Amanda: Hi guys. Welcome back to the podcast. I am Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra.
Amanda: And today Kendra's gonna take the helm and introduce our topic.
Kendra: Okay guys, so this is actually something that's truly part of my testimony in life and something that's near and dear to me that I actually overcame and the first part was awareness. So, Brene Brown, we love Brene Brown and her Atlas of the Heart. Her chapter on shame and guilt and it also includes humiliation and embarrassment, but we'll talk about that in another podcast. We really felt like this podcast should be dedicated to shame and guilt because I think a lot of what also gets instilled in us as professionals is we always talk about that perfectionism.
And perfectionism actually comes out of us really trying to avoid a feeling of shame or going down that shame spiral, or if we do make a mistake, the reason we are perfectionist, cuz we can't accept it, we go down the shame spiral. So it does kind of over arch into several of our pain points as physicians.
But first, I will just give you a perspective on how she puts it in the book of what shame is. So shame kind of says, “I am bad”. So the focus is on self, it's not really on a behavior, it's actually on self. You actually label yourself as bad or negative or not good enough. And so the resultant feeling, so you think, “I am bad”, and then you feel unworthy of love, belonging, or connection. So it's really not a positive change driver because you just really don't feel like enough. And so you just hang on to that as kind of a self title for yourself and it doesn't really motivate you to change.
So one of my first experiences with this was actually in college and I'm in my pre-med classes and I had never got a C before, but I got a C in organic chemistry and it devastated me because in my mind my thought was medical doctors do not, not get good grades in their main classes, like chemistry, A & P, Biology, whatever you took. And how it was thus reinforced to me is I went to my pre-med mentor and she looked at my transcript and said, “Have you thought of doing something else?” And I just looked at her cuz I was like actually no, I've always wanted to be a doctor. I'm on my way to be a doctor. What do you mean? And she said, “well, these grades are not the grades of someone who gets into med school.”
Needless to say I left that appointment with my head down and a new realization, if it wasn't already there. It was really apparent that I wasn't good enough and that I probably should come up with a backup plan. So that was kind of my first experience with shame.
On the other hand, guilt is also a feeling and it's more or less like I did something bad. So it's focused more on a behavior. It's a thought about that you made a bad choice and then you get that uncomfortable feeling that when we really look at it, we probably work. In a way or made the decision in a way that was against something that we value or we believe or some sort of moral standard that we have for ourselves. And so it actually can be a driver of positive change. It can say, “Hey, I messed up. This really wasn't what I wanted to do, and so I'm going to. Not even go there again and therefore, choose a healthier lifestyle. So I would say that the biggest example of my own life was I. Was in medical school and I ended up getting pregnant. I was not married at the time and it was just a big shock to me. But my immediate, cuz my comfort zone is anger. Remember I go straight to anger, I go back in the cave and I get angry. So I was like, how could I be such an idiot? I know how to prevent pregnancy, much less have sex outside of marriage because, When I grew up, one of the moral values I had was sex was a covenant in marriage. And that's my strong Christian background, and that's what I believe. So I really had a lot of guilt. Not only was it going to be rather apparent that I had sex outside of marriage because now I'm pregnant, so now I have to move forward and I'm a fourth year med student, and I'm smarter than this. I know how to do this.
So what I ended up doing was keeping it to myself, which then that guilt actually spiraled into my shame and it took me to a really dark place. And one of the things, Brene, I love what she says, the three things about shame, shame feeds on silence, secrecy and judgment. So, I had plenty of judgment for myself. I was very comfortable judging myself, and I kept it to myself, and I lived in secrecy, right? So we just kept it silent. My family didn't want to talk about it. Nobody wants to talk about it. I certainly didn't know anybody else going through this. And so Brene says three things about shame. One, we all have it. Everybody has a stronghold or a struggle. Number two. We're all afraid to talk about it just because we've already done this self-judgment and we just automatically think everybody else is gonna judge us. Number three, the less we talk about it, the more control it has over us. So this is basically how I kind of spiraled into that really pit of shame was that I never talked about it. I had to tell who I had to tell, but outside of that, and so it just really got control over me. One of the things that really drives shame too is we are made for connection. It gives us purpose, it gives us meaning, like we live for connection and community. That's what drives us. When you're in a pit of shame, you actually are afraid that it's going to disconnect you. So what happens is if anyone found out, do you find yourself saying that If anyone found out I'd be kicked out of the friend group or kicked out of the residency or kicked out of the whatever, but it's just an absolute fear of getting disconnected.
So over all of the research that she did, Brene came up with a pretty impressive definition of shame, and it's the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love, belonging, or connection. And like I said, shame really thrives on secrecy, silence and judgment. So not only are you not talking about it and not telling anyone, but you continue to believe the thoughts that you are unworthy of love or belonging or connection, because even at that point it was like, am I gonna be a single mom? Am I like all these patients I take care of in the ER with all these kids and a single mom? I had to go get pregnancy Medicaid because I was a medical student. So I'm in the office looking around, seeing all the people that are in there with me. I knew I was gonna be on food stamps, wic, like my thoughts went out of control. So I definitely had some real struggles. Good news is that there's an antidote, and so the antidote to shame is actually empathy.
So once you finally stop judging yourself and actually get brave enough to deal with yourself with kindness and compassion, you can reach out and find someone that may or may not have gone through the same situation and when they receive your story with empathy and they say, “oh, I've been there, done that, and that must have been hard.”
Whatever they say, it actually starts the process of healing. Empathy is very “other focused", and so not only may it help that person that experiences the same thing, but it also, it melts away the shame and starts your healing. So, that really started, yeah, that really started my journey to healing was when I finally did reach out.
Amanda: I think that is such a powerful testimony and I completely. Can empathize exactly with what you're feeling. I probably have about 50 shame spirals at one time. Some big, some small, but man, it's such an isolated place to be and you being brave enough because the statistics are what, actually, in my own family, nobody ever spoke about it, but that same exact scenario happened to probably every other person in my family back in the day and I didn't know. Nobody talked about it cuz oh my gosh. We just don't talk about these things. We'll have a podcast sometime about my own marriage and the infidelity within it because that was a giant shame spiral that I had, but that's a topic for another day. But just getting locked in that vortex of isolation is just such a horrific place to be. So now we'll talk about self-compassion because that's the first step in healing from shame, and it first requires you to start to be kind to yourself, and then you can be brave enough to start to share your story with somebody else. A lot of this information is from Kristen Neff, who is the director for the Center of Mindful Self-Compassion. She's also the creator of the Neff Self-Compassion Inventory. So self-compassion is comprised of three things. The first is self-kindness. The second is common humanity. And the third is mindfulness.
So the first one, self-kindness. We're going to contrast that with self-judgment. Self-kindness is warm and understanding towards ourselves when we fall or suffer or fail, versus failing ourselves with self-criticism. Recognizing that failing and imperfection is an inevitable part of life is key for self-kindness, and it's the truth. Versus when we are angry, when life falls short of expectations, and the worst for me is my own voice that I could never escape. That was constantly saying those things like, I can't believe this happened to you. I can't believe, what did you do wrong? You must suck. You know, all of that sort of stuff. And that applies to so many different things. So self-kindness is the first part of self-compassion.
The second is common humanity. Common humanity. Let's contrast that with isolation. So common humanity is the realization that suffering and personal inadequacy is just part of being a human being. It's part of our shared human experience. We all think that we're this special snowflake. I'm the only person that's ever had problems in my marriage. You're the only person you know who succumbed to hormones. You know what I mean? Like it's just crazy. Like if you, I mean, it's good stuff, right? But like of course the dopamine and oxytocin, both great! I mean, you know what I mean? But it's just absolutely ludicrous that we're the only person on the planet in the millennia of time that things like this have ever happened to. But I know exactly what you're talking about. So common humanity versus isolation. We are not special snowflakes like it is happening to everyone. And that realization, God, it is so powerful to realize you're not alone in these sorts of things. So self-kindness, common humanity, and then mindfulness.
Mindfulness is nonjudgmental awareness of our thoughts. So often we get completely sucked into the story of what our thoughts are telling us and begin to over-identify with them, whereas these are just events that happened until we start having these thoughts. There are no feelings of shame or guilt until we have those thoughts about the situation because you can be in the exact same situation as somebody else and they literally wouldn't have thought twice about it. They would've just been like, okay, well here's how things are. I know some people in my life that just roll with things like just, it's not an issue, but it's my issue around all of these thoughts that I have of self-judgment and everything else that send me into a shame spiral over and over and over. It is definitely a well worn path in my brain to just shoot straight into the vortex. If you don't know what I'm talking about, with a shame spiral, it starts with the event and it starts building into a giant calamity. Like this has happened to me when I missed a medical diagnosis before. That honestly, like I brought up myself to like medical review and my medical director and everything else, and they were all like, you're good. You documented. Great. Well, that's not where my brain went. My brain devolved into, if I didn't catch this, I. Then maybe I haven't caught it multiple times, then maybe I'm actually a horrible doctor. Maybe I'm actually hurting people out here. Maybe I suck as a human. Like do you see that? Like how one thing,
Kendra: Maybe I should just go live in a cave and not impact the world ever again.
Amanda: But that's how I was. And since I was in shame, I wasn't talking about it and I was so isolated and living in absolute misery. So that, so this is the section on self-compassion. Remember Kristin Neff, and remember, self-compassion is comprised of self-kindness, common humanity, and mindfulness. They're just thoughts, guys. It doesn't mean they're true. And that's where a coach can kind of help you tease out like, whoa, whoa, Nelly.
Laura: I am glad that you brought up a medical example, because this, I, they laugh at me because my hobby is to talk about how the medical training system is a system of narcissistic abuse, which we'll talk about later.
Kendra: This episode is coming up. Stay tuned.
Laura: But it is, and abusers use shame. Abusers use shame. And many times it's because they've been abused themselves and they don't understand what they're doing is wrong. And I think that may be the case here, but when we're going through our training, shame is just dulled out right and left. And it could be you forgot to check the patient's temperature on rounds or you're not retracting appropriately during the surgery or you got the wrong kind of coffee for your attending or whatever it is. There's lots of opportunities to feel shame while you're in training, and then later if you miss a procedure or if you miss a diagnosis, like Amanda said, or your case is the one in M&M, like these are all such shame filled experiences and at the heart of them, really is this threat of being ejected from the tribe, of being cast out and not being, not being able to even survive. I think really at the heart of it is that it makes shame so tough because it is telling us that there's a threat to our actual survival. And so it creates lots of problems. Doesn't put us in a growth mindset. Doesn't, doesn't make us think, “okay, what's my next best step?” And another one we didn't talk about is money shame. I remember being in college and I came from a situation where my parents had gotten divorced late in high school. We had been doing okay for a while before that, but when they got divorced, like suddenly no money anywhere for me to go to school. And of course I didn't wanna go to the school where I had the scholarship.
I wanted to go out of state. And so I'm in school on loans. I got a work study job. But I did not have much money at all. And I, like, I was definitely selling my plasma for pizza money. But I remember bouncing checks, like I had bounced a couple of checks and I remember that's one of the biggest, I don't know why, but this was a very potent shame moment for me when I bounced a couple of checks and it's like you said, Kendra, it's like you did something that you knew should have been preventable and you felt so dumb about it and then you kept telling yourself how dumb it was and how wasteful, is super difficult to manage, you know?
Amanda: So can I interject because I also went to college and bounced multiple checks. Never had a thought about it, just like I should clean up my finances. I literally never thought twice about it. Like, yep, I didn't balance the checkbook. That's what I'm telling you guys. It's so powerful. It's so powerful. Yeah. I also, by the way, got a C in organic. The exact same story, Kendra. However, I did not visit apparently the malignant pre-medical advisor. I just was like, yeah, I'm gonna retake this because I don't see how I'm gonna ace organic 2. When I literally have no idea what, you could say that the professor was difficult to understand. That's all it took. I don't understand what she's saying. And I really do not have the basis for organic 2, so I just re-enrolled. That was it. No, you guys, it's never the circumstance. It's your thoughts and your story about it. And it's just, that's so funny. And we believe it.
Laura: We believe it so much.
Kendra: We had the same organic chemistry teacher, I think, and I did too. I re-enrolled because I thought, well, this advisor is telling me that I should have a backup plan, but I'm gonna prove her wrong. You know? That was my pride. But anyways.
Laura: Yeah, so, and I think that it's exactly like you said, that when we feel the shame, we don't talk about it, and that's where it becomes the shame spiral. So, some ways that we can become more resilient to shame is number one, to recognize what might trigger shame in us. Again, pay attention to what the facts are, the neutral circumstance. Pay attention to your thoughts about it and don't believe fake stories, like don't believe that whatever is happening is making you not worthy to be alive. It's just not true. So practice some critical awareness. Check the facts, make sure that you are understanding all the things that are driving the shame. And sometimes it is interesting to get, like, get curious about it and be like, “Why am I feeling the shame about this?” And not guilt. Guilt can be a useful emotion where we use that to make a change. Shame is just like, “I'm a horrible person.” And so what is it? Is that coming from us? Is it coming from someone else telling us that? In which case, red flag, probably need to get away from the person or situation. Run, run away. If you're feeling shame at the hands of another person, institution, individual. Then reach out. Once you have decided to be kind to yourself and realize that you know this does not make you the special snowflake of horribleness. Like you are not the worst person ever. That really this has probably happened to someone else. Find those people and talk about it. That is so incredibly healing. Just to know that you are not alone. This is what is super powerful in coaching when we're coaching other physicians is because we're there, we're able to be open and talk about the things that happen that, that we might not feel comfortable talking about in other situations. And that is so healing because we've all missed diagnoses, we've all missed procedures. We've all forgotten to gather information for rounds. We've all shown up not as our best selves with our patients sometimes. We've all done that. We've all done that. This, it's called the practice of medicine. It's not the perfection of medicine. So we've all done it and talking about it just brings so much relief.
Amanda: Can I add something too? Is that, Brene says too, your vulnerability, though. You can be choosy with that. Not everyone deserves to know your story. Not everyone's going to be careful or caring about your story. Another bit of advice. When I was going through my stuff, you can tell your story from your healed wound, probably safer than from your fresh open wound. So the people that you pull close to you when things are exceptionally fresh, be wise about that. Because vulnerability and just reckless oversharing on Facebook, probably isn't the greatest.
You know what I mean? Don't take from us that we're like, everyone should be vulnerable in all situations. There is some discernment that goes with that.
Laura: Yeah. Oh, definitely. Definitely. But don't hide yourself in a closet. I think that this is probably behind a substantial percentage of physician suicide, honestly. Is people holding on to the shame and going into this shame spiral alone and never, never talking to anyone, never getting a perspective that they're not alone, that it's common, that there's still such a worthy human being and that they're a great doctor. Still. Like, it's great doctors who do this. The crazy like criminal doctors who are out doing wacky stuff. They're not going into a shame spiral. It's the people who really care and want to be the best version of themselves. And a lot of times that they go through these shame spirals. So just remember that silence, secrecy and judgment, especially self-judgment, feed shame. And so be kind. Be kind to yourself.
Where perfectionism exists, shame is always lurking. Remember that where perfectionism exists, shame is always lurking. So if you identify as a perfectionist, look around, where is shame? Just make sure that you understand that your worthiness to be on this planet has nothing to do with your ability to do any medical procedure, your ability to diagnose anything, your ability even to clean your house, none of that. You are still that sweet little baby that arrived on the planet and is a hundred percent worthy of love, a hundred percent worthy to be here. You're here to grow and learn just like everybody else. One other thing that was shame. Many times we are comparing ourselves to other people. When I talked about my little stairwell, I like to think about going up the stairwell is becoming a better and better version of myself. When I stop and look at someone else on their stairwell, what happens to me? I'm not going up anymore. So let's focus on our own path up being kind to ourselves and not let shame have a place at our table. Not let it have a voice in our minds. Brene Brown says that she is a self-proclaimed, recovering perfectionist and an aspiring good enough-est. And while B minus work might not be enough to get you into medical school, B minus work is enough to help you be your best version of yourself throughout the rest of your life.
Kendra: Yeah, I would say too, I am an aspiring, do good enough-est, be good enough-est. And I will say that definitely, you know, when we talk about shame, it's so compelling in so many cases. And you know, part of that does start with already the thoughts that we have about ourself even, or the situation. And then you get this negative experience lumped on to, on top of it. And we know that can occur in so many different ways. We see the violence in America today. A lot of it has its root in shame or a person was humiliated or embarrassed in some way. There's just a lot of connection there. So, I hope that you were able to get a little encouragement today to identify with one or two of these things we're saying, and then also know that we are here for you. Through our own testimonies, through our own struggles, and through our own healing and recovery. We can say that we've been there in your shoes and that we would open a safe, empathetic space for anything that you would bring to a session.
So, get ready because coming up next is our next free class called “Too Much to Do and Not Enough Time: Said Every Doctor, Every Day”. This one is on time management and it will be coming up on May 10th at 12:00 PM Central Standard Time. So stay tuned for the rest of the details and if you want to become a part of this next free class, scroll down to the bottom of the show notes and click the link. And we are now offering CME for listening to our episode. So, if you would also like to claim CME for listening to this episode, scroll down to the bottom of the show notes and click the link.
Until next time, you are whole, you are a gift to medicine and the work you do matters.