By Dr Viveka Nainani
Dr Viveka Nainani s an intensive care registrar currently working in Melbourne
When I decided to write this article, my first thought was that I would be too nervous to show it to anyone because it wouldn’t be good enough. From calling myself ‘just’ a junior registrar, to minimising achievements (‘I bought a place - but it’s only an apartment’) and being unable to take compliments, I am frequently affected by Imposter syndrome. However, as it turns out at least another 5.3 billion people - that is, over 70% (1) of the world - suffer from it too.
The term ‘imposter phenomenon’ was coined by psychologist Pauline Clance in 1985. She recalls being in graduate school and ‘taking an important examination and being very afraid I had failed’ and ‘remembering all I did not know rather than what I did’ (2). It wasn’t until she started to teach that she heard female students expressing the same feelings, so she and Suzanne Imes coined the term ‘Imposter Phenomenon’ and wrote the first paper on the concept. Interestingly, their impression was that this was only seen in women because ‘success for women is contraindicated by societal expectations and their own internalised self evaluations.’ I took the Clance Imposter Phenomenon Scale test (https://www.paulineroseclance.com/pdf/IPTestandscoring.pdf) (2) and scored 75, which indicates I ‘frequently’ have Imposter feelings. A high score indicates that Imposter Phenomenon frequently and seriously interferes with a person’s life.
So why do we feel like we haven’t earned our successes?
Multiple factors lead to Imposter Syndrome, including perfectionism, one’s upbringing, genetics and environment. The research is conflicting on whether Imposter Syndrome is more common in women or men, or simply unrelated to gender at all – so I decided to ask some of our ICU colleagues what they thought. Almost every person I asked thought imposter syndrome was more common in women.
The overarching reasoning behind this was that imposter syndrome is perpetuated by expectations – both those that women have for themselves, and that society has for them. I have observed and personally experienced that women have to work much harder to gain the same level of respect from colleagues (and sometimes patients) despite being of the same or more senior standing than a male counterpart.
The environment is part of the problem. In workplaces that are male dominated or that foster gender bias (be it conscious or unconscious), the characteristics of a male leader are seen as the desirable stereotype, so when a female leads differently, this is perceived negatively. If the female emulates the male’s style of leadership, this doesn’t work either -because of society’s expectations for acceptable female behaviours. This leads to women having increasing feelings of doubt in their abilities and have a significant impact on the contributions that they feel safe enough to make (3).
On top of that, women being and acting as confident as men are often penalised rather than rewarded for the same behaviours. When I have seen female colleagues saying similar self-assured statements to men, they were described as ‘pushy or ‘abrasive’ which negatively reinforces these actions, exacerbating feelings of doubt and leading to Imposter Syndrome. I have been called ‘too nice’ to work in the surgical field, and ‘too emotional’ many times to the point where I have wondered if it impacts on my ability to be a good doctor, rather than appreciating the increased empathy I am able to have for my patients. This also comes back to gender stereotypes in upbringing and what we’re praised for as children – girls are praised for being ‘sweet,’ ‘nice’ and ‘obedient,’ while boys are ‘strong’ and ‘confident.’
Imposter syndrome is strongly related to low self-esteem – a lack of confidence in one’s value or abilities can lead to feeling like a fraud, or questioning if success is deserved. The American Psychological Association showed women across different cultures and countries had lower self esteem than men all the way through from adolescence to adulthood (4). Furthermore, a compelling statistic from a Hewlett Packard internal report states that men apply for a job when they meet only 60% of the qualifications, but women only apply if they meet 100% of them. As Forbes put it, ‘men are confident about their abilities at 60%, women don’t feel confident until they’ve checked off every item on the list’ (5).
What if women and men experience imposter syndrome equally, but men are less likely to talk about it? The stereotype that women should be quieter and men should be more assertive and confident could be detrimental for men too – meaning if men fail to conform with this they are ‘weak.’ Does the gender gap serve to amplify the concerns in women but then concurrently hide or downplay the same issue in men?
One viewpoint is that imposter syndrome isn’t related to gender at all – and is more career specific. For example, perfectionism is a trait that is strongly linked to Imposter Syndrome and is particularly noted in careers such as medicine and law. More specifically, intensivists focus on every small detail about a patient to make life or death decisions about their care, leading to a stereotype that ICU staff are perfectionists. However, in striving to reach an unrealistic or unattainable goal, you are more likely to be disappointed, again perpetuating the cycle of imposter syndrome.
There is no doubt that both individual and systemic factors play a role in imposter syndrome. On a larger scale, we need to be the ones to create the change in a society that is holding us back. On an individual level, we have the power to change the way we see ourselves. Feeling incompetent and being incompetent are completely different things.
I used to joke about my imposter syndrome, or just brush it off. But now that I know the harmful effects it could have on my career and my thinking in general, I’m going to try and deal with it. I’m no longer going to say I ‘only’ bought an apartment – I’m going to say I own property. I’m going to look people in the eye and say ‘thank you’ in response to compliments. And I’m going to introduce myself confidently as an ICU registrar.
Writing this article has helped me delve into the causes of my Imposter Syndrome and start to work on those. I hope you have gained something from it too.
1. Sakulku J, Alexander, J. 2011. The Imposter Phenomenon. International Journal of Behavioural Science. Vol 6, No. 1, p75-97.
2. Imposter Phenomenon (IP). Pauline Rose Clance. 2013. Accessed 10th November 2021. https://www.paulineroseclance.com/impostor_phenomenon.html
3. Stop Telling Women They Have Imposter Syndrome. Tulshyan R, Burey JA. 2021. Accessed 10th November 2021. https://hbr.org/2021/02/stop-telling-women-they-have-imposter-syndrome
4. Bleidorn W et al. 2015. Age and Gender Differences in Self-Esteem – A Cross-Cultural Window. Journal of Personality and Social Psychology. Vol 111, No. 3, p360-410.
5. Act Now To Shrink The Confidence Gap. Clark NF. 2013. Accessed 10th November 2021. https://www.forbes.com/sites/womensmedia/2014/04/28/act-now-to-shrink-the-confidence-gap/?sh=543217a55c41