The imposter's guide to imposter syndrome

Imposter syndrome is a concept that is having its time in the sun. Although first christened almost forty years ago in a professional article, it seems positively de-rigeur. Diagnostic concepts come and go but the extent to which they take root in the popular imagination is an indication of how far they speak to broader social phenomena. This one co-exists with increasing awareness of gendered discrimination in the work place. The article linked above is about women's experience specifically, and a recent book (Valerie Young's The secret thoughts of successful women) has expanded on the theme. Perhaps imposter syndrome might be recast as a description of the way that women have been made to feel by male dominated professional spaces.

Its widespread acknowledgment means there are some self-help interventions out there for chronic self doubters, with a dedicated website (impostersyndrome.com, the companion to Young's book) leading the way. These interventions tend to focus on a version of cognitive re-structuring, with a large helping of positive self talk. We are encouraged to "learn to think like non-impostors" by engaging in self directed pep talks. Techniques like saying out loud that we are awesome, or making a list of "at least 10 things that show you are just as qualified as anyone else for the role you are seeking." This kind of approach involves entering into an argument with yourself about the reality of whether you are or are not in fact an imposter.

Having been through that self-argumentative cycle myself multiple times, it seems to me that the big problem with debating yourself out of imposter syndrome is the corrosive skeptical worry that you might be wrong. This doesn't need to feel plausible, only possible. On self examination I can easily find areas of relevant knowledge I feel I don't have, and evidence of times I failed to meet a relevant personal standard. "OK" I tell myself, "but everyone has limitations and failures." "Yes" I snap back, "but yours are worse!"

At this point it has helped me to notice what I am up to. I suspect a degree of characterological inclination toward self-sabotage; an overly aggressive super-ego. Here the ruminations on imposter syndrome become a self indulgent cocoon. A "poor me" reclusiveness, a way to hide in an endless cycle of self-abuse and avoid hard work. I have also noticed a decidedly unattractive inclination toward self deprecation in conversations - picking up on my own defects. The result is often reassurance from others, which is presumably the point.

In fact the whole concept of imposter syndrome sets up a specific question ("am I an imposter?") and invites arguments about how to best reach an answer. The dysthymic self attends to evidence that affirms the proposition ("I definitely fouled up in that meeting; "I don't know half of what I need to in order to be competent"; "I can account for all my achievement in terms of luck rather than merit"). The positive therapeutic self is supposed to weigh evidence more favourably. But this is an effortful process, and runs the risk that (without the support of an external voice) you conclude that you are an imposter after all.

I have found it more helpful to engage a gestalt shift in attention that leaves aside the question of whether I really am an imposter. It even leaves room for the possibility that I am. The focus moves instead to the facts of any given professional situation, and to considerations of what ought to be done. Instead of looking in at the person, look out at the parameters of the task, regardless of who is undertaking it.

Viewed this way, the "imposter" question evaporates. It can even be viewed as a convenient evasion.

For the real issue in most professional scenarios is not so much you as the task you confront. The question is not "do I belong?" but "what has to happen?" In work situations you have already been selected for a job. Perhaps there was someone else on the interview shortlist who would have been better at it in some sense. Too bad. It is unlikely that person (or anyone else) can replace you imminently. The ethical thing to do is to work hard and keep your end up in the now. That will probably involve hard work. You certainly cannot save the situation by appeals to the idea you "belong" after all.

Are you going to direct your attention to the job in hand, or are you going to expend energy fretting about whether you really ought to be there? Unless you're in imminent danger of harming people (say, you somehow wound up convincing people to let you perform a surgery or fly a plane without the relevant qualifications), you most likely owe it to those around you to do your job as well as you can.

I realise this approach lacks the positive validating tenor of typical imposter syndrome self help. This is not a comment on the general validity of positive-validating approaches. It is a letter to myself, and so reflects instead my personal preferences. Deliberating over whether I am an imposter has resulted in some half hearted self-praise. But seeing the ways in which that whole game is a distraction has been altogether transformative.

Neurolit

Let me not be mad - A.K. Benjamin.
Bodley Head - 2019.
212 pages.

Into the abyss - Anthony David
Oneworld - 2020.
189 pages.


By the time Oliver Sacks died in 2015 he had become something of an untouchable. Not exactly a "national treasure" - but whatever the transatlantic equivalent of that might be. It seems strange to remember that, although he had attained sage-like status at his death (see Vaughan Bell's obituary post for a lovely example of the justified affection Sacks' inspired), he attracted controversy earlier in his career. The ethical worry about Sacks was that he was "the man who mistook his patients for a literary career;" writing for the "voyeuristic cognoscenti."

Whatever other legacies Sacks may have left, he arguably created more or less an entirely new literary genre ("neurolit" perhaps?), and every publisher of popular neurological case studies since has been keen to get "Oliver Sacks" onto the cover in some form, to provide the requisite signal to browsers.

I could read Sacks endlessly. After he died I ploughed through many of the ones I hadn't yet got to. I also worked through some of the expanding shelf of his literary progeny: Paul Broks, Suzanne O Sullivan, Jules Montague, the list goes on. As a psychologist this is all work related, but it is also a guilty pleasure - like detective fiction or spy thrillers.

Two recent books in the Sacks tradition have revealed some of the different things it can offer. A.K. Benjamin is the pseudonym for a mysterious clinical neuropsychologist who writes in the idiom of a world weary psychoanalyst. Anthony David is an academic psychiatrist and giant of his field whose first foray into popular writing is a spare but immaculate primer on psychiatry.

Benjamin's book comes with something of a "twist," for we learn by the end that some of the clinical vignettes within pertain to his own mental health problems. This device is personally revealing, but the use of pseudonym necessarily takes some of the edge off. In the end it is far from the most interesting part of the book.

I wasn't taking notes as I read Let me not be made, but so vivid and honest is the writing that much of it has implanted itself in my mind. Healthcare often involves an element of facade; of adopting a confident professional position and sticking by decisions despite the knowledge they could be wrong. Benjamin sees and - you sense - detests this facade.

In an extraordinary passage he writes of the emotional work that patients (sometimes) do to protect clinicians from the worst of their experiences. Our patients do us a service, Benjamin points out, by dying well. Most of us want a social encounter to feel comfortable and will collude with people, including clinicians to make it so. This is a form of protection, but it is coursing in the wrong direction. The person receiving the salary ought to the be the one doing the protecting. Benjamin invites us to recognise that it is often the other way round. That this is so brings into relief the importance of discomfort. If someone can make you feel uncomfortable, and you can sit with that discomfort and bear it, you might really be doing something for them.

The title of David's book seems to conjure something rather vague and mystical, but it in fact denotes a precise idea. Karl Jaspers once posited an "abyss" between the mechanistic and hermeneutic forms of understanding people. David sees the psychiatrist's task as bridging this abyss, to provide a working understanding of people that draws on both. Much has been made in mental health of the biopsychosocial model. David points out that in offering an apparent theory of everything, this idea threatens to explain nothing. Here he is on the way psychiatrists ought to related to the three strands, bio, psycho and social: "Every time we meet a new patient, we must decide which of the three, if any, is most important." (p.2) This is a punchy and pragmatic version of sense making that I recognise in the referral questions to a neuropsychology department, and it seems potentially at odds with my own profession's sometimes broadly inclusive formulations.

Each case study here seems carefully sculpted to reveal something important about the discipline of psychiatry - there is a patient with Capgras and Cotard's, who allows David to illustrate the meaning of the two-factor theory of delusions; another who illustrates the paradoxical neuropharmacological connection between psychosis and parkinsonism. Unusually for neurolit - David also includes a case that illuminates the issue of race and psychosis - allowing him to weave in some reflections on Frantz Fanon.

My own route into neuropsychology has felt weird to me - like many I was inspired by the intrigue of astonishing neurological phenomena and a desire to understand them. But I came into the field via an interest in psychoanalysis, phenomenology and mental health. What is the appeal of these books to this jobbing clinician? As a psychologist, working in neuropsychology, I realise I read them as something like a form of supervision. Academic texts give you statistical generalities, but there is nothing like a vivid account of the minutiae of clinical work and some startling clinical advice (at one point he abruptly announces to a family affected by head injury that they "will never be the same again") to help you really learn something.

A book like Abyss then is something like a series of lessons - archetypal illustrations of how people can be distressed. It expands ones clinical repertoire, opening up new possibilities for formulating complex situations. This is more or less what you would expect from a prominent expert in psychiatry. The cases are well worked through and served up with aplomb. But they are also like events from a distant past. As a clinician I envied David the unruffled clarity he brings to bear on each situation. A patient appears to recover from a crippling depressive guilt, only to throw himself under a lorry within moments of being discharged. David is unsettled, but seeks solace in Durkeim's writing on anomic suicide and emerges a wiser clinician with what reads like relative ease.

Benjamin's book offers something more emotional, and counterintuitively more reassuring. Here is an author who portrays the startling and graphic events that bring people into contact and inevitable emotional entanglement with neuropsychologists. He is vividly impacted by his patients and has gone searching in some unusual places (tibet, his own dreams; psychoanalytic theory) to try and make sense of them. But as he shows in a remarkably drawn scene of an NHS team meeting ("the decision is made, the knife is readied, and nobody who was there can quite say what just happened" - p.67), there is never really anything like a complete sense to be made. The best we can hope for is to figure things out a little better and a little more usefully. The note of horror, the terrible senseless randomness in the world that lets brains grow tumours and collide with skulls at high velocity, haunts the pages relentlessly.