When your profession becomes your identity: the shame that cannot be admitted

“When someone asked me who I was, I said: a surgeon. When I had to go on sick leave for three months, I no longer knew what to answer.”

This sentence could have been spoken by a doctor who, after a complication, can no longer walk into the operating theatre. By a lawyer who lost a case he was sure he would win. By a banker who, after years at the top, was left without a job and for months still leaves the house every morning in a suit because he doesn’t know how to tell his wife. In all these stories it is not only a plan or a career that collapsed. What collapsed was the answer to the question: who am I?

And beneath that collapse there is almost always the same emotion, one that is not talked about in these professions: shame. Not guilt over a mistake, but a deeper, quieter sense that there is something wrong with me as a person. That feeling, and why it is so hard to admit in certain professions, is what I want to write about here.

When “what do you do” becomes “who are you”

We are all, to some extent, what we do. Work gives us structure, meaning, contact with others and a sense of being useful. There is nothing wrong with that. The problem begins when a profession is no longer one of the things that define us and becomes the only one.

With doctors, lawyers and investment bankers this happens more often than you might expect. The road into these professions is long and demanding. Years of study, exams, traineeships, specialist training, nights in the hospital or the office. People invest their youth, their relationships, their health. With an investment that large, it is almost inevitable that the profession grows into an identity — you will find a short explanation of the concept in the knowledge base under identity.

The people around you contribute too. A doctor is called “doctor” even at the market. To relatives, the lawyer is the one who knows. The banker is the family’s measure of success. When everyone sees you through your profession, you begin to wear it yourself like skin rather than clothing.

What happens in the body when you are being judged

In 2004 the psychologists Sally Dickerson and Margaret Kemeny published a meta-analysis of 208 laboratory studies on which stressors most strongly trigger the stress hormone cortisol. They found something important: the strongest response was not caused by tasks that were merely difficult, but by those in which a person risked negative evaluation by others and had no control over the outcome. They called this social-evaluative threat.

This finding says a great deal about the professions I am writing about. Doctors, lawyers and bankers are constantly evaluated — by superiors, colleagues, clients, patients, judges, the market. And outcomes are often only partly in their hands. A patient has a complication despite a flawless operation. A judge decides otherwise. The market falls. When the profession is your identity, every such judgement hits not only the work but the person.

In another paper the same year, Dickerson and colleagues went on to describe how shame is the emotion most closely linked to this response. Shame, in other words, is the body’s response to a threat to our place among other people.

Shame is not guilt

As early as 1971 the psychologist Helen Block Lewis described a distinction that June Tangney later supported with a long series of studies. Guilt is about an action: “I made a mistake.” Shame is about the self: “I am a mistake.” The difference seems small, but its consequences are large.

Guilt turns a person towards repair. Because it concerns an action, it can be admitted, apologised for, learned from. Shame turns a person towards hiding. Because it is not about an action but about who I am, there is nothing I can repair. I can only hide. In several studies, Tangney and colleagues showed that a tendency towards shame is linked to withdrawal, to outward-directed anger and to poorer mental health, while a tendency towards guilt is much less so. I wrote about this in more detail in Guilt and shame are not the same — and the difference matters.

In people whose profession has become their identity, guilt turns into shame very quickly. A mistake at work is no longer something I did, but proof of what I am. And because the profession is what everything else rests on, shame does not hit just one part of life. It hits the foundation. You will also find a short explanation of this emotion in the knowledge base under shame.

Conditional worth: I am good as long as I succeed

Jennifer Crocker and Connie Wolfe described a concept I come across often in therapy: contingent self-worth. We build our sense of worth on different domains — relationships, appearance, moral values, achievement. When self-worth is heavily tied to one domain, ups and downs in that domain shake our sense of worth too. Among students whose self-worth was tied to academic success, for example, a poor result hurt their self-esteem noticeably more than it did for those whose worth was not tied to grades.

When self-worth is tied to a profession, a person lives in a constant test. Every day they have to prove again that they are good enough. Success brings relief, not joy. Failure brings not just disappointment, but the sense that something has been exposed that was hidden all along: that you are not really enough. I have explained how self-image, self-worth and self-confidence differ, and how each is built, in Self-image, self-worth, self-confidence.

In the 1980s the psychologist Patricia Linville proposed that people with a more differentiated self-concept — with more distinct roles and domains that define them — cope with stress more easily, because a blow in one area does not hit all the others. Later research produced mixed results, and the idea is not as simple as it sounds. But the picture it offers is often useful in therapy.

The aim is not for a person to stop valuing their profession. The aim is for the profession not to be the only pillar holding up the sense of who I am.

Shame that the system creates

It would be unfair to say shame is only a personal matter. The professions I am writing about often cultivate it. In medicine, law and finance, unwritten rules have long been passed down: mistakes are not admitted, tiredness is a sign of weakness, whoever asks for help is not cut out for the job. A young doctor learns that complications are not talked about. A young lawyer learns that doubt is not shown. A young analyst learns that the time you leave the office is the measure of commitment.

These rules do not come from malice. They often come from genuine responsibility: where life, liberty or large sums are at stake, reliability is essential. But when reliability becomes infallibility, the system produces people who are not allowed to make mistakes — and who feel ashamed in front of themselves at every one. How this culture shows up as perfectionism is the subject of Perfectionism in professions where mistakes are not allowed.

The result is loneliness. If no one admits mistakes, everyone feels they are the only one making them. And because they cannot admit them, they never find out that everyone does.

A conversation about what cannot be said

In therapy, this kind of shame rarely shows itself directly. It shows up in unusual precision, in humour that arrives at exactly the right moment, or in someone talking about a mistake as if it were a textbook case. Something like this (a composite, not a real person):

“Statistically, the complication was to be expected. It happens with procedures like that.”
“I believe you. And what about you, when you think back to that morning?”
“I … I haven’t told anyone. At home they think it was an ordinary day.”
“Why not?”
“Because they’d see me differently. As someone who isn’t coping.”

The statistics were real. But they were also a shield. Beneath them lay the feeling that if the people close to him found out, they would stop respecting him — that his place in the family depended on things always going well for him. This is shame in its purest form: not fear of the consequences of a mistake, but fear that others would see him the way he saw himself in that moment.

How shame hides

Because shame is so painful, we rarely feel it directly. The mind quickly covers it with something easier to bear. In people with demanding professions I notice a few common hiding places:

• More work. If I am afraid I am not enough, I will work even more to prove otherwise. That is the subject of Work addiction: the one addiction people reward.
• Cynicism. If I don’t care, it can’t hurt me. Mocking patients, clients or the system is often armour around vulnerability.
• Anger. Shame I am not allowed to feel spills over into irritability towards juniors, a partner or children.
• Withdrawal. The person avoids colleagues, gatherings and conversations where it might come out that they are not coping.
• Substances. A glass or a tablet so that the voice in the head goes quiet.
• The inner critic. A voice that judges again every day and is never satisfied. Where it comes from is the subject of The inner critic: where the voice that constantly judges you comes from.

These hiding places are understandable. All of them are attempts to survive something that feels unbearable. But all of them carry the same price: the shame stays untouched and grows stronger in silence. How shame is connected with burnout, and why it is so hard to speak about, is the subject of Burnout and shame.

Exercise: who am I when I am not at work

This exercise takes about fifteen minutes. Do it somewhere quiet, with paper and pen.

1. Complete the sentence “I am …” ten times. Write quickly, without choosing. Then count how many answers relate to your profession.
2. For each answer that is not your profession, write down when you last gave it time. A week ago? A year ago? You can’t remember?
3. Recall the last mistake at work that stayed with you for a long time. Write down one sentence you said to yourself then. Is it about the action or about you?
4. If it is about you, rewrite it so that it is about the action. From “I’m incompetent” to “That day I missed a test result.” Notice what happens in your body.
5. Think of one person you could tell about this mistake. You don’t have to tell them. Just notice whether such a person exists — and if not, that in itself is important information.

If the exercise confused or unsettled you, that is normal. Shame does not like the light. Self-compassion can help here — not as going easy on yourself, but as a way of talking about your mistakes without falling apart.

There are no right answers in this exercise. It is simply a look at how much of you is taken up by your profession, and how much room is left for everything else.

Where this idea does not apply

I also want to be honest about the limits of what I am writing.

A strong professional identity is not an illness. For many people, their profession is a source of deep meaning, vocation and joy. A doctor who sees herself first and foremost as a doctor is not necessarily in trouble. The problem begins only when the profession becomes the only thing carrying her worth, and when she experiences every failure as an exposure.

Not every uncomfortable feeling after a mistake is shame that needs taking apart. Sometimes it is healthy guilt, telling you that something really was wrong and needs putting right. When the system does not allow a person to do the right thing, it may also be moral distress — not a personal failing, but a response to impossible circumstances. Therapy must not blur responsibility where it exists.

Sometimes there is depression beneath the shame. When a sense of worthlessness lasts for weeks, and comes with sleeplessness, loss of interest and thoughts that it would be better if you were not here, it is not only about professional identity. Then the first step is a conversation with a doctor or psychiatrist.

The system has to change too. An individual can work through their shame in therapy, but if they return to an environment that humiliates them at every mistake, it will be an uneven fight.

What helps

Shame is not healed by explanations. It is healed in relationship. Because it arises when others see us as “wrong”, it also comes apart when someone sees us in our vulnerability — and stays. Many authors have written about why vulnerability is a condition for closeness, not a threat to it. I wrote about how shame whispers “there is something wrong with me” in Shame: the emotion that whispers “There is something wrong with me”.

In relational family therapy, in which I am training as a therapist in training under supervision, we understand shame as something born in relationships — often in a family where love was quietly tied to achievement. Christian Gostečnik describes how such patterns are passed down from generation to generation and repeated in adult relationships. A doctor who must not show a mistake may once have been a child who was not allowed to bring home a bad mark. When that connection comes into view, shame loses some of its power: it is no longer the truth about me, but a story I learned.

If you would like to explore this pattern in more depth, one option is a longer session with a genogram, A Look into the Past, where we draw your family tree together and look at what was passed down in your family about success, mistakes and worth. Sessions take place in person in Ljubljana, and I also work in English.

And if the shame is so strong that thoughts come up that it would be better if you were not here, do not stay alone with it. In Slovenia, call the mental health crisis line on 01 520 99 00 (every day from 7 pm to 7 am), the Samaritan helpline on 116 123 (24 hours a day), or in an emergency 112.

What to remember

• When a profession becomes the only pillar of identity, every mistake at work hits the foundation of who I am.
• Guilt says “I made a mistake” and leads to repair; shame says “I am a mistake” and leads to hiding.
• The strongest stress response is triggered by situations in which others evaluate us and we have no control over the outcome — in these professions, that is everyday life.
• Shame likes to hide in work, cynicism, anger, withdrawal or substances, but it stays untouched.
• Shame comes apart in a relationship where someone sees you vulnerable and stays — and where it becomes clear where the pattern was learned.