Episode 34 Shownotes - Challenges of High Achieving Women After Cancer

You are listening to Best Life After Cancer Podcast 34!

Well, hey, my friends, how are you today? I started this podcast a while ago, and it never came to fruition, but I am realizing it is such an issue for so many women, I really needed to just get it out and into the world. Ever have a week where things don’t go the way you planned, and it ends up with someone being angry with you? We all have had that. The worst is when you apologize several times, and they decide to stay angry. I don’t live that way, so it is foreign to me. Hard to understand and interpret. I, like many other women, am quick to label it as my fault. I try to fix it, but to no avail. Then come really great feelings like shame and fear. What will it mean if someone is angry with me? Who will they tell? What will happen? It makes me want to run and hide. As a physician, this fear sometimes comes up when a patients is angry at me. I worry if they complain, what the administration will say, what my peers will think. My brain tells me these things never seem to happen my colleagues. (which by the way is untrue – this happens to all doctors, but many feel uncomfortable and don’t share it, so we continue to feel alone.) But back to my brain. It tells me I must be failing in what I do. This, my friends, is known as imposter syndrome. It is actually quite common in high achieving women. Women who are successful, bright, loving, but inside feel like they are not good enough. That someone will find them out, and then it will all be over. That if people knew what they really thought, no one would want them on their team, no one would hire them, no one would value them. I don’t feel like this as often now as I did when I first came into medicine. I have enough evidence from patient reviews and recognition from other doctors that I am doing a great job that most of the time it stays at bay. But sometimes it still sneaks back in. And now, as I start a new phase in life, with coaching and podcasting, it has popped back up. It is crazy, right? 20 years at this job, voted by other doctors as a Top Doc in Philly multiple years running, a podcast with more than 4,000 downloads, and more. But still, sometimes I doubt myself. I doubt that people care what I have to say. If someone criticizes, my brain tells me that what I am creating is not valuable. So why do I think this is important to discuss on a cancer podcast? Because I suspect a lot of the women who listen to this podcast – the women with type A personalities who are working hard to find a new normal after cancer, have experienced this. For some, the cancer actually helped this – it made them realize that so much of the drama our brains create is sweating the small stuff. But I think for many, the cancer made it worse. Because now your brain is more sluggish, more things get forgotten, or not done the way you would have in the past. Some women might have pushed themselves relentlessly before cancer, and now just don’t have the same stamina. So you beat yourself up more. Because you look in the mirror, and see less of the sharp, trim, well put together, smart woman that you were before. This is not how we should live. If we are going to feel better long term, we need to deal with all the places that our brain is telling us we are lacking. We owe it to ourselves to work through this. To allow ourselves to not be perfect and not jump to the conclusion we are failing. And even more so, to not take on other people’s judgements and angst. To allow them to be wrong about us, instead of telling ourselves that they are right, and believing whatever unpleasant things they say are true.
But let me take a step back. What exactly is the imposter syndrome? The term impostor phenomenon was introduced in 1978 in the article "The Impostor Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention" by Dr. Pauline Clance and Dr. Suzanne Imes. They defined impostor phenomenon as sense of self-perceived intellectual phoniness. The researchers investigated the prevalence of this internal experience by interviewing a sample of 150 high-achieving women. All of the participants had been formally recognized professionally by their colleagues, and had displayed academic achievement through degrees earned and standardized testing scores. Despite the consistent evidence of external validation, these women lacked the internal acknowledgement of their accomplishments. The participants explained how their success was a result of luck or hard work over intelligence and abilities. The researchers determined that the women who experienced impostor phenomenon had symptoms of stress, depression, generalized anxiety, rumination and low self-confidence. Clance and Imes stated that the impostor phenomenon was less prevalent in men. Following the publication in 1978, though, more research has determined that this experience occurs in demographics outside of just high-achieving, successful women. Studies suggest that more than 70% of people experience the impostor syndrome at some point in their career.

This is described some places as the imposter cycle. It is thought that we start down this path with a graded or achievement-related task. Thoughts about the assignment may bring feelings of anxiety, self-doubt, and worry. The cycle describes two possible reactions that stem from these feelings. Some people will respond with over-preparation and others with procrastination. With procrastination, this eventually turns into a frantic effort to complete the job. Once the task has been completed, there will be a brief sense of accomplishment and relief. But if positive feedback is given once the work has been completed, the individual will discount the positive feedback and attribute it to luck.

Conversely, if the person responded to the assignment with over-preparation, successful completion will be thought of as a result of hard work. In the impostor cycle, gaining success through hard work or luck is not interpreted as a matter of true, personal ability. This means that it does not matter which mechanism is used to complete the task. Even if the outcome results in a positive response, the feedback given has no effect on the person’s perception of personal success. This leads to discounting positive feedback.

This sequence of events serves as a reinforcement, causing the cycle to remain in motion. With every cycle, feelings of perceived fraudulence, increased self-doubt, depression, and anxiety accumulate.
Although impostor phenomenon is not a pathological condition, it is a distorted system of belief about oneself that can have a powerful negative impact on an individual's valuation of their own worth.

If you have never experienced this, be grateful! Sometimes, it is hard to even know where to start if you are someone who sometimes feels like you are not enough. But for sure, it starts with being aware of the voice in your head, and what it is telling you. That voice thinks it is doing a good thing, pointing out our shortcomings to try to keep us safe. The voice in our head thinks it is dangerous to try to advance, to stick out from the crowd. It wants to keep us safe by keeping us solidly in the middle of the pack. But that part of our brain that was hyperaware of danger in the form of wild animals in the past is less useful in the board room, hospital, court, office or other places we strong women congregate. So, be aware of what it is telling you. First, get these thoughts out of your head and onto paper. This is called a thought download. It takes all of what is in your head and gets it out so it is not swirling around in a crazy mixed up soup of emotion. That gives us a bit of relief and ability to take a breath and honestly evaluate the situation. Then, reread what you wrote. Look for things that are FACTS. This means provable in court. What a patient or client said can go in this category, if you use the exact words that they said. It can include exact outcomes (lost a case in court, patient had a specific side effect from treatment). All the drama comes from what we tell ourselves those things MEAN. For me recently, I had someone posting things on my Best Life After Cancer Facebook page. I want to keep that as a place for help, support and uplifting of others, so I asked the person not to post certain things on my FB page. The person said a lot of things, (their exact words are facts) but the real issue is what I made it mean. For me, being told they didn’t like that, and didn’t want to be a part of it any longer translated in my brain to I am a terrible person and coach. When we really look at what our brain is telling us, we need to evaluate. If it is telling you all the awful things – you will lose your job, someone will see you’re a fraud, what you are doing is not valuable, evaluate. I evaluate this in 2 ways. First, I ask myself, “Are these things even true? What is the LIKELY outcome of the situation, if you lean in and don’t try to hide from it?” My brain will often tell me I am going to crash and burn like a fighter plane shot down over the jungle. But honestly, the usual outcome it is not going to be getting fired, sued, disbarred, blocked from partnership or any of the things that part of our brain tells us might come to pass. Write down what is swirling in your brain. See what is FACTS, what is LIKELY and what is just DRAMA that your brain is telling you MIGHT happen. Then decide how you want to show up. Is it ducking your head and cringing? Shame makes us want to do that. Personally, I want to show up honest, problem focused, forward thinking. If there is a problem, I don’t want to hide and wait for it to get me, even though shame is clashing it’s cymbals inside my temples and telling me that avoiding is best.

The second way I evaluate these types of things in my life is after I figure out what is true and what is just my brain’s drama is to take a minute to explore – in what way is what the person said absolutely true? This is where growth comes. That is, if we can stop freaking out and get out of the drama and look at how we are part of the problem. Because even if we can never control what someone else thinks, says or does, we need to evaluate the part we played and decide if this is how we want to show up. I will give you two quick examples, loosely based on real examples from my life. From the example before, someone posts something on my page that does not bring the energy and learning that I want on my page, and I ask them to stop. They get angry and cut ties. In this case, as I evaluate, I see that the words I chose to have the discussion may not have been the best words, because I want to come with love, support and service, but I do want to have the page as a safe, uplifting place for all survivors. I learn that I can do things in a better way, but I do want to stay true to myself in creating what I think is the best space for those who want help. I see that I believe that this interaction may have consequences, and I work through my thoughts on this and decide how I want to proceed. I have learned from this, which is so beneficial over just telling myself I am failing, right? And if one person decides not to be a part of what I do, this is not a problem. It is ok. I have heard other entrepreneurs say, “I may be the sweetest peach on the planet, but some people only like apples”. I wasn’t the right support for her.

Then, there are times when we take action that feels really uncomfortable, and leads to people saying harsh things that we KNOW come from the right place in us, and with those, we need to understand that the fear thoughts need to be addressed so that we don’t shy away from difficult conversations. For example, over the years I have had patients that I treated that had challenging family members. Sometimes, the family is so angry about the diagnosis that they are truly making it almost impossible to give the patient the care they need. I had this happen once, and I chose to call out the family member. The person said I had the worst bedside manner they had ever seen, and they would be taking this to the hospital administration. I held my ground, because I KNEW the patient needed me to be her advocate. I didn’t yell, or get angry. I let the family say what they wanted, allowed them to be wrong about me and continued to press for what was right for the only person who mattered, which was the PATIENT. Not my comfort. Not the family member’s happiness. Ultimately, the patient, and getting what was right for her. After the encounter, I had all the thoughts – I will get fired. This is a disaster. Just what I need, an irate family calling the administration. But I did the work on my thoughts, and realized I would take the same action, over and over again. There was nothing I would do differently. Surprisingly, and honestly, quite touchingly, the family member came back and apologized and had a complete turnaround in our interactions following that. Ultimately, they even applauded my grit to not back down and only do what my patient needed.

So the bottom line – we need to live in integrity with ourselves. We need to say what we need to say to be our own advocates. We need to not be too fearful that someone won’t like us, or that what we say or do will have negative consequences. When our brain starts to tell us that making someone else angry or having someone say they disagree is a problem, and we let that change how we act, that is when we REALLY have a problem. If you are living in a way that is focused on people pleasing, you may not be making the best decisions, for you and for others. Sometimes, people need the hard truth, not what will make them happy.