An ADDitude reader recently wrote: “I am a 41-year-old emergency room doctor. I know that I am good at what I do, but I am always waiting for the other shoe to drop, for something to happen that will show everyone that I am not good enough. In med school, I used these negative emotions to motivate myself to do things. When I graduated, I remember thinking, ‘Everyone’s a doctor. No big deal.’ So to distinguish myself, I decided to specialize in emergency room medicine. Now I realize that I was trying to prove something. The joke around hospitals is that all ER docs have ADHD, but no one really knows the challenges that ADHD presents. I was diagnosed when I was 39, and I’ve never told anyone about it. My colleagues, although nice, would lose respect for me if they knew. My ADHD makes me feel like a fake sometimes. It is exhausting. What can I do about this?"
The Good News — and the Other News
You have chosen a career that capitalizes on your ADHD strengths . You thrive in the emergency room because it is stimulating.
Every patient brings a new set of challenges and requires you to adapt. You are never bored at your job .
Like many high-achieving professionals with ADHD, you are using shame to motivate and manage yourself. You feel that there is something wrong with you. Shame tells you, “I am a failure” and “I am bad.” It threatens your well-being. You spend the day trying to hide your flawed self from others, and you are fearful that you will be found out.
Neurotypical people have prefrontal cortexes that act like a butler. “Sir,” the butler calmly says, “your keys are on the table.” Or “Madam, you must leave now if you want to be on time.” Many individuals with ADHD, having limited access to their prefrontal cortex, rely on their emotions to make decisions and to motivate themselves. Shame provides a well of negative emotions from which they can draw.
So instead of a tranquil butler, ADHDers have an angry neighbor threatening them with his shoe. “If you lose your keys again,” he yells, “I’ll throw this at you!” They feel bad and create emotional cues to help them remember their keys. They begin to listen for that angry neighbor to “help” them remember their keys. They learn that shame improves their performance. In med school, you probably learned that you could use your strong negative emotions to motivate yourself academically. To live more peacefully with yourself — and to be more productive — you have to find ways to challenge your shame.
The first thing to do is to look for signs that shame is overtaking you. Here are three that many ADHDers should be on the lookout for:
>Unworthiness. Do you feel unworthy and believe that when you make a mistake, it is evidence that you are worthless? There is a big difference between humility and feeling unworthy. Humility allows you to accurately assess your strengths and weaknesses; unworthiness leads to belittling yourself in your head and around others.
>Fear. You said, “I am always waiting for the other shoe to drop, for something to happen that will show everyone that I am not good enough.” You think that things will eventually go wrong and that it will be your fault. Do you fear that you are a fraud and that others will discover that you are secretly disorganized, careless, or not as smart as you appear?
>Avoidance. When ADHDers’ emotions are dominated by negative thoughts, we avoid doing things that cause us pain. What are you avoiding? Are you attending to details at work, but putting off things in your personal life because they feel negative or aren’t interesting?
Tip:The first place to look for shame is in your conversations with your colleagues and friends. Listen closely to what you say — you will be surprised at what slips out. When shame shows up in your language and thoughts, you need to challenge it. Ask these questions:
Is this shame-based thinking?
What lies am I telling myself?What would my life look like if I were to let go of this thought?
What do I need to do to move in the right direction?
Stay Out of Other People’s Heads
Hospitals are known for their competitive, political environment. For example, there are rivalries between specialists, and disrespect between teaching doctors and their research colleagues. Because of the shame you feel, you are sensitive to criticism and harsh comments, seeing negativity in messages — even where there isn’t any. Take a step back and look at social structures before assuming anything. Then ask yourself if there is anything of value in what anyone is saying about improving processes.
Tip:As you listen to a person speak, summarize what they are saying: “He is saying that…” or “She is asking me to....” As you summarize, don’t allow your feelings of shame to color the other person’s words. Thoughts like, “He probably thinks I’m an idiot” or “She thinks that I can’t do this” will not help you succeed. As a rule, you can only be held responsible for your own thoughts, so stay out of other people’s heads.
Avoid the Perfection Trap
When you finished graduate school, you commented that you thought “everyone” was a doctor and that it wasn’t a big achievement. Believing that earning your M.D. isn’t a major achievement is a sign that you are using perfectionism to keep you motivated and to achieve bigger goals. Many individuals believe that a drive for perfection is due to their type-A personality, when it is really due to their feelings of inadequacy and shame. Perfectionists with ADHD will often dismiss their achievements in order to motivate themselves to complete more tasks. They believe that they can motivate themselves by being overly critical in their self-evaluations, focusing on their flaws rather than their achievements. So no matter how well a task is done, there is always a sense of failure that it wasn’t done even better.
Tip:Instead of demanding perfection, teach yourself to value daily accomplishments, no matter how small. Ask yourself, “Do I give myself appropriate credit when I finish something? Or am I embarrassed and disappointed because my accomplishment doesn’t seem to be enough?” In doing that, you will begin to monitor your use of time and energy.
Watch for the times when you may be getting caught on the small, unimportant details in life. Ask yourself, “Would there have been a difference (spending this extra time, say) that would have been significant in the long run?” Answer that question as honestly as possible. Rather than siphoning your energy to pay the perfection meter, imagine how much better your resources could be spent, meeting other challenges. Ultimately, chasing perfection will hold you back in your life.
Don’t Invite Shame to the Party
Listen for those times when you talk negatively to yourself. If you use phrases like, “I should have…” or “I’m sure I will mess this up…,” you are tapping into shame. Your self-talk is damaging, and it needs to stop in order for you to develop healthier self-esteem.
Tip:Shame needs to be confronted. Tell your angry, shoe-bearing neighbor to stop. Some of my clients say out loud, “This is shame, and it isn’t helping me.” One of my clients has even named the angry neighbor. When negative thoughts pop up in his head, he says, “No, Frank. Not now.”
It takes courage to confront shame. One client of mine said, “I never thought I used shame, I just thought it was there to live with.” He felt that he deserved his harsh inner critic, and adds, “I am so much happier when I deal with it.”