Lately, the term “impostor syndrome” has gained prominence in both popular and scientific literature. First coined in 1978 as “impostor phenomenon,” it is typically “characterized by chronic feelings of self-doubt and fear of being discovered as an intellectual fraud” within academic circles (Clance and Imes; Villwock et al.). Unlike the general academic impostor, however, medical impostor syndrome entails a supplementary characteristic that warrants its own label: namely, that the physician-impostor not only fears the seemingly unavoidable unmasking of their own “actual” fraudulence, but that their supposed imposture will cause needless suffering or even death. This is, no doubt, a timeless and natural fear among any medical practitioner, as it is partly premised on the plausibility of its consequence. A physician can cause a patient’s death. We even find evidence of it in Macbeth, in which Shakespeare depicts the terror that subsumes Lady Macbeth’s physician when he is unable to diagnose her intense psychiatric episode. I term this subset of impostor syndrome “the physician’s terror.”
Despite the terror physicians may feel about harming their patients, popular media tends to depict doctors as both highly knowledgeable and deeply compassionate. Hugh Laurie’s television portrayal of Dr. House strikes the viewer as unsettlingly precisely because he lacks the latter quality while exhibiting a near-robotic mastery of the former. Dr. House reveals a facet of the patient-physician relationship that is generally agreed upon as common sense: in a scenario in which we, as patients, had to choose between receiving treatment from a compassionate doctor who lacked medical knowledge or an amoral doctor who had memorized every textbook she had ever read, we would always, begrudgingly, choose the latter. Of course, the notion of a perfectly knowledgeable physician—like Dr. House—is pure fiction. But it is comforting for both patients and doctors to engage in this self-deceptive credence, lest they start to imagine the terrifying reality that doctors, no matter how intelligent they are, remain bound by the limits of their innate capacities. We would rather envision, as T.S. Eliot does in “East Coker,” the physician with “the sharp compassion of the healer’s heart / Resolving the enigma of the fever chart” (152-153).
Shakespeare, however, presents a much bleaker account of the diagnostic method than Eliot’s in Macbeth, which serves as English literature’s most chilling illustration of the physician’s terror. Lady Macbeth’s physician, appearing briefly at the end of the play, is called upon to treat her rapidly degrading mental instability. Upon witnessing her madness, he admits that “this disease is beyond my practise” and, hence, “more needs she the divine than the physician” (5.1.49-64). The 21st-century reader may interpret this physician as a naive believer in humours and superstitions, practicing a craft that shares nearly nothing with contemporary evidence-based medicine, and his appeal to the divine only amplifies the plausibility of this claim. But although Shakespeare’s physician is unable to treat Lady Macbeth, it would be wrong to assume that his ineptitude is due to a rigid commitment to mind-body dualism—that, in other words, he believes Macbeth’s psychological sickness to be “of the soul” and not “of the body.”
In fact, early modern medicine did consider “psychological” illnesses—at least in part— physically treatable (Clark 302). In “The Anatomy of Melancholy,” first published in 1621, Robert Burton suggests that “the distraction of the mind, amongst other outward causes and perturbations, alters the temperature of the body.” Indeed, Macbeth’s physician exhibits empirical methodology; as soon as he enters the ante-room, his first impulse is to gather a quick symptomatic history from the Gentlewoman: “In this slumbery agitation, besides her / walking and other actual performances, what, at any / time, have you heard her say?” (4.1.9-11). Then, anticipating a potential diagnosis, he exclaims: “Hark! she speaks: I will set down what comes from her, to satisfy my remembrance the more strongly” (4.1.28-29).
It is no surprise, then, that the physician calls out for God to “forgive us all!” before leaving Lady Macbeth untreated (5.1.65). No matter how much time and effort he has spent refining his craft and knowledge, his skill proves to be insufficient. Even if his clinical method has been finessed to perfection, the physician lacks the power and medical repertoire for its successful application. In other words, he has reached the limits of his professional capacities. Until that point, the terror of his clinical ineptitude, and the fear of its deadly consequences, would have only been manifested as a private psychological phenomenon. Upon his clinical encounter with Lady Macbeth, however, he actually experiences the physician’s terror and finds himself forced to confront it.
But Macbeth was set in 11th-century Scotland, after all. Common wisdom would lead us to believe that medical practice then was limited by a dearth of empirical understanding and methodology, let alone technological innovation. Nowadays, we might hope that Lady Macbeth’s doctor could possess the ideal capsulated pill and would be able to offer her a permanent antidote with the flick of a pen.
But this is not quite the case. Doctors are still limited in their power to alleviate suffering, as much as Dr. House would like to convince us otherwise. Their tools may have greatly improved since the last millennium, when Lady Macbeth lost her mind, but external forces still counteract and even dictate the effectiveness of their interventions. This truth leads me to reminisce on that non-fictional moment, last March, when I read about the overloaded northern Italian healthcare system. Doctors were forced to make life-or-death decisions premised not only on medical necessity but on material limitations. In this case, infrastructure—something beyond their control—restricted their ability to provide ideal care. “Regular doctors are suddenly shifting to wartime footing,” reported the New York Times (Horowitz). Care was reorientated toward palliation, and the medical team was forced to make rapid ethical decisions: who would get to access limited treatment first, and why?
The intrinsic moral impulse in deciding who to treat first cannot be taught in the same systematic way as medical knowledge. There may be developed guidelines to accommodate drastic medical situations, but, as Immanuel Kant wrote in the Critique of Pure Reason, “a physician … can have at command many excellent pathological … rules … and yet … may easily stumble in their application … for he may be [lacking] in natural power of judgment” (178). Even having the power to heal—the empirical knowledge, technology, and infrastructure that Lady Macbeth’s physician was lacking—does not guarantee an escape from the nagging physician’s terror. As Kant notes, a failure to judge a clinical case adequately—like a failure to understand it—could still lead to terribly costly errors. But there’s reassurance to be found in the fact that a physician’s responsibility does not only reside in the theoretical task of knowing everything, but also in a faculty that is perhaps both undefinable and unteachable, yet common to all of us. Only experience can reinforce the kind of clinical intuition required to make judgments that cannot be summed up in the pages of a textbook.
Perhaps the only way to transcend the physician’s terror is to resign oneself to that fact, much like the acceptance of our own mortality functions to relieve our fear of it. Regardless of scientific and clinical innovation, a doctor’s innate capacities will always be limited. Shakespeare’s physician demonstrates great humility, therefore, in recognizing and resigning himself to his own limitations. This, we can say, is fundamental to the practice of medicine, and the 21st-century practitioner, despite the hubris of modern intellectual and technological advancements, can still learn a thing or two from a fictional doctor practicing in the Middle Ages.
Burton, Robert. The Anatomy of Melancholy. Oxford. Printed for Henry Cripps. 1651. Project Gutenberg. Accessed 13 Nov, 2020. https://www.gutenberg.org/files/10800/10800-h/10800-h.htm
Clance, Pauline Rose, and Suzanne Ament Imes. “The Imposter Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention.” Psychotherapy: Theory, Research & Practice, vol. 15, no. 3, 1978, pp. 241–47. Accessed 3 Jan 2020. https://psycnet.apa.org/record/1979-26502-001
Clark, Sandra. “Macbeth and the Language of the Passions.” Shakespeare, vol. 8, no. 6, 2012. Accessed 13 Nov, 2020. https://www.tandfonline.com/doi/full/10.1080/17450918.2012.696278?needAccess=true
Eliot, T.S. “East Coker.” The Complete Poems and Plays of T.S. Eliot, Faber & Faber, 1969, pp 177-183.
Horowitz, Jason. “Italy’s Health Care System Groans Under Coronavirus — a Warning to the World.” The New York Times, 12 Mar 2020, https://www.nytimes.com/2020/03/12/world/europe/12italy-coronavirus-health-care.html Accessed 13 Nov, 2020.
Kant, Immanuel. The Critique of Pure Reason. Translated by Norman Kemp Smith, Macmillan & Co Ltd, 1958.
Shakespeare, William. “Macbeth.” The Norton Shakespeare, edited by Stephen Greenblatt, Walter Cohen, Jean E. Howard, Katharine Eisaman Maus, W.W. Norton & Company, 2008, pp. 825-878.
Villwock, J., Sobin, L., Koester, L. and Harris, T., 2016. Impostor Syndrome And Burnout Among American Medical Students: A Pilot Study. [online] National Center for Biotechnological Information. Accessed 25 Nov, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116369/
Author bio: Emmanuel Adams is a writer and medical student at McGill University. He holds a BA in English Literature and Philosophy from McGill University.
Image credit: Johann Heinrich Füssli, Lady Macbeth (1784)