At birth, our rudimentary brains have very few developed circuits. Through everyday experiences, we slowly develop simple circuits before the more complex circuits form. Our interactions with caregivers teach us words and shape our concepts, and we ultimately string concepts together into thoughts.
We have tens of thousands of thoughts every day, but many go unnoticed. Our brain utilizes an autopilot mode so that each day isn’t a completely new experience. Ninety-five percent of our thoughts are looped—repeating daily. Given enough time, thoughts repeated in these loops create beliefs.
Where does the content for our beliefs originate? As the circuits in our brain mature, the various stimuli in our environment, such as people, books, events, etc., inform our world experiences and thus our thoughts about them. These influences shape the moral, ethical, and spiritual development of thought.
The greatest influencers of my thought patterns were my family and my profession, in that order. I hail from a wonderfully supportive family. My parents modeled love and cohesion even though they divorced when I was five years old. My parents were full of empathy and compassion. When they told me I could be anything I dreamed of, I was spurred forward even at the hardest moments. They modeled giving with a common theme of helping with no strings attached. My parents also modeled a strong work ethic; it served me well in training.
In training, my strong work ethic and intent to be of service morphed into perfectionism. “First do no harm” is a concept those of us in the medical community are taught to adhere to. An earlier version of the Hippocratic oath stated it this way: “I will abstain from all intentional wrong-doing and harm.” Is it really that simple? So long as we don’t intend to harm, we have fulfilled our oath? Society would say no.
Health care professionals are expected to be perfect; people and lives are on the line. But health care professionals are also human, and human beings are imperfect. How do we reconcile this fact? When a medical error is made, health care professionals tend to be roasted in the public forum. Intentions are rarely of consideration; results are. Other factors which may have contributed to error (e.g., systemic issues) are rarely emphasized. We are expected to be perfect in an imperfect system.
Our expectations of self are rarely different from that of society. Perfectionism permeates our work life; it eventually suffuses our home life too. We should be all things to all people: the perfect parent, the perfect spouse, the president of the PTA, an active member to professional organizations. We tell ourselves we should be able to do it all.
Here, we do ourselves great harm.
In embracing perfectionism, we suppress self-compassion. We may show compassion to our patients, but we forget how to turn that same compassion inward. Kristen Neff is one of the foremost researchers regarding self-compassion and defines it as “being warm and understanding towards ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or flagellating ourselves with self-criticism.” We health care professionals tend to minimize our own suffering; we weigh our suffering against the suffering of others—usually finding it lacking and that, in turn, invalidates our own suffering. We additionally invalidate our own suffering when we mislabel self-compassion as self-pity. Some people do suffer more than others, but there is no suffering competition. Suffering is suffering.
It is said that failure is our best teacher. But how do we harness lessons from failure in a profession where failure equals professional incompetence and potentially negligence? The antidote is self-compassion—the yin to perfectionism’s yang.
How do we cultivate self-compassion? Kristen Neff defines three foundational elements in self-compassion: kindness towards self, mindfulness (recognition of our suffering), and recognition of our common humanity. Moving towards that goal, we must change our thoughts about ourselves—these thoughts that are recycled and have become patterned. Where do you go when defining your thoughts and feelings about yourself? Do you go to your past or to your present? Most of us utilize our past to inform our current beliefs. With these beliefs, we become authors of our own manuals of personal expectations of self and how we secure approval, acceptance, love, and connection.
How do we know what we’re capable of if we are only defining ourselves by the manual we create from the evidence of the past? We don’t! Here we are again limited by our own manual. Again, I say burn your manual! Burn this thing that defines your own expectations for self and thereby determines your own approval of self.
Health care professionals can recognize that we are imperfect human beings, and that while we can’t be perfect, we will be enough.
We can recognize our own suffering even when others don’t.
We can decide that our own suffering matters.
We can be strong enough to practice compassion with ourselves.
We can decide that we are worthy.
We can decide that we are deserving.
We can decide that evidence from the past isn’t always evidence for our future. Here, in this realization, resides limitless possibility.
Purge the perfectionism!
This is my battle cry; I’m not doing that anymore.
Cathi Whaley is a hospice and palliative care physician.
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