Welcome to the Drive Time Debrief with the Whole Physician, a podcast to burnout-proof your medical career with candor, humor, and encouragement. You've spent tens of thousands of hours learning how to care for others, but now it's time to learn proven tools to care for yourself. If you're tired of feeling stuck, disillusioned, and exhausted, you're in the right place.
Start your journey to bring back contentment and purpose. Now, here are your hosts, three board-certified emergency physicians, Doctors Morrison, Cazier, and Dinsmore.
Hey, guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we are continuing our series on schema therapy and the early maladaptive schemas that commonly show up in physicians specifically. In the last episode, we talked about self-sacrifice and subjugation, the schema that turns many physicians into the person everyone can count on—oh, except themselves.
So today we're talking about two schemas that are deeply connected to physician loneliness, and that is emotional inhibition and emotional deprivation. These are the schemas that can make doctors look calm, capable, composed, and self-sufficient on the outside, but inside it's a different story. They're feeling numb, lonely, disconnected, or quietly desperate on the inside.
So emotional inhibition says, "I should not feel this." Emotional deprivation says, "Even if I feel it, no one would really be there anyway." When those two go together, you get the doctor who needs absolutely nothing. It's the doctor who says, "I'm fine." They're the one in our favorite meme with the dog surrounded by fire.
But yeah, it's the one who's like, "I don't need anything. I'm not gonna ask. I don't wanna bother anybody." It's the doctor who keeps functioning. It's the doctor who can handle everyone else's emergencies but may not have any idea how to let someone into their own.
Okay, so let's start by defining these two schemas. Emotional inhibition is the pattern of suppressing emotion, vulnerability, needs, anger, sadness, tenderness, play, spontaneity—any of these feelings, actually. We don't like to feel feelings, right? Because if we did, that might also lead to feeling not safe, or maybe unprofessional, or maybe inconvenient at times, or weak, or pointless, whatever you wanna put in there.
There are lots of excuses. But emotional deprivation is the expectation that your normal emotional needs for comfort, empathy, protection, attention, or understanding probably will not be met. So emotional inhibition says, "Don't show it," and emotional deprivation says, "Well, no one's coming anyway." And together they can create a physician who is very good at functioning and not very practiced at being comforted or feeling anything, really.
And so let's make a distinction here. Emotional inhibition is not the same as emotional regulation, and we've talked about this a lot, because we don't even have words for feelings. We're not sure what's happening, right? And when we talk about emotional regulation, we first have to identify what we're feeling.
Emotional inhibition means, "I can't afford to feel this," and regulation means, "I can feel this and stay connected to myself." So that's naming the feeling, allowing it, and then choosing what to do next—that's regulation. Regulation gives you flexibility. Inhibition gives you containment, but often at the cost of things like, "I don't even feel like a living being," or, "I don't feel alive," or, "When was the last time I did something and felt alive, or felt like I mattered, or felt present on this earth?"
And working in medicine for any amount of time can definitely do that to you. So even if you see a calm doctor who may seem grounded, he or she may just be frozen—frozen in time. The unbothered doctor may look resilient, but he or she is totally disconnected, and the doctor who never asks for help may look confident, but he or she may have learned a long time ago that help doesn't come, so why would we ask?
And this matters because functioning is not the same as feeling okay. A lot of doctors are incredibly functional—actually, terrifyingly functional. We can run codes and lead a department and raise kids and balance a checkbook and pay bills and answer messages and manage everyone else's crisis, showing up for everyone on the planet, and still have zero access to our own emotional life.
And because we're so competent, other people might not notice either, because we do all this under the guise of having it all together, or once again saying, "I'm fine." And the more competent you are, the easier it is for people to miss what's underneath, and that could be a lot of pain.
Okay, so let's talk about how these schemas develop and show up in doctors. Where is this coming from anyway? Like all schemas, they usually begin as adaptations. A child may learn that emotions are too much for other people.
I'm pretty sure I've scarred my kids when I was on nights and super cranky, and they... I'm like, "When you see my eyes looking like this, this is not the time to start throwing things at each other and pinching each other and all that." But yeah, a child might learn that emotions are too much for other people.
They might learn that sadness is dismissed, anger is punished, fear might be mocked, or maybe their needs are inconvenient. A child could easily learn that comfort is inconsistent or completely unavailable. They might learn that they need to become impressive instead of vulnerable. I think that happens to a lot of doctors, actually.
A child might learn to become funny, smart, helpful, tough. They might become the spiritual leader and be really impressive in that way. They might become independent or low-maintenance instead of emotionally honest. A child may learn, "No one knows what to do with my feelings, so I'll just handle them alone." Or, even more painfully, that having needs doesn't lead to comfort—it leads to disappointment.
Again, this is not about blame. Everybody's parents were doing the best they could. This is just becoming aware that that might be your adaptation, and it might make a lot of sense. Your nervous system learns, "I'm safer when I don't need much." Or maybe it learns, "I'm safer when I don't show what I feel," or, "It's better if I just take care of myself."
And then that child grows up and becomes a physician. Surprise. Welcome. And medicine takes that adaptation—all of the ones we're talking about—medicine is particularly good at finding people who have that adaptation and reinforcing it over and over and over. We train to stay calm in crisis. We train to keep moving after unbelievably traumatic cases.
We train to compartmentalize our own emotions and just keep our heads down and get through it. We're trained to prioritize the patient, the team, the department, the schedule—literally everything above us. In many environments, emotion is tolerated only if it's brief, private, and doesn't cause inconvenience.
It doesn't slow anything down. And to be fair, in acute care, emotional containment can be adaptive. Literally, if you're operating on somebody's aorta, you're probably going to have to hold your feelings until after the case. So it makes sense. If the airway's crashing, this isn't the moment to discuss your childhood needs.
If a trauma comes in, you need access to skill, focus, and attention rather than emotional processing in that moment. But if you never come back into your body, your grief, your fear, your anger, or your need for comfort, you don't become resilient. You become disconnected from yourself.
In physicians, emotional inhibition can look like saying, "I'm fine," when you are absolutely not fine. I also see a lot of physicians who are like, "Well, this happened to me, and I'm okay," and I just think to myself, are you though? Are you really? Yeah, that begs the question—are you though?
'Cause that explains a lot. I don't think this is landing the way you intend it to, 'cause I'm thinking you might not be okay. It can look like making jokes instead of telling the truth. It can look like intellectualizing the pain. It can look like being excellent in a crisis and then collapsing in private.
Maybe you haven't cried in years, but you're wondering why you feel numb, 'cause we're not letting it out. It can look like discomfort when somebody is tender toward you—being wildly ill-prepared for a compliment, maybe, or some sort of loving gesture. It can look like not knowing what you feel until your body tells you through, I don't know, insomnia, irritability, headaches, dread, exhaustion.
Your body knows. If you paid two seconds of attention to it, it would tell you, "We're not doing well." Emotional deprivation can look like never expecting anyone to check on you. It can look like feeling embarrassed when you need comfort. What about choosing emotionally unavailable environments because they feel more comfortable?
It just feels more familiar. It can look like feeling lonely even when you're surrounded by people. I mean, right? There are a million people in the hospital, and yet so many of us feel totally isolated and alone. Maybe it looks like being the person everyone comes to, but privately feeling like there's no one you can go to.
It is one of the quiet tragedies of physician burnout that many doctors are surrounded by people all day and still feel profoundly alone. These doctors are useful, respected, needed, admired, but being needed is not the same as being known. It's not the same as being comforted. It's not the same as being connected.
And if no one sees your needs, it may be because you learned to hide them so well that no one can find them. So how do we begin to heal these schemas of emotional inhibition and emotional deprivation? The first thing we need to do is address a fear that many of us have. A lot of doctors worry that if they start feeling, they will fall apart.
And have you ever been in a situation where someone says, "How are you doing?" and you're just doing everything you can not to lose it, because someone's actually showing you some empathy and concern? It makes sense. When you've stuffed all your feelings down for so long, it can be kind of like that beach ball you shoved under the water.
You're just worried that if you let any of it come out, it's gonna explode. Or maybe you worry that if you start needing, you're gonna become a burden to somebody. Or if you start talking about what hurts, you'll be seen as dramatic or weak or unprofessional or, in some way, too much. But learning how to heal emotional inhibition does not mean we're gonna be trauma-dumping every feeling on everyone around us.
It doesn't mean you're becoming emotionally uncontained or losing your ability to function, or that you're gonna somehow start crying and not be able to stop. It really just means becoming more connected to ourselves, and we can do it in a stepwise way. It doesn't have to be all at once. It doesn't have to be a big, dramatic crying session or whatever that would look like for you.
Healing emotional deprivation doesn't mean demanding that other people perfectly meet every need. It means learning that your needs are actually real, legitimate, and allowed to be brought into safe relationships. And so the first step is just noticing. For many of us who are emotionally inhibited, jumping straight into expression feels like too much, so we can start a little smaller and just ask ourselves, "What am I feeling?
Where do I feel it in my body?" And I know that sounds hokey to some of you. It's because we're all kind of cut off at the neck in terms of being able to have any sensations in our bodies, whether we deny our need for food, for drink, for going to the bathroom. But our feelings actually do show up as sensations in our body, and they can give us a lot of good information if we just practice noticing.
Do I feel tightness in my chest? Do I feel a pit in my stomach? Do I have a pleasant sensation that's telling me something different? So just knowing that we can pay attention to those sensations in our bodies, and asking, when we think of a difficult moment where we felt like our needs weren't met, what did I need?
What did I need in that moment, and what did I do instead of actually feeling that feeling? We're not trying to fix emotions. There are no bad emotions. We're just trying to notice that they exist, and that's the first step to processing them. So you can start with the most basic words. Most of us are a little bit alexithymic, or emotion-blind, and a lot of us can only name a few emotions, but we can just start with those first, basic ones.
Mad, sad, glad, scared, ashamed, lonely, hurt, tired. We often want the most precise language possible, but we don't need to have really good emotional granularity or detailed emotional language at first. Just beginning with those basic words is great. Starting with what's true—what is it that I'm actually feeling?
And the next step is separating the idea of privacy from secrecy. Privacy is healthy. You don't owe your inner world to everyone. You don't have to share anything you don't want to share. But secrecy is different, and that's where we have this feeling that this part of me must stay hidden because it's unacceptable, burdensome, or unsafe.
And a lot of doctors call that privacy when it's actually just loneliness. And the best way to connect with other human beings is by showing a little bit of vulnerability and asking this question: "Is this private because I'm choosing discernment, or is this secret because I'm afraid of being known?"
And there's a big difference there. The third step is practicing tolerable honesty. Not full emotional exposure, or a five-hour processing session, or telling everyone everything—it's just one honest sentence with a safe person. Like, "I'm having a harder time than I'm letting on. I don't need you to fix this, but can I just share it, because I don't wanna be alone with it?"
Or, if they're offering advice, as many of us do—because we want to try to fix the bad feelings of the people around us—just say, "I think I just need comfort or a listening ear and not advice. I'm used to handling things alone, but I don't wanna do that right now. I feel embarrassed even saying this, but I need some support."
Something about that case stayed with me. And if you have a case that keeps coming up in your mind, it may be your mind telling you that you need to share it, that you need to externalize it in some way. So find a safe place to do that. Tolerable honesty is how emotionally self-sufficient people learn to be connected with other people without getting completely flooded.
And then the fourth step is strengthening the healthy adult response. Emotional inhibition says, "Don't feel this." I think of Elsa: "Conceal, don't feel. Put on a show. Make one wrong move and everyone will know." Sound familiar? It's not healthy. Emotional deprivation says, "No one will be there anyway."
But the healthy adult says, "Of course you feel this. It makes sense. You don't have to handle this alone anymore." The healthy adult does not shame the need and does not demand that every person meet the need perfectly. It simply says, "This need is real, and I can respond to it with care." So that's the work.
It's not about becoming needy or demanding that everyone fill all your emotional needs, but about acknowledging that we have some emotional needs. It's not about becoming dramatic or losing our ability to function. That's not gonna happen, okay? If you are a doctor and you've made it to where you are now, that's just not gonna happen.
But this helps us become more alive, more connected, and less alone in our own lives. So I'm gonna share a little example. Imagine a physician has a difficult pediatric case, and during that case she performs beautifully. Maybe she's running a code, maybe she's in the operating room. She's calm, focused, decisive, clinically excellent, and afterward, everyone moves on.
There are busy things happening, and there are more patients to see, charts that need to be done. There's always another crisis to attend to. It was a painful case, and no matter what the outcome, the one that always comes back to me is this: I have this very distinct memory of putting a chest tube in a three-year-old who'd been shot, and she didn't make it.
And, you know, the schema of emotional inhibition might say, "Don't feel this. There's no time. Just keep moving." And it might say, "No one is gonna know what to do with this anyway. Don't bother needing anything." And you might have a coping style of shutting down or going numb or just acting like you're fine—maybe you scroll, or eat a bunch of junk food, or drink too much alcohol, or shop too much, or do something to stay busy so you don't have to feel it.
Or maybe you become hyper-controlled or critical or irritated, because that tenderness, that sadness, feels too exposed. And the healthy response sounds different. It says, "That was a hard case. Of course it affected me. I can still be a strong doctor and need a moment of care." And I'll offer that that actually honors not only your own feelings—it honors the lives of the people we care for, it honors our team members, and it's really important.
It might be a small action—stepping outside for two minutes, putting a hand on your chest, or having a two-minute debrief with your team. It might be telling a trusted colleague, "That one really got to me." It might be texting someone after work and saying, "I don't need you to fix anything, but I had a hard case, and I don't wanna be alone with it."
That is schema healing. That's teaching our nervous systems that our feelings matter and that we can get our emotional needs met. We're not falling apart or oversharing. It's just telling the truth sooner and with more kindness.
So this week, we want you to notice where emotional inhibition or emotional deprivation may be showing up for you. Where are you saying, "I'm fine," when you're really not fine? Where are you functioning instead of feeling? Where are you calling it privacy when it may actually be more like loneliness? Where do you assume no one will show up for you before you've even given a safe person the chance?
And where might your healthy adult say, "Actually, this need is real, and this feeling makes sense, and I don't have to handle this alone anymore"? 'Cause remember, being needed is not the same as being known, and being competent is not the same as being connected, and functioning is not the same as feeling okay.
So next episode, we're going to dive into defectiveness, shame, and approval-seeking, the schemas underneath so much physician imposter syndrome. So 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 link below, or click the button and give us a rating and review—it also helps other physicians find our podcast and moves us up on the list.
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