Long before the use of psychedelics entered the scientific and cultural mainstream, I discovered Depakote Sprinkles. As a psychiatry resident, looking for palatable ways to administer unpalatable medications was stock in trade. In high doses, Depakote can blunt mania and decrease aggression. But what about a light dusting? A dash of Depakote on top of an ice cream sundae? Just enough to modulate my emotional intensity, minus the weight gain and hirsutism. Forget psilocybin: what I thought I needed was to microdose mood stabilizers.
Who picks Depakote as their hypothetical drug of choice, you might ask? It's not that I have bipolar disorder, or borderline personality disorder, or any other condition for which psychiatrists routinely prescribe this medication. What I am is engaged. Expressive. Emotive. When people like what I’m saying, they tell me how much they admire my passion. When they don’t, I’m criticized for being too intense. Because here’s the thing I’ve learned: There’s a fine line between inspiring people and intimidating them. And if you are a physician leader in a corporate medical environment, you’d better stay within the lines.
I reflected recently on this professional passion paradox when I read this LinkedIn post: “The biggest concern for any organization should be when their most passionate people become quiet.” I should know: I was once that passionate person. In what feels like another lifetime, I was one of my organization’s most enthusiastic and vocal physician leaders. And my evolution to who I am now, an employee who holds no leadership positions and holds my tongue, has been both deeply painful and enormously liberating.
First the painful part. It’s confusing to be praised for your passion while simultaneously being told to rein it in. Luckily, I received a lot of specific instructions. For example, a direct communication style, while efficient, is threatening to those who process information more slowly. Soliciting feedback from individuals during meetings is overly aggressive. Expressing disagreement, especially if not delivered with a smile, is unacceptable, as leaders must ensure that everyone in a meeting feels comfortable at all times. Practice more neutral facial expressions. And most importantly, stop taking everything so personally.
Hmm. I remember thinking that unless there was a line item for Botox in the departmental budget, I was screwed. But I tried. I really, really tried. Initially, modulating my communication style and limiting expressed emotion seemed like necessary developmental tasks. Over the years, mine was a multi-modal approach: a physician leadership program, psychotherapy, professional coaching, yoga, propranolol. My organization invested in developing me as a leader, and I wanted to produce dividends. Somehow, I believed that working harder to soften was the answer. If only I could grind down my sharp edges, I would fit the mold.
But here’s something you probably don’t need a psychiatrist to point out: When we’re single-mindedly focused on becoming someone we’re not, we lose who we are. And you can’t just change one part of yourself without disrupting the overarching structure of your entire personality. The effort to make myself smaller, quieter, less enthusiastic, and more contained in service of a misguided belief that this would encourage others to shine ultimately resulted in collective dimming.
After all, wasn’t my passion the very engine that fueled my desire to lead? And where else would the energy to drive change, motivate people, imagine a better future, and solve complex problems come from? And don’t our patients deserve leaders who believe that the health care status quo is unacceptable and advocate fiercely for better care?
I believe they do. And my walking around, speaking softly and carrying a small stethoscope didn’t seem to advance this goal. Paradoxically, the quieter and more detached I felt, the more positive the feedback on my performance reviews became. Perhaps it’s true that minimizing expressed emotion made me a more effective leader. Or perhaps what organizations want from their physicians is attenuated enthusiasm and cheerful conformity in service of cohesion and frictionless productivity. Maybe both are true, or neither. I agree with Anaïs Nin: “We don’t see things as they are, we see them as we are.”
And sometimes we can’t really see things at all. I hadn’t yet realized that diluting my passion extinguished my joy. But I believe that the Universe sends us signals if only we wake up and pay attention. Which is how I found myself on a walk one day, mired in internal conflict and blistering self-criticism, uncertain about my professional path, unaware of my surroundings, nose to the ground, when I saw it. A shiny black rock, different from all the rest, demanding to be noticed. I picked it up and turned it over and saw painted in thin blue letters the instruction “Be Yourself.”
Which brings me to the liberating part. That rock became my transitional object, sitting on my bedside table, a tangible reminder of where I’m headed and where I’ve been. I am no longer willing to disavow the aspects of myself that are fundamental to who I am. I decided that if I couldn’t bring all of myself to my leadership efforts, I would bring none. Because the cost of treading a middle path was too great, leading me nowhere but through endless circles of exhaustion and self-doubt. Sorry, Sheryl, I chose to Lean Out.
It's foolish, however, to walk away from something without moving toward something new. So I renegotiated my contract with my employer, and more importantly, with myself. I stepped down from leadership. I took a leave of absence. I cut back my FTE. I got a writing fellowship. I went to Peru. I began to reconnect with the parts of myself that I actually liked, back before I was told to turn down the volume.
What I needed to learn was not how to be a pallid, restrained version of myself, but how to embrace the entirety of who I am and to trust in the opportunities this acceptance will create. Now, my passion is channeled toward my patients, my relationships, and myself. I am comfortable my temperament being inconsistent with leadership in a corporate medical environment, perhaps in any environment, I don’t really know. Now, however, this realization feels less like failure and more like emancipation. I’ll defer the Depakote. Because I no longer want to lead anything — anything, that is, other than a more integrated, passionate, authentic life.
Do you feel you're able to bring your full self to work in medicine? Share why or why not in the comments.
Elizabeth LaRusso, MD, is a Harvard-trained psychiatrist who specializes in women's mental health and physician wellness. She lives with her family in Minneapolis. Dr. LaRusso is a 2021–2022 Doximity Op-Med Fellow. She reports no conflicts of interest.
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