Hi, guys. Welcome back to the podcast.
I'm Amanda.
I'm Laura. And I'm Kendra. Today's episode is for the women physicians. However, if you're listening to this podcast, you know a woman physician, and you probably love her.
So today we are welcoming on the podcast Dr. Jennifer Reid, who is a board-certified psychiatrist. She trained at Columbia University and UCLA and serves as clinical faculty currently at the University of Pennsylvania and Cooper Hospital. Dr. Reid is the author of a book, Guilt Free, as well as several other publications. She also is the host of her own podcast, A Mind of Her Own, which provides helpful and accurate information about mental health treatments. Her work has appeared in The New York Times, The Guardian, and Psychology Today, and she's been featured in The Next Big Idea Club as a must-read author and has won multiple academic teaching awards. Welcome, and thank you for coming on the podcast, Dr. Reid. Thank you so much for having me. This is such an exciting thing to look across three faces of physicians here to talk to.
It's really fun.
Good morning, Dr. Reid. It's so great to have you. Tell us a little bit about this book called Guilt Free. Thank you, and please call me Jennifer. I'm happy to use that. So Guilt Free is a book that I wrote as a psychiatrist but also as a busy working mom who was struggling myself with guilt over many years, and talking with my sister, who's a breast surgeon, about her own feelings of guilt.
And so many women in my practice, including women physicians that I was seeing, were describing this feeling, not always called guilt, but I'm not doing enough. I'm not enough. I'm not productive. I need to do things more. Why can't I handle things better? Just this kind of constant message, and I wanted to find a way to really describe it and share what I do with individuals in therapy in a book form, right?
Try and get that information out there. We know there's a shortage of psychiatrists and therapists, so how do I deliver this message in a way that people can receive? That's amazing. I know that's gonna be resounding with a lot of our listeners. So thank you so much. I already feel seen.
Guilt in women physicians hits personally for you and all of us here together on this podcast, but tell us a little bit more about that. Well, I really see the combination of growing up as a woman in this modern era and being sort of socialized as a physician. There's a lot of overlap there in what those expectations are, and we can talk about some of the key expectations women face that create guilt.
But this idea that we need to be constantly taking care of everyone else around us, I mean, obviously, that's in the job description as a physician, but there's a sense of omnipotence that we truly can prevent bad things from happening, fix things that do happen, anticipate the future of what's going to happen, and that we have to take responsibility for everyone else's experiences, which we certainly feel as women.
But I think as healthcare providers, our sense of responsibility, which is really socialized into us over and over again, these are our patients, right? It expands far beyond our actual ability to control anything. As you very well know, as ER physicians, things come in and you just react to them as best you can, but you can't control all the years leading up to that person presenting to you.
So I think there's this powerful overlap, women and then healthcare providers of all stripes, and then when they come together, it's this perfect storm of guilt based on this caretaking expectation, based on this responsibility that we carry trying to do things perfectly and really have it all. Yeah, that makes sense.
I feel like it did probably start well before we got into medicine. That's a really good point. But unfortunately, then when you go into medicine, maybe it's a little more augmented or maybe we feel as if to show up, we have to take it maybe to the next level. I don't know. It seems out of proportion maybe at times throughout training.
And then, of course, when you get into attending hood, then there's multiple layers. So that's a really good point. But yeah. Why do you think women experience so much guilt? Well, I wanted to have some way that we could examine guilt in our own lives across contexts because, you know, we all have so many different roles.
We're daughters, we're mothers, we're friends, we're physicians, we're volunteers, et cetera. And so I sort of came up with the guilt equation, which is based on many concepts out there. But the idea is simple. It's just that guilt is our expectations of ourselves in a role minus our perceived reality. So minus what we notice we are doing.
And perceived is really important there because it's not actual reality. It's not like we're all having a very clear list of the things that we're doing that we're paying close attention to. We often focus on what we haven't done yet. So the equation is really a way to say, "Okay, what are my expectations in this particular role, and what is my perceived reality?
What am I actually doing? What am I noticing I'm doing, and how can I actually square those up a little bit closer?" So I think when it comes to women, I think that expectation piece is huge, and I think it's ever-increasing because we're just accumulating. It's additive. We've been enabled to increase our opportunities.
We are all women in medicine, which is wonderful, and we do make up the majority of medical students at this time. But guess what? The expectations that maybe our mothers, grandmothers, and their predecessors carried forth haven't really dissipated. We still are expected to do a lot of the things that they did even in the absence of working outside the home.
We know they were working very hard in the home, but not so much in a career otherwise. So those expectations are massive. And I think because we're all fairly ambitious go-getters in medicine, we do pay attention to what we need to try and do better, how we can grow, how we can change and develop ourselves.
But then I think we are more prone to missing out on what we're doing well. As you may know, many of your peers have that feeling. Like I think about her, she's so miraculous, and she's telling me that she just feels guilty all the time. Right. I like your equation because that takes a nebulous idea and puts it into something that we can almost measure.
But then on the other hand, aren't we supposed to have high expectations? It sounds like having unreasonably high expectations, unachievable expectations, is detrimental to us then. Right, because if you are over and over again unable to reach unreachable expectations and you think that means you're a failure, you can see how this is just this constant sense of failing, right?
If I think I can be-- For example, my parents, my father was a physician, my mother stayed home with us, and in my mind, and I've realized this as I've been writing this and talking about it, my expectations of self were that I could do both what they were doing perfectly, right? I could be the doctor that could see everybody that had any need, always available to them, always reading, keeping up with absolutely everything, and I could be this fantastic mom who's cooking homemade meals and baking her own bread and raising pets that all the kids loved.
I mean, all these different things. These expectations, yes, we should expect things of ourselves. Yes, we should try to grow and be ambitious. But I think it's when not meeting this expectation means that we see ourselves as without value or as somehow flawed or inadequate, that's where I really want to draw attention to this guilt, because it's draining us even when we think we might be trying to motivate ourselves with guilt.
It's a really costly way to do so. I have one more question before we move on to the next one. I'm already hearing some people who are deeply committed to their unreasonable expectations trying to argue, "But then I'm just settling." What would you say to them? Mm-hmm. Right. So I think that
we can have these anxious thoughts when we try to make a change. So the sense of, "If I don't feel guilty that I'm not going to the gym, won't I just give up on exercise entirely and crawl into bed and never leave?" I think we have this sort of hyperbole, these exaggerated catastrophizing ideas about what it means to give ourselves credit for what we're already doing, and cutting down on expectations that aren't serving us except to sort of place this finish line further and further ahead that we just are never able to reach.
And that's draining and demoralizing. So there's nuance here. Like anything, I can't put this in a TikTok. There's nuance to what that actually looks like somewhere in the middle. But I do think it's really important for people to recognize that guilt sneaks in all these different ways, trying to motivate us, protecting us from other emotions, showing that we care, right?
If I don't feel guilty about something in a patient environment or with my kids, that I must not care. It's like, no, there's room in between that. There's room between "I feel just terrible 'cause I can't do what they want me to do" and "I really care about them." Like, that can coexist. We can disappoint others and will if we're living and talking and engaging with people, but we can do that and still really see ourselves as loving and compassionate women.
How would you say that we carry the messages from our childhood into our adult lives, and why can this contribute to guilt? Mm-hmm. Well, when I describe socialization, it really is how have we been trained? We are all excellent students, right? This is why we're doing the work that we do in healthcare.
We have learned how to learn, and so we learn from our environment from a very young age. We learn from our parents, our grandparents, our teachers, our coaches, our friends. And part of that is this concept I like to describe as reflected appraisals, which is that we see ourselves the way that we were reflected back from those important people in our lives.
So this might come up in your childhood nickname or your childhood role. Like I was the smart one. I was the one who took care of everybody. I was the one who never got upset about things and was just always relaxed. I was the emotional one, right? Like these sort of generalizations that aren't accurate, but we carry forward.
And so it may be that that's the story we're telling ourselves now. For example, if you were someone who really, you were in an environment where your role was to kind of people please, make sure everyone was happy, maybe to even protect siblings or somehow make sure everything went okay, your parents were arguing a lot and so your role was peacemaker, as you get older, you might have more difficulty than others with conflict because it really feels dangerous.
Like, your brain has learned that I must protect from conflict even at a cost that hurts me, that disappoints me, or makes me take on more than I can handle. So you see how these messages that we're carrying forward affect how we're interacting with people around us. It's sort of our blueprint for interaction.
And the work that we're doing with so many different types of therapy, and I talk about in writing, is how do we rewrite that? How do we take these first drafts of who we are supposed to be and rewrite them according to our own values and expectations? Ooh, I really love that analogy. That's really powerful.
And I've often said that it takes kind of a special home environment to create future doctors. Like, not everyone would sign up for what we sign up for, and some of it seems like it's because it makes sense to the brains that developed in our childhood homes. So what you said really resonates with me.
What are the four main categories of unreasonable expectations that so many women, especially women in medicine, face? Yeah. Well, these four categories, as I was thinking about the women I've worked with, my own experiences, my friends and family, it was sort of like what are these key areas?
Because I wanted women to recognize that so many of us experience these. It's not just I'm coming up with this myself or I'm doing this to myself. It's like there are major categories for a reason that so many of us have been taught and repeatedly expected to respond in this way. So the four are constant caretaking.
I need to take care of everyone around me in all environments. It's hyper-responsibility or hyper-accountability, that it's my job to kind of modify how I'm engaging with others in order to try and make them feel a certain way or make sure they don't feel a certain way, right? Like I'm somehow responsible for their feelings, which even as a psychiatrist I know I can't truly control someone's feelings.
The third is seeking perfection, this idea that we've received messages, of course, for years and years both about appearance but also just moods we're allowed to feel or express or, you know, appetites in different ways, whether it's sex or alcohol or pleasure or time to ourselves. This idea we need to be perfect and in self-control perhaps.
And then the last is this having it all, which, you know, I don't want the message to be that women can't do what they want to do, because of course we can. But this idea that we're gonna have it all almost simultaneously, perfectly, without effort, without support, and without any sign that there's any part of that that's not exactly what we wanted and we're enjoying it, right?
Like being a brand new mom and saying, "The only emotion I'm allowed to feel is joy." Well, we all know, at least for me, it was a lot of other emotions. Many, you know, boredom and fear and exhaustion and joy and just so many different things. So those four areas, constant caretaking, hyper-accountability, seeking perfection, and trying to have it all, women can sort of catch these guilty thoughts and sort of plug in that equation and figure out which category does this fall into.
And frankly, when I go through this in my regular day, it hits all of those. Like so many of them are just over and over again I'm experiencing. And in healthcare, it's just only magnified. Yeah. That's a lot of food for thought there. Because I think a lot of us come into our careers in medicine thinking perfectionism is a virtue, and thinking a lot of these things that you just named are just kind of our personality or that's the way it is or the way it should be.
And so I think it's super helpful to take a pause and just be curious and question it. Are these things in fact true? Do I really want these things? So thank you for that. Yeah. I've been thinking about guilt a lot lately as a form of social control, in that if we're sort of told and taught and reminded to be looking inward and trying to fix something in ourselves, we're not looking out at the problems that exist.
And I think in medicine in particular, burnout rates are still sky high, and I think part of that is that our compassion, our altruism, our belief that this is a calling is weaponized against us. Mm-hmm. And guilt is really the result of that. And what does guilt do? It pushes us to do more, to take on more, to apologize for things we haven't gotten wrong, to try and fix a situation.
And so I think women in particular in medicine are being really stimulated to feel guilt, and then that's making decisions for them that aren't serving them and are really draining them. And I think that unless we make some big changes, this will just continue. It's almost as if somebody's benefiting from our martyrdom.
Hmm. It's weird. Imagine that. Hmm. Could it be the case? It is strange. Yeah, more food for thought. So when those feelings of guilt start coming up, there's a lot of questions we can ask ourselves about where it's coming from and is it based in reality. Hmm, social control. Yep. I don't wanna get my tinfoil hat out, but I don't think you're wrong.
I don't think you're wrong. So how can we begin to make positive changes to prevent burnout and career dissatisfaction, not to mention depression and anxiety?
Well, I think when you look at it as a social issue, not an individual issue, that's really important. My sister and I joke a lot about, you know, they mean well, but sort of wellness committees that offer free yoga classes or cookies in the break room. You know, when really what we want is more administrative support, more staffing, more flexibility in hours, reasonable time with patients, et cetera, et cetera.
So I think just knowing that this is not something we are doing to ourselves is an important step, and that's why I want -- I'm hoping women are talking to each other about this, because I think the more that we can kind of unite together working against the problem instead of working against ourselves, I think that could actually lead to more change.
I'm not saying we can fix a really broken system, but I think we can step in that direction. When it comes to what we can do individually, the guilt equation is helpful because it does point out two variables where at least we could shift our thinking and shift our approach that could maybe lead to decisions based on agency or desires or needs as opposed to guilt.
So around the expectations piece, working against that message that's telling us, "I need to keep these sky-high or else I will just stop," because that's an anxious thought. It's not accurate. Maybe you'd crawl into bed for a few days, and maybe you should, but then you're gonna get up and live your life, 'cause this is what brings you meaning and engagement, right?
So how do we create expectations -- how do we look at where they came from and maybe push back on the ones that are coming from messengers we don't really want to listen to? Social media, for example, a sort of a parent who was just never satisfied with anything that we could do, a prior version of ourselves that really thought we needed to do things perfectly to have any value -- how can we push back on that myth?
And then on the other side, that perceived reality, how do we just take more notice of things that we're doing well? Women in medicine, think about all the years you put in, the time you've put in, the patients you've cared for, how good your outcomes are. Like, can you pay attention to some of that? Because not only does it make you feel better, it also, I think, enhances your sense that I have value, and I need to be able to step into a room to negotiate for differences in administrative support or salary or whatever it might be with that sense, that strong sense of my value, because I think we undervalue ourselves as really the key players in this healthcare system.
It doesn't go without us. AI is not that good yet. So how do we kind of know our value to go in and make some of these changes? And I think peeling back the guilt just gives us more energy and confidence. Hmm. I love that. So I'm hearing you say I'm not supposed to get my therapy on TikTok.
Darn it. You know, there are some good ideas there. The trouble is the nuances, right? When I try to post quippy little things, I'm like, "But in this situation," right? Or, "But remember, this isn't for everyone." I'm like, "Okay, this has already lost the fun." So it is hard.
This is complex, right? Nuance doesn't get as many clicks probably. Yeah, exactly. Okay. Right. Well, why does guilt help us feel powerless, and how can we find a different way to cope with this difficult experience? Mm-hmm. Well, here's the thing that's so interesting about guilt, is that it does give us this sense of control.
The trouble is, though, that that sense of control is that, "Okay, it's my fault, and so I can just fix it, and this won't happen again," or, "I can prevent someone from feeling this. I can prevent this negative outcome." Thinking as a physician, I can prevent someone from getting sicker or not responding to the meds I'm giving them.
We really can't do that, but it gives us this illusion of control, and so that's, I think, one of the reasons guilt can be so sticky, is because what happens when we let go of that guilt? In a situation, we have to recognize aspects of our own powerlessness. Because we can't control all of that. When it comes to parenting, I can't truly control how happy my kids are gonna be as they grow, how healthy they're going to be as they grow.
I can do everything I possibly can on my end, but I can't really control that. So I think recognizing that guilt gives us this illusion of power, but it doesn't actually let us cope with what's truly underneath that. Maybe it's grief, maybe it's fear and sadness. Like, if we can truly name what the real emotions are, it's a lot easier to react and respond to them than it is to just kind of live in guilt as sort of a distraction from those feelings.
That's so interesting because you're turning it on its head a little bit, I think, in my mind and people's minds. What I'm hearing, though, around here, we love a cognitive distortion.
But there's a lot of internal control fallacy that we have, that somehow we are capable and able to control everything in our lives, and we see this in our coaching clients a lot, of feeling as if they've failed every outcome that isn't perfect, and yet they're not taking into account, you said this earlier, the 50 years of diabetes the person had or the entire way that they've been living for decades that led up to this visit or whatever it is.
And then the other thing that I thought I heard you getting at is that in a way, it's kind of egotistical thinking that we're in charge of the world -- is that what you're saying, or am I putting a weird spin on it? Well, I think that it feels good to think that you could fix something, that you are all-powerful, and it feels good that other people think you are, right?
That if your patient is like, "You just changed my life. You saved me," that feels amazing. And I think that it feels good for people to have those expectations of us in a number of roles, that it feels good to be seen as the one who will always get things done. "Oh, call her. She'll get it done.
Call her. She'll do a great job, no matter how exhausted she is. She'll take care of it. She doesn't have needs that go beyond. You know, she'll just show up. She'll take that shift." So I think it does feel good. I think we do have to relinquish that sense of omnipotence or that power that we might take from it because we don't truly have it, but it feels good to have people think that we do.
And so it's sort of like we have to think about what we're gaining by making this change and by letting go of some of these beliefs. We're gaining this sense of agency and confidence and removing this guilt that's just like casting a shadow across our lives. But there are things we may be giving up.
And that guilt might protect us from some of those tougher feelings, and it might be briefly motivating, and it might be a way to quickly show that we care or tell ourselves we care, but at a really, really high cost. So maybe it's much more reasonable to try to be a team player rather than the star player of medicine or life?
I don't know. Well, that brings up a great point. There was this woman, Peggy McIntosh, who talked about imposter syndrome and kind of a different spin, a different take on that, in that women feeling imposter syndrome in some circumstances may be asked to be placed at the top of a hierarchy when they actually would rather it be more of a team of leaders atop.
Like, that maybe we're more collaborative and working as a collective, which evolutionarily would make sense. This is how we raised children for eons. And so maybe there's an aspect of our desire for leadership that wants to really be more collaborative and more egalitarian and help others rise as opposed to rising above them.
And so I do think it's interesting to consider that idea of imposter syndrome. Maybe it's actually telling us we're being asked to be placed in a hierarchy when that's not what we see as the best path forward. It's inspiring to me to think about it that way, that we as women in leadership are able to potentially mentor.
Of course, this doesn't always happen. I write about this too, that there are situations where women in leadership are actually more toxic to those coming below them, and I think some of that is based on what it took to get there and the adaptations and adjustments they had to make to fit into a very male-focused career path.
Fascinating. Okay, so what is the best way -- I've loved this. What's the best way for people to find your book, to get in touch with you if they want resources or, what's out there? Yeah, so Guilt Free is available in any major bookstores. I like bookshop.org 'cause it supports all your local bookstores, and they're increasing in number, so we must support them. And then my website is just jenniferreidmd.com, and something I really, really want to point out on there is I have something called Guilt Free Groups, which are free. It's not something I'm earning money off of. It's just a way to download this guide and be able to get together with other women in a small group and kind of go through the book's ideas together.
And you can get a guide, so you don't even technically need the book, though it would be helpful. And just the idea of trying to get women in a room talking about this because I think that's where the true change happens is where we support each other. We don't police each other's guilt. That's another thing that can come up.
So people can check that out on my website as well, and my A Mind of Her Own podcast is linked on there too. I love that. Well, any last thoughts before we close? Just the idea that guilt is so costly and that it's draining and it's sort of a governor on our path forward. And so I think removing it is such a powerful act of resistance and empowerment.
So I hope women are willing to check it out and try to move forward.
Do you think that there's a healthy amount of guilt? Like, is there any amount of guilt that would be okay or acceptable? I mean, like Amanda said earlier, I can see some of our clients being like, "Ugh, I can't let go of this totally." So is there any amount that would be like, okay, that's healthy or that's moderate or whatever? Right. I mean, guilt is an adaptive emotion when it's occurring at the right time and in the right place and amount. It's something we've had for eons because it helps us come together. If we've done something that was awful and it hurt somebody else, for us to say, "I feel guilty," and move toward repair, it shows that we care about them.
So it helps to bind us together. If we felt zero guilt, well, that would be pathological, right? Mm-hmm. We would just be going around hurting everybody and not feeling anything. So absolutely, but really in modest amounts. I was talking with someone, describing it as sort of like men wearing cologne.
Like maybe a little bit will bring connection, but when it's overpowering, it's just distracting and uncomfortable. So thinking about guilt as a matter of degree, but so much of this guilt, the major part, the part of the iceberg that's under the water, is this really toxic, overwhelming guilt, and it's making women feel awful.
Yeah. That makes sense. Thank you for that clarity, 'cause I do think that makes sense and it helps put it in perspective, just like you said. We don't wanna be pathological, but we could swing the pendulum either way. Well, thank you so much for joining us today. It's really been an honor to talk about this with you and your expertise and sharing it with our listeners.
I know that it is going to resonate with so many, and you offered up some great solutions, and you really gave us a perspective that maybe will, like you said, empower us even more to understand what we're going through.
So thank you so much. Well, thank you for having me. These were awesome questions. I always learn so much in doing these interviews because like how would I respond to that? So thank you all for having me and for the work that you're doing. Thank you. And that's it for today's episode, friends. If you found this conversation helpful, the best way to support us is to subscribe, so click that button now and leave us a rating and a review because that helps other physicians find us, and it moves us up on the list.
And we'd love to hear from you, so if you've had experiences with guilt or anything we've talked about on today's show or any other show, email us at [email protected] and don't forget to follow us on the socials @thewholephysician. We love connecting with you there. And if you would love to join our weekly newsletter called The Weekly Well Check, you get bites of encouragement straight to your inbox, plus all the details about our upcoming master classes, our retreat in November, if I could drop that nugget.
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