Imposters

There have been all kinds of new and important research studies coming out this past year during the COVID-19 pandemic.  We've certainly learned a lot about the SARS-CoV-2 virus, and thankfully we have more tools in our armamentarium to prevent (vaccines!) and treat COVID-19, the illness caused by that same virus.  There have been so many research studies that have come out on COVID-19 lately that it's virtually impossible to keep up.  Unfortunately, not all of this research is good.  As one of my colleagues recently pointed out (see "A second pandemic? Perspectives on Information Overload in the COVID-19 Era"), we live in a world of almost instantaneous access to information - and not all of this information is accurate. At times, social media and the lay press have reported new treatments before they have been subject to rigorous peer review.  Take for example the case of hydroxychloroquine which was touted as a miracle drug early on during the pandemic (including by POTUS), even though the evidence suggests that it does not prevent death from COVID-19 and may, in fact, be harmful.

I do not wish to contribute to this information overload or be accused of spreading false information, but I think the evidence in this case will support my claim.  The COVID-19 lockdown has a cause-and-effect relationship with the amount of television that I have "binge watched" in the past several months.  The evidence will show that I am not alone!  Earlier this year in a letter to the editor of the journal Psychiatry Research, a group of investigators found that during the lockdown, 73% of individuals surveyed (the survey was conducted in India, Bangladesh, Nepal, and Indonesia) reported a significant increase in binge-watching.  The average time spent watching television or related media increased by 3-5 hours per day.  Just over 9% of those surveys stated that they had binge-watched more than 5 episodes of a television series in one sitting, while around 20% stated that they had watched between 3-5 episodes in one sitting.  I have to admit, 3 episodes used to be extremely rare for me, but now it seems almost average!

Thanks to COVID-19, I learned that I really enjoyed the television series, The Office (I actually never watched it when it was on regular television).  We've watched The Crown (all of it), The Marvelous Mrs. Maisel (we lost interest after the second season), Grace and Frankie (I still haven't made it through the whole series yet), and Bridgerton (do NOT watch with your daughter - we fast-forwarded through a lot of it).  The two questions I get asked on Monday mornings have now become, "How was your weekend?" and "What shows did you watch?"  Lately, my wife and I have started watching the Bravo television series Imposters.  It's a pretty good show about a group of con artists (Maddie, Max, and Sally) who work for an evil villain known only as "The Doctor."  They make their targets fall in love with Maddie, and when the targets marry her, they steal all of their money.  We've enjoyed it, but apparently the series was canceled after the second season.  So, in the next few days, we will have to find another series to binge.

Anyway (I know - this was a very long-winded build-up), as I was thinking about binge-watching in general and this series in particular, I started to think about the impact of COVID-19 on something that has come to be called "Imposter Syndrome".  "Imposter Syndrome" was first described in a 1978 paper by the psychologists Pauline Rose Clance and Suzanne Imes, who wrote, "despite outstanding academic and professional accomplishments, women who experience the imposter phenomenon persist in believing that they are really not bright and have fooled anyone who thinks otherwise."  In essence, men and women who suffer from "Imposter Syndrome" feel that they are frauds - even when there is absolute proof that they are not.  

It's now recognized that "Imposter Syndrome" affects both men and women - indeed, some studies suggest that it affects more than 70% of the population.  There is even some suggestion that the COVID-19 pandemic is making "Imposter Syndrome" worse (see here and here).  The most important thing to recognize is that if you are feeling like a fraud - you are not alone!  Almost all of us, at one time or another, have felt like we are not qualified to be in our position or deserved our status in life.  

Which brings me to the article ("Stop Telling Women They Have Imposter Syndrome") that started this whole thing.  Just a few days ago, Ruchika Tulshyan and Jodi-Ann Burey wrote a Harvard Business Review post suggesting that for women in the workplace, "Imposter Syndrome" is more often due to systemic racism, microaggression, classism, xenophobia, discrimination, and other forms of bias.  They write, "..as we know it today, imposter syndrome puts the blame on individuals, without accounting for the historical and cultural contexts that are foundational to how it manifests in both women of color and white women. Imposter syndrome directs our view toward fixing women at work instead of fixing the places where women work."  According to Tulshyan and Burey, we should focus on addressing the culture of bias that exists in the workplace, rather than the feelings that have come to be called "imposter syndrome" per se.  We should treat the cause of the disease, not the symptoms of it.

We hear this same sentiment a lot when it comes to addressing physician burnout (see, for example, my post, "Don't ask me to take resilience training!").  Rather than focusing on the conditions - the system-level and organizational issues - that contribute to burnout, we tend to focus on the individual.  By focusing on the individual, we are subconsciously blaming the individual.  When emphasize things like resilience training and mindfulness (which I feel are important to address too) to the exclusion of the system-level factors, we are basically saying "Toughen up buttercup."  I think the same is true for "Imposter Syndrome."  By focusing on the individual, we ignore the system-level issues that are really at fault.

So what can a leader do to create a climate that hopefully prevents the feelings associated with "Imposter Syndrome"?  Melody Wilding for the Business Insider recommends five key points:

1. Foster psychological safety - I can't emphasize enough how important it is for leaders to create a climate of trust, transparency, and openness where workers feel that they can raise concerns, ask questions, and provide constructive feedback to leaders.  

2. Show what it means to work like a human -  Leaders can take steps to address overwork and perfectionism by modeling empathy and understanding.  It's okay to make mistakes.  It's okay to take a break away from work.  It's okay to leave work at the end of the day, rather than staying and working late all the time.

3. Recognize people's accomplisments - Here is a great point - praise the process not the result!  As the psychologist Carol Dweck (of "growth mindset" fame) recommends, leaders should praise the effort ("You worked really hard on this!") rather than solely focusing on the achievement itself.

4. Utilize feedback for development - I really like the concept of a 360 assessment, where not only the supervisor, but also the subordinate and peers can provide direct feedback.  However, building upon the first point, 360 assessments are useless and frequently counterproductive if there is not a climate of psychological safety.  

5. Create a culture of inclusion - building upon what Tulshyan and Burey emphasize, we absolutely have to address issues around diversity, inclusion, and equity in the workplace.  In my mind, these things go hand in hand with building a culture of psychological safety, which is foundational to everything else we've discussed here.

I want to end this post with a couple of quotes.  A famous scientist once said, "The exagerrated esteem in which my lifework is held makes me very ill at ease.  I feel compelled to think of myself as an involuntary swindler."  That scientist was Albert Einstein, arguably one of the most brilliant minds throughout all of history.  It's amazing to think that even Einstein was subject to these feelings of being an imposter.  However, he said something else that is just as important, if not more so.  Einstein once said, "Everybody is a genius.  But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid."

We should stop judging fish, by its ability to climb a tree.