please, if something comes up for you, and some of these are big T traumas. Please seek out a therapist or counselor or somebody who can help you through these big T traumas because you're worth it.
You see boundary erosion when a child's time and energy aren't respected. Maybe the child is constantly interrupted or expected to be helpful 24/7 or signed up for excessive activities even when they're completely exhausted. The message that the child gets is, your needs don't matter. You're valuable when you're doing.
And man, I do think that there are a lot of physicians that equate their worth with their production, not necessarily medical production, but like a discomfort with rest, an evaluation from how much you accomplish. And that is fascinating where that comes from. And maybe this is part of it. But finally, one of the most subtle and damaging forms is a relational boundary violation.
And this is where the parent turns the child into a confidant or therapist. And I know, I know we don't do it on purpose but it happens not infrequently when the child is expected to calm down a raging parent or cheer up a depressed one, or carry the emotional weight of the household. What that child learns is it's my job to take care of others.
It's my role to fix things even at my own expense, even when it hurts me. And when this happens over and over, a child grows up without a clear sense of where they end and where others begin. They become an adult who can't say no without guilt, for instance, they feel responsible for everyone's emotions.
They override their own instincts to keep the peace, and they confuse love with self-sacrifice. They are not the same thing. That's not a personality trait, that's developmental trauma. Ouch. I haven't heard that term before, but yeah, it's developmental trauma. That's codependence. So if this hits home, we want you to hear this.
It is not your fault that you struggle with boundaries. You weren't taught how to have them so much in life. You have to be shown how to do things. You possibly have been taught how to abandon yourself in order to survive, but because we now know that the brain doesn't finish growing and adapting and transforming itself, it's never too late to learn. Every time you say, this doesn't work for me. Every time you listen to your body, that tightening, every time you pause before automatically filling the void and saying, yes, you are doing the work of healing because you deserve boundaries. You deserve autonomy. You deserve to know that you are a human with needs.
Your feelings matter. Your voice matters. Your humanity matters. And even if no one before honored them when you were little, you can honor them now.
That's really good. To really just hone in on what Amanda said, like you do have feelings and they're not too much, or you have needs and they're unique to you. They're not your partner's needs. They're not your kids' needs. They're not your mom's needs. They're your needs. And also you don't have to explain them, right, because this is the part of where somewhere in the childhood you felt like they were too much, so you shut down or you felt disqualified having a need, so you stored it away. And so now it's manifesting in a situation that might be triggered by a family member or just even in going somewhere like, you know, even just going to a park or going to a movie.
Just being in an environment can trigger this. So this is really great conversation and a great awareness of maybe digging a little deeper and figuring out that, oh, this is why I'm curious about why I cannot take care of this type of patient very well. Well, now I'm figuring it out. And so it's good information to have and it allows for that growth.
And we always talk about growth does not come without a little bit of discomfort. And so, like we said last episode, one of the really key reframes or mind shift resets is not look at discomfort as a negative thing or an enemy. We can look at it as like, okay, what does this tell me?
What if we made it as neutral as possible and just talked about it like, I'm noticing a signal here. What is this signal? The ship's going down, or maybe I just need a few crew on board to help me, you know, navigate this trail, so please. Always, always, if something resonated, if something we talked about today really struck a chord, tell us about it.
We'd love to hear from you. Email us at [email protected]. We post some amazing content, so always follow us on the socials and we love your reviews. So keep those coming and give us five stars so other docs can find us. So until next time, you are whole. You are a gift to medicine and the work you do matters.
