I have been listening to The Nocturnists’ Shame in Medicine series and thinking about how shame shows up in my trauma therapy practice with healthcare professionals. The doctors and nurses I work with describe feeling not just burned out, but shame about their burnout. They experience shame when they can’t meet the impossible expectation that they are super-human. The unwritten rule is that they should excel at work and home without needing silly things like sleep, food, or meaningful connection to others. The people around them all appear to be able to do it all, so why should they experience needs that might slow them down?
When your job is about taking care of others, it’s assumed that you don’t need care. You’re healthy and that’s why you can do this job. But the reality is, self care is being promoted for a reason. True self care, nourishing our minds, bodies, and spirit, rejuvenates us so that we can continue providing good care.
What Is Shame?
If you’re human, you’ve experienced the sensation and emotion of shame. Sometimes it’s a slight flush in the cheeks. Other times, it’s a much more disturbing, gut wrenching experience that closes your throat and makes it feel impossible to breathe or speak.
The behavioral and cognitive responses to shame can be similar to a trauma response, yet neuroscience research suggests that shame occurs within a unique neural network (Piretti et al., 2023; Davis, 2019). Experts in psychological shame suggest that shame develops along with our social awareness in our early attachment experiences (Gilbert, 1998; Schore, 1998; Tantam, 1998; Parnell, 2013). Shame connects to a sense of “wrongness.” It has a moral aspect to it, where there’s something about us or our behavior that doesn’t align with a social expectation (Gilbert & McGuire, 1998).
Fear Of “Not Being Good Enough” In High-Achievers
When you are at the apex of your profession, whether you’re in medicine, law, or business, you are used to being the best. Your 70% (if you ever allowed yourself to only do the job 70% of the way) would be someone else’s 120%. You know you excel and you draw a lot of confidence from being at the top of your field.
For some people, that little voice that’s constantly whispering “you’re not good enough” is the thing that fuels them to excel. You went from putting in extra effort to make sure you did a good job to completing complex tasks easily and efficiently.
When you’re used to doing well and pushing through without breaks, it’s disorienting when something forces you stop. A freak accident or illness lays you out in the hospital, and you find yourself wondering why you can’t push through it. Maybe it’s the first time in a long time that you heard the little whisper, “You’re not good enough” or “You’re a fraud.” You know other people are able to work from their hospital rooms, so why are you having such a hard time? Rest is something other people need, but you’re not supposed to get sick or find yourself incapable.
Those thoughts, those little whispers, are shame. They’re your comparison to the status quo in your field. When you’re not feeling you’re best, it suddenly means you’re not enough. It might be an old thought and feeling or it could be the first time you’ve ever recognized that in yourself. Either way, it’s disorienting and you want to go back to feeling like yourself.
Shame About Burnout in Healthcare Professionals
Sometimes, the thing that slows you down isn’t a physical illness or freak accident. Sometimes the job itself wears down healthcare professionals, causing burnout. You care deeply about seeing patients get better. Healing people is a high. The focus required in the emergency room or the OR helps you find distance from the stressful things in your personal life. The marriage under strain or the dance recital you’re missing don’t exist here. But when you leave, you can’t ignore the disappointment you feel or the look on your kids’ faces.
With nurses in Colorado experiencing the highest burnout in the country, this is a crisis that needs to be addressed. Your job is a high-stress/high-impact combination, leading to burnout at the same time you derive deep fulfillment from your role. You’re underpaid and the cost of living is skyrocketing in Denver.
You know you can’t work harder than you already are. Your career means everything and your patients need you. But your family does, too. You know something needs to shift, but you can’t imagine what that could be so you find yourself pushing harder in every aspect of your life until something breaks.
Unfortunately, that thing might be you.
Signs of Burnout
When you’re burning out, you might find yourself experiencing crying spells. You can push through and show up with your kids one day, but the next day you only have energy to crash on the couch scrolling.
You feel like you’re failing everyone and you don’t know how to stop.
You’re used to grinding through pretty much anything that comes your way. Everyone else seems to handle it all, so why can’t you?
And there’s the shame about the burnout: “Why can’t I do this?” is equivalent to “What’s wrong with me?”
Your burnout experience has led to shame because you’re not meeting the unwritten rule that you have to excel at everything.
How Do You Address Shame and Burnout In Healthcare Professionals?
You can’t treat what you can’t name. Similar to your work in medicine, our work will start with assessment and diagnosis. Of course, there isn’t a “burnout” or “shame” diagnosis in the DSM, so we’ll explore whether this is an adjustment disorder (has something recently changed?), mood disorder, or anxiety disorder. The benefit of being an out of network provider is that while I’ll want to know your constellation of symptoms and how they show up for you, I don’t have to put a formal diagnosis in a medical chart unless you’re using your out of network insurance benefits.
Once we have a clear picture of what’s bringing you here and your history, we can begin our work. The shameful thoughts and beliefs you experience only deepen your burnout. While I can offer tools to help you manage burnout and build connections to your family and friends, lasting change often comes with deeper work to address the root of your shame.
Sometimes doctors and nurses worry that this work will get rid of their spark or drive. I have yet to see that happen. When healthcare professionals complete their work with me, they identify feeling reconnected to the things that brought them into the field. They feel energized and like they are able to meet their own high expectations with more ease and without the burden of shame.
Modalities that I use to address burnout and shame include CBT (cognitive behavioral therapy), IPT (interpersonal therapy), DBT (dialectical behavioral therapy), and EMDR (eye movement desensitization and reprocessing).
P.S. I wrote about how I address Shame with EMDR for the EMDRIA Focal Point Blog.
References
Davis, S. (2019). The neuroscience of shame. CPTSD Foundation, accessed 8/31/2025: https://cptsdfoundation.org/2019/04/11/the-neuroscience-of-shame/
Gilbert, P. (1998). What is shame? Some core issues and controversies. In A. Gilbert & B. Andrews (Eds.), Shame: Interpersonal behavior, psychopathology, and culture (pp. 3-38). Oxford University Press.
Gilbert, P. & McGuire, M. T. (1998). Shame, status, and social roles: Psychobiology and evolution. In A. Gilbert & B. Andrews (Eds.), Shame: Interpersonal behavior, psychopathology, and culture (pp. 99-125). Oxford University Press.
Parnell, L. (2013). Attachment-focused EMDR: Healing relational trauma. W.W. Norton & Company.
Piretti, L., Pappaianni, E., Garbin, C., Rumiati, R.I., Job, R, & Grecucci, A. (2023). The neural signatures of shame, embarrassment, and guilt: A voxel-based meta-analysis on functional neuroimaging studies. Brain Science, 13(4), 559. https://doi.org/10.3390/brainsci13040559
Schore, A. N. (1998) Early Shame Experiences and Infant Brain Development. In A. Gilbert & B. Andrews (Eds.), Shame: Interpersonal behavior, psychopathology, and culture (pp. 57-77). Oxford University Press.
Tantam, D. (1998). The Emotional Disorders of Shame. In A. Gilbert & B. Andrews (Eds.), Shame: Interpersonal behavior, psychopathology, and culture (pp. 161-175). Oxford University Press.