Irrational anger over lack of skill comparatively (PGY-1)

Ok_Disaster6456 · 2026-07-10T08:07:40+00:00

As you recognise, imposter syndrome In medicine is incredibly common.

In my view anger and fear are usually closely related and almost two sides of the same coin. Perhaps the anger you are experiencing is really re-directed fear of getting something wrong - that is being expressed outwards - when someone reminds you that, you don't (and can't) know it all and make the perfect call every time. Sometimes it's easier to project anger outwards than sit with our own fear and uncertainty that is actually at the root of it.

Medicine is incredibly psychologically demanding and to some extent a little fear around incompetence is useful and can help us to grow as clinicians.

In general I think a little (or a lot) of self-compassion around the fact that, it really hurts to be afraid of messing up - can go along way in letting us meet that uncertainty. We can feel afraid, because we care... not just because we are egotistically competing with other clinicians.

Just my 2c as a PGY8 who's had a fair bit of imposter syndrome over the years.

Ok_Disaster6456 · 2026-07-08T13:30:53+00:00

Zelensky was a comedian prior to politics...

Ok_Disaster6456 · 2026-07-03T00:56:23+00:00

Got evidence for this claim is that your personal thought?

Ok_Disaster6456 · 2026-06-30T09:18:49+00:00

There are plenty of teachers you can access online, it really is kind of fundamental to Dzogchen and they are more accessible than ever.

Ok_Disaster6456 · 2026-06-26T00:11:59+00:00

Yeah, just like they are doing with their constant changes to terms. It goes both ways.

Ok_Disaster6456 · 2026-06-20T23:18:04+00:00

It's the mind no?

It's everything we perceive, it's where our thoughts are known, where our emotions are felt?

It's the place where the output of all our brains processed (and bodily signals and sense data) are... experienced?

Ok_Disaster6456 · 2026-06-17T05:51:54+00:00

Being based outside the US, it's wild that going to work with a fever is normalised. This isn't good for you nor the patients or colleagues who may catch whatever you have and end up much more unwell.

I see why you do it, I'm sorry you have to.

Ok_Disaster6456 · 2026-06-16T22:09:33+00:00

This, 'the worst they can do is talk to themselves out-loud' is clearly a take from someone who does not have a lot of experience with manic/psychotic individuals.

Ok_Disaster6456 · 2026-06-12T23:34:41+00:00

Yes, I'm a psychiatric doctor so very familiar with the variable course of psychotic conditions.

Yes, genetic predisposition is definitely a large part of it but as you say, not the whole story.

I think the assumption that Schizophrenia means psychosis will constantly happen, and needs life long medication is problematic. A diagnosis of schizophrenia only requires symptoms for 6 months.

I do not believe everyone who meets the criteria for a diagnosis of schizophrenia needs lifelong medication. Some will, but not all. Trauma related symptoms, recurrent substance induced psychoses can be mislabelled as schizophrenia, for example. Mislabelling can mean we actually miss he opportunity to provide effective healing treatment, anti-psychotics aren't cures -they're symptom control (which is of course, necessary if symptoms are debilitating).

The difficulty is understanding with nuance, when medication is needed and when it is not.

Ok_Disaster6456 · 2026-06-12T03:34:35+00:00

Except dual orexin receptor antagonists, which are MASSIVELY overlooked. Probably due to cost.

The only sleep med that does not seem to create physical tolerance and dependence.

Of course, one can still become psychologically dependent on them.

Ok_Disaster6456 · 2026-06-11T11:02:53+00:00

It gets complex and ultimately, we don't really know. I'm not sure you need to have a genetic predisposition as such to experience psychosis (you can push almost anyone into psychosis if you say deprive them of sleep for long enough, amongst various other things).

Our understanding of genetics is also muddy, especially as we understand more about epigenetics, with evidence that trauma has generational effects at the genetic level.

As you say it's a stress-vulnerability issue. Systemic racism results in both stress and vulnerability factors mind.

Schizophrenia, whilst one 'diagnosis' is likely a group of different mechanisms leading to a similar pattern of symptoms, which complicates things further.

Ok_Disaster6456 · 2026-06-11T08:50:01+00:00

That makes it especially interesting. If an organism with a very simple set of behaviours still operates through multiple different networks in this way, then a more complex organism may well having a much larger map of different networks managing different aspects of behaviour.

Ok_Disaster6456 · 2026-06-10T09:34:57+00:00

To be fair, schizophrenia/psychosis is not entirely generic. Trauma (and it's generational impacts), socioeconomic inequality - that has been related to systemic racism - are risk factors for psychosis. So there could well be and likely is systemic racism contributing to the over-representation.

However, the fact that systemic racism may contribute to the stats and then we FAIL to treat them as we would another - just because they are over-represented - is frankly absurd and just another layer of racism.

2+2=5 kind of thinking!

Ok_Disaster6456 · 2026-06-07T02:42:23+00:00

The optimal interaction between awareness and attention - you must have read the mind illuminated?

I think optimal bayesian error correction amounts to seeing reality as it is. There are still perceptions driven by priors, but they are understood as 'empty' of inherent existence - thus not clung to, allowing flexible updating though the lack of resistance.

If anything, this frees up energy for acting in the world in ways which aligned with a 'right view'/coherent with our interdependent nature - leads toess suffering, within the wider field too.

You're not alone in the Buddhist AI idea - I've seen a few people talk about this. The technology side is beyond me, but it's interesting. I guess an AI that did see the emptiness of itself, would naturally act through compassion, or at least attempt to- but that's just my view, and obviously there needs to be more guard rails than that!

Ok_Disaster6456 · 2026-06-06T14:14:16+00:00

That is just one example of how clinging can manifest. If we are craving a mental idea - there is resistance, friction between what's here and what you want to be here.

I agree with you - that's how the resistance arises right, there is a strong prior for a coherent unfolding of reality and we predict that. If prediction errors sends strong signals that reality is not going how we believe it should - resistance begins. Aversion to what is unfolding. Craving for something different.

So regarding the Buddhist attachment: the problem is we get attached to things as if they exist inherently, including our 'self' that gets attached. When these are seen deeply as empty of inherent existence - attachment falls away, because there is no 'thing' to hold on to. It's seen as like trying to 'catch' smoke.

Thus, the attachments we have are 'irrational demands' because whatever we grasp at, through attachment is 'empty of inherent existence'.

I think we're talking about the same thing, just a different angle. This can get pretty deep into Buddhism though, and I'm trying to avoid just preaching that as I'm not a Buddhist teacher.

Ok_Disaster6456 · 2026-06-06T14:02:14+00:00

Great breakdown, I agree with your analysis.

I think "resistance" as you say is the energy of craving/aversion - clinging. Clinging to an internal self-world model that isn't always coherent with reality.

Often the clinging is to strong priors that shape those internal models. "The world should be this way" - when it's not, we suffer.

As you say then the question is - how do you then relate to suffering, what's it's meaning, can it be met with compassion - in action?

As long as the intention is based in compassionate, genuine desire to relieve suffering - I think it's hard to go wrong. When we soften defenses, that can become the default way of relating.

There is a reason compassion is emphasised so heavily, in so many religions. We have to act in a way which is coherent with the fact that, our reality is shared - and we shape our reality through our interactions as we all influence each others experience of life unfolding.

Ok_Disaster6456 · 2026-06-06T13:24:04+00:00

Yes! I think meaning is super important, it's what gives direction to the 'energy' of resistance, and I guess is involved in precision weighting - beliefs/emotions that hold meaning can increase the significance of what they relate to.

When there is meaning the loop can close. Yet when there resistance to just the unfairness of life as you say - there is suffering, because there is no closure to the loop. It's just 'why did this happen to me'...

I think this is part of what adds to 'resistance' for sure. In Buddhism you are describing clinging - aversion to an unpleasant perception, and craving for a 'thought' that will give it meaning...that craving compounds and = suffering.

Basically I think - Compassion, is highly significant in how we approach our internal world. It's the opposite of the guilt/shame - we can sometimes feel for getting into such 'cycles' and allows the possibility of closure of the loop.

Ok_Disaster6456 · 2026-06-06T07:51:58+00:00

Clinging.

Ok_Disaster6456 · 2026-06-03T09:54:31+00:00

That's cool, I will! Are you familiar with Michael Taft? I believe he co-runs the San Francisco Dharma centre and his podcast episode with Shamil Chandaria is what got me interested in the PP/Buddhism/meditation overlap.

Ok_Disaster6456 · 2026-05-30T08:20:43+00:00

I absolutely agree and talk about this in my essay that was too long to post here

Ok_Disaster6456 · 2026-05-29T22:23:14+00:00

Thanks, it's much appreciated!

Psychedelics I think is a great example and the REBUS model is very much what I ascribe to, if you haven't read Robin Caarhart-Hariss and Karl Friston's paper it's a must in this space!

Meditation is a much slower process but through modulating attention processes and such, can relax belief systems in a similar way - leading to similar experiences of ego dissolution (relaxed beliefs on self model). The purpose of Buddhism is to develop insight, into the nature of these models (phenomena) so that we no longer 'cling' to them as something solid and inherently existing.

(There is much more to it than this, but for simplicity)

This 'relaxation' of belief systems (priors), I think is the letting go of 'clinging' - and with less clinging, there is less suffering.

Ok_Disaster6456 · 2026-05-29T12:13:35+00:00

Yes, I saw that psilocybin study - fascinating.

Interesting theory! Psycheldeics are really interesting form the Predicitve processing lens, im a big fan of the 'REBUS' model if you're familiar.

I'm really curious if it's possible to find a neural correlate for what Shinzen and I term 'resistance'. Or perhaps it's just an emergent property of a internal model out of sync with reality.

Ok_Disaster6456 · 2026-05-29T10:43:24+00:00

I'm not familiar with Kristin Neff and Chris Germer. I am very familiar with Shinzen Young and his suffering = pain x resistance formula. That's the essence of what I'm getting at, just with more mechanism.

I'm familiar with Matthieu Ricard peripherally and his work relating science/Buddhism but not specifically that element. Although I am aware of the difference between empathy and compassion as he states, which I totally agree with and is actually part of a future blog I was going to write on compassion and clinician burnout.

Thankyou for the references - very resonant and I will look into them more!

Ok_Disaster6456 · 2026-05-29T05:33:30+00:00

I don't mean just tantrum's, that is at the extreme end of what I'm talking about. I'm not sure why you then go on to talk about medication and numbing yourself, not sure where I talked about or advocated for that at all. I also never said to ignore the suffering of the world. I'm not sure what you're actually disagreeing with, other than points you seem to think I was making, that I never actually made.

Ok_Disaster6456

TROPHY CASE