Hey guys, welcome back to the podcast. I am Amanda. I'm Laura. I'm Kendra. And today we are going to be diving into the concept of contempt. We started a long time ago, a series where we were trying to develop emotional granularity, meaning you could name what you're feeling because most people, Brené Brown says, can only name like mad, sad, and glad.
But having emotional granularity, being able to express what you're feeling, is so helpful as far as owning the emotion and being able to dissipate that emotion, whatever the emotion is. So today we're going to talk about contempt. And another reason why we're talking about this is because I was listening to Terry Real, and I recognized, unfortunately, a lot of my tendency is in the topic of contempt. And I do not feel like an angry person. I don't feel like a particularly malignant person. Maybe other people have other opinions, but I could recognize so many of these qualities in myself, and it was eye-opening.
So today we're going to talk about contempt, how it shows up in medicine, its two extreme ends of shame and grandiosity, and what we can do about it to improve our wellness as physicians. Contempt is a word that we don't often associate with ourselves. I didn’t, but it is a hidden driver of stress and disconnection. I'm going to say that again: it is a hidden driver of the stress and disconnection many physicians feel.
Contempt, when left unchecked, can damage our relationships, erode our sense of self, and harm the culture of care within medicine. Drawing from Brené Brown's *Atlas of the Heart* and Terry Real's work on grandiosity and shame, we will explore how contempt shows up in our lives, our practices, and what we can do about it. And understanding is the first step.
Yeah, I think that as we talk about this, we're all going to have that experience where we realize that the culture of medicine really is riddled with a lot of contempt—for ourselves, for other physicians, for patients, and for their families, a lot of the time. And what we like to say is our goal, especially with our clients, is to be able to live a wholehearted life where we're authentic and loving and genuine. Contempt really can get in the way of that.
Contempt is one of the emotions that, you know, Brené Brown has in her book *Atlas of the Heart*, which we love. It is basically a dictionary of emotions. She has a section in there called "Places We Go When We Feel Wronged," and contempt is one of the entries there. She defines contempt as a mix of anger and disgust, often accompanied by a sense of superiority, especially if the contempt is directed outward. It's the "I'm better than you" emotion.
In fairness, none of us are really ever thinking, *I am so much better than you,* but when we look at the way contempt shows up for us, we can see that there is a sense of grandiosity and superiority in it. We just have to have our eyes open to it.
So it's the "I'm better than you" emotion, and it is particularly harmful in relationships because it conveys dismissal and dehumanization. This is, if I'm correct, one of the Four Horsemen that the Gottmans talk about. It is one of those things that forebodes not good things for a relationship.
It says, *You're not worthy of my respect or regard.* And it's more than criticism. Like, ouch. It's more than criticism. It’s a helping of shaming and cruelty. Okay. And when we see how much we actually show contempt, that is a gut punch—to realize that we are actually cruel when we show contempt to other human beings in our relationships or in our practice of medicine.
It's different from anger in that it results in distancing, isolation, and exclusion. Whereas anger is engaging with someone and trying to create a solution, contempt is pulling us away from other humans. The contemptible person is not worth our time or energy—kind of like untouchable. It gives the perception that the contemptible person is incapable of change.
And when we think people are incapable of change, I think about the emergency department, especially in training during my earlier years in my career. It was so easy to label patients in ways that were really dehumanizing—"that drug addict," "that alcoholic." I never said "scumbag," but that's something you do hear occasionally, and it’s cruel. It really is cruel. But it's routine for us to do as practitioners.
Understandable, I mean, honestly. Absolutely. Because we're stressed. We're trying to make sense of chaos and an incredibly difficult job. And in trying to compartmentalize human suffering in a way that we can package it and deal with it.
If we are able to show our full empathy, sometimes it just feels so heavy. It feels like we're taking everything home. And if we dehumanize people somehow, it makes it easier for us to process—at least in that moment. But long-term, it doesn't make us the kind of people we want to be.
Yeah. It seems like it dismisses us too because we just might feel something for that case that may trigger something, either a post-traumatic deal, secondary traumatic stress, whatever, but it allows us even to dismiss ourselves really. Yeah. If something were to come up.
Yeah, I think it’s a strategy that we use in a misguided way because we’re so uncomfortable with the fact that sometimes bad things happen to good people or that there’s no rhyme or reason why these horrific things happen. So somehow our brain tries to turn it into this, *Well, that happened to them; I’m not like that person,* you know? Right?
Yeah, absolutely. Our brain wants control. It wants certainty. And yeah, it perceives some safety if we "other" people—if we cast them out in a figurative way and say, *Yeah, gosh, no. How dare they live like that? I have no idea.*
Yeah. I feel like this occurs to me. For some reason, I was on July 4th, like, I don’t know, five or six years in a row. And maybe not on the 4th of July, but on the days, like either the weekend before, if it wasn’t on the weekend or whatever. But I just worked a lot of July 4ths in a row. And you just become so like—I mean, we joke about it, you know, five-finger Freddy, one-finger Freddy, or whatever. But it’s like these awful things.
And I can remember vividly by the third or fourth time being just like, *Here we go again,* and just really dismissive. I mean, we had a firefighter come in as a patient who was doing the fireworks for the community. And his colleagues, his fellow firefighters, had to respond to this horrific— I mean, he blew out half his face, his hand. It was just, it’s a horrific explosion, and he’s never going to see again. Probably his dominant hand was gone—all these things. And his colleagues are bringing him in, and you know, it was just like, *Testosterone and fireworks again,* and just like zero empathy. Like, *Geez, what is this again? Or like, why is it always testosterone and fireworks?*
You know, I mean, you just audibly make these comments in the room, and this dude’s awake. He just got half his face and his hand blown off. But it was just so horrific to see his face disfigured, his limbs disfigured. And then, you know, his colleagues, who love him dearly because they’re fellow firefighters—probably also thinking, *It could have been any one of us that this happened to*—are just looking at me like, *This is like my brother. Hello, a little empathy or sympathy or something, right?*
And it was just straight cruelty. Just straight contempt for the fifth explosion I’d seen or whatever for that day.
Yeah, and we’re showing up wholeheartedly every time no matter how many times we see someone—whether it was an ill-advised thing or not. Every time we see someone blow their hand up with fireworks, we’re going to go in there and treat them like they’re our kid or they’re our brother, and feel sad for them and not have that contempt. But it’s so easy when we’re seeing horrible things happen over and over again to go there. It’s just—it’s human.
So, Terry Real expands on this idea by showing how contempt can manifest both outwardly and inwardly. Outwardly, it shows up as grandiosity. And I often thought of grandiosity as somebody with narcissistic personality disorder. Actually, no, grandiosity is any time we think we know better than other people, or we think the way we do things is so much better, or we see anyone else as less than us in any way. Ouch.
Yeah, it’s very common, especially among doctors, to have some grandiosity. Inwardly, if we’re directing contempt toward ourselves, it manifests as shame, which is the belief that we are inferior and unworthy. These two sides of contempt feed off of each other, and we see—I see it a lot in doctors. A lot of doctors do a lot of self-shaming. And then, when they’re taking a call for a transfer from an outside hospital, they’re quick to be like, *Oh my gosh, did they do anything for this patient? Why didn’t they do this? Oh, like I would never go there for care,* et cetera. I’m sure we all recognize those kinds of conversations.
Yeah. They’re very, very common.
Absolutely. Both of them can be going on at the same time in the same person, and they feed off of each other and create cycles of disconnection. They’re both defense mechanisms against vulnerability and emotional discomfort, and yeah, we know. We know that vulnerability has not felt like a safe thing to have, especially as we’re going through training in medicine when we see other people showing contempt for any sign of weakness or vulnerability.
The quirky thing about contempt is that the person holding contempt often wants to feel better about themselves or the job that they’re doing. This is interesting, too—there’s been research that shows that people who gossip, which oftentimes has some contempt or grandiosity in it, actually get a surge of oxytocin, which is that pro-social hormone of bonding. It helps people feel more safe and connected for the moment, but ultimately it leads to more disconnection. So they want to feel better about themselves or the job they’re doing, so they do it by diminishing the object of their contempt.
Brené says that research has shown that the contemptuous person is likely to experience feelings of low self-esteem, inadequacy, and shame. And we can say a lot of doctors experience all that. So if that resonates with you, you are not alone. It is very, very, very common. You might see this after berating yourself for doing a terrible job and then lashing out at someone else in a misguided attempt to feel better and offload emotional pain. And that’s done subconsciously. It’s not like you’re intending to inflict your pain on somebody else. But it does manifest itself as grumpy, grouchy, short-tempered kinds of ways of showing up, either for our colleagues or our family. And again, it leads to further disconnection.
Yeah. Like, *No wonder I did a horrible job because all of you guys suck,* you know, like that sort of idea.
Yeah. So we talked about a few things—how it shows up in medicine and how common it is. But really, I mean, this starts back in our training. The culture toward perfectionism and no safe place for vulnerability really elevates the bar to some impossible standards to be met. And so of course, when we don’t meet those impossible standards, we turn right inward and have a shame spiral, right? Or we project the contempt onto our colleagues because if for some reason someone’s doing better than us or meeting the standards that they’re killing themselves to meet, it’s like, *Oh, you know, just like you said, I suck 'cause y’all suck,* or whatever. Like, it’s really tricky. It’s really tricky. But keeping that grandiosity in check, I think, is probably one strategy.
Here are some examples of how it shows up in medicine. So you have this external contempt. Basically, you’re blaming others. You judge—we’ll judge Judy there. You’re real irritable. Just real snippy, like, *You know, why is my team so incompetent? Why can’t anyone do this as good as I can? Why do I have to do everything myself?* That one stings a little because I mutter that under my breath consistently in the emergency department. *Just do everything myself.* Like, that definitely shows my outward grandiosity there.
Grandiosity in medicine: If we think about the times we’ve dismissed patient concerns as unimportant—especially in the ED—like if it’s not life- or limb-threatening, we don’t really care. So that diagnosis can go way down, like, *Okay, maybe it is just a muscle strain or a cold or whatever, but this is not worth our time. We’re emergency medicine doctors. We save lives.* Right? Not to mention when patients come in and, you know, say they’ve already talked to Dr. Google, and you dismiss that and say, *This is what Dr. Morrison says.* Basically, it’s just saying, *I’m above you.* But really, you know, these patients are coming in full of fear. So if they can unload the fear somehow—and it’s right there in their pocket on their phone—they’re going to do that, you know, regardless. It’s so much more about them than us.
So communication with contempt looks like hostile humor. Sarcasm? Wait, wait, wait, wait. Name-calling, mimicking body language such as eye-rolling, disgust. Superiority is basically what you’re saying toward a patient, colleague, or transfer call—ones that you consider like a *dump* or *this patient shouldn’t be here.* Right? We talk about, you know, *should* all the time—it’s coded with shame on it. So this is that contemptuous attitude that, you know, we nickname some of our less sick patients in different rooms. That might be that name-calling to make it that much less painful, but definitely sarcasm runs rampant. So that’s that grandiosity.
Then we talk about team dynamics. Shame often surfaces when we feel inadequate or fear judgment from colleagues. What we talked about—perhaps you’ve experienced this during an M&M conference or a peer review meeting where a mistake was scrutinized. We might internalize the contempt thinking, *Wow, glad I wasn’t a part of that,* or, *I’m such a failure.* But within teams, shame isolates and leads to burnout. Grandiosity really erodes trust and basically works against that spirit of collaboration. And so both of these extremes disconnect us from ourselves and others.
Then, when we turn it inward, the contempt toward ourselves shows up as self-criticism, perfectionism, or the maladaptive high-achiever that we talked about—feelings of inadequacy or insecurities. Physicians are often their own harshest critics. Preach, preacher. If you’ve ever berated yourself after a challenging shift with thoughts like, *How could I have missed that? I’m terrible. I don’t belong here. I shouldn’t be working here. I shouldn’t be a doctor,* that’s self-directed contempt. Your imposter syndrome is bringing in a negative view of self. You’re judging yourself, and you’re basically saying, *I’m terrible.* So you’re basically saying, *I identify as terrible.* Right? So, like, you’re bringing that inside you: *I am terrible.* Not, *That behavior could be improved if I were just to have slowed down and reviewed the labs or whatever it is.* It’s really just saying that you’re judging yourself and owning up to, *I am a terrible doctor—that is becoming my identity.* When really, we don’t have a lot of evidence for that. If we really were to peel it back and just look at that, there’s a lot of evidence for that. And so really taking that on as an identity instead of just a behavior that would promote change—that’s bringing in that contempt inward.
So, a little side note on politics. Studies have shown that our nation is more polarized than it has been at any time since the Civil War. It’s because of something called motive attribution asymmetry. It’s the assumption that your ideology is based on love or righteousness, while your opponent’s ideology is based in hate or evil. Since each side believes it is driven by benevolence and the other side is evil, it renders the other side as the enemy with whom one can’t negotiate or compromise. Motive attribution asymmetry leads to something far worse than intolerance. It actually leads to contempt—not only for other people’s ideas, but actually for other people.
Yeah. I think that’s super important because people scratch their heads, like, *How could the Nazis have been able to get away with what they could get away with?* And it’s because of stuff like this. This is how it starts. It’s when we look at other people as not fully human because of their beliefs or what they, yeah. Very few people go out of their way to talk to somebody who has different religious beliefs from them, who has different political ideologies from them. It is very easy to find your little pocket and stay within it. And so then it becomes very easy to dehumanize the other perspective. And that’s the scary part—it’s not just the perspective that you end up demonizing, but the other person, that other entire group of people, without ever meeting them sometimes.
Yeah. And sometimes it’s shocking when you read surveys they do of people in different political groups. Like, some of them actually think that the country would be better off if the other people were just wiped out. And it’s like, *What?! That is crazy.* It’s crazy. You know, and our systems don’t really do a whole lot to mitigate that at all. I mean, the way social media is, the way media is, it feeds you exactly what you want to believe. And so you just get more and more reassured that you’re on the right side, and the other people are not. Like, there’s no reason to challenge that unless you’re very intentional and know about this concept of motive attribution asymmetry.
Turns out, I know people on the extremes of many sides, and they happen to be lovely people, shockingly. They just have different ideas. So, anywho, clearly it’s a problem, and clearly it leads to dehumanizing, and that’s not why we went into medicine.
So how do we start to break the cycle of contempt? The good news is you don’t have to stay stuck in this cycle once you start to realize what’s happening. So let’s talk about what we can do about it. It’s important because both being treated with contempt leads to feelings of rejection, anxiety, depression, and sadness, but also, when you treat others with contempt, it’s also damaging. It raises your level of stress, it stimulates both cortisol and adrenaline, and I don’t know too many people that need more stress. So if you do, I am happy to unload some of mine. But here’s the thing: recognizing contempt is going to require some self-reflection, some mindfulness, some intentionality, and that’s what we’re trying to bring awareness to today.
It’s noticing when we feel that mix of anger, disgust, and superiority, or when we’re drowning in self-doubt and shame, when we’re turning it on ourselves—neither one’s appropriate. We’re trying to get to the middle. What can we do about contempt when we recognize that we’re doing that, either projecting it outwards or inwards?
Well, here are some strategies. Number one: practice curiosity. So, Brené Brown emphasizes curiosity as the antidote to contempt. Instead of judging a patient or colleague, ask yourself, *What’s going on here? What is this? What might this person be feeling?* What did they Google? And are they petrified that they have a brain tumor, you know, before you just start dismissing them? A little curiosity can go a long way.
For example, if a patient’s being noncompliant, instead of thinking, *They just don’t care about their health and they’re trash or whatever,* what barriers might they be facing? Probably a good explanation. Maybe they can’t afford your prescriptions. Maybe they—You know, we keep office hours, and maybe they’re working jobs where they’re never able to come. You know, when we were doing the Blue Zone stuff, a lot of these countries that have exceptional healthcare go to people’s homes and check in on them rather than, like, *You’ve got to come in on my time and then pay money that you don’t have.* Well, how’s that going to work?
I have one, too, that I’ve worked with several clients on, and it’s that when they’re dealing with belligerent family members or patients and they get mad back—if we get mad back, it doesn’t help. But if we can look at that anger that they’re having—that’s really a secondary emotion covering up probably fear and helplessness and sadness.
Loss of control.
Yeah, loss of control. And if we can go to that and say, *Hey, I know you’re feeling scared, and I’m really sorry,* you just have a completely different experience with that person rather than just giving them back what they’re dishing to you.
Yeah, that is such a fascinating thing that I learned in coaching, is that when something happens to you, the tendency is to shovel an even bigger helping right back to the person. So, like, my favorite example is I literally said out loud one time, *I can’t stand her. She’s so judgy.*
Oh my God. There you go. That is exactly what I was doing.
So, the second strategy after practicing curiosity is “name it to tame it.” So when you feel contempt creeping in, name it. Say to yourself, *I’m feeling superior right now,* or *I’m being judgy,* or *I’m sinking into shame,* or *I’m sinking into self-contempt.* Naming that emotion can reduce its power. Like, *Oh, that’s what that is.* It helps you dissociate a little bit, practice the metacognition, and just watch that emotion rather than fully engaging in it.
Number three is cultivate empathy and compassion. Empathy counteracts contempt by reminding us of our shared humanity. And that’s the thing—even the people across the table are humans and worthy of love just like we are. As Terry Real suggests, step off the one-up or one-down position and meet each other as equals. That’s the goal.
This might look like apologizing to a colleague after a tense exchange or showing kindness to yourself after a tough day. Both are equally difficult, I think. So try to replace self-criticism with self-compassion. Say things like, *I’m human. Mistakes happen. The mistake doesn’t define me,* or *I’m feeling overwhelmed, and that’s okay.*
Another thing that is similar to what Mel Robbins says is to put your hand over your chest. Something about that seems like it triggers the parasympathetic when you’re pressing down on your own chest. And say something like, *I’m doing the best I can right now.* Have compassion for yourself. You probably really are doing the best that you can. Sometimes it’s just not going to work out. That doesn’t mean you’re a bad person. You’re still doing the best you can, and you deserve credit for that.
So then, on the other side, use humility to soften your grandiosity. Remind yourself, *I don’t have to do it all or know it all. I might not even know the best way to do it.* Actively listen to your team and accept feedback without defensiveness. Validate others’ contributions to foster connection and trust. And normalize vulnerability when it’s appropriate by sharing with trusted colleagues—not people who haven’t earned your trust, but people who have earned the right to hear about your vulnerability.
And then another one that they suggest is to engage in self-reflection. It really is going to take some time to self-reflect, to pick up on this. Journaling or speaking with a therapist or coach can help uncover patterns of contempt in your life. And ask yourself things like, *Why am I holding contempt for others or myself? How can I shift this?* Or an even more fascinating question is, *What am I trying to protect myself from?* I think that’s a fascinating question.
The goal is to move to the middle ground—not a one-up or one-down, but in the middle. You want confidence balanced with humility. You want self-acceptance balanced with accountability. It’s awesome.
Yes. So, in terms of how we can build a culture of respect in medicine, just remember that as physicians, we also have the power to influence the full culture of medicine, not just the interactions we have with our own patients and colleagues. And here are some ways that we can foster environments that minimize contempt and maximize respect.
We can model vulnerability. Vulnerability is not a weakness; it is a strength. And when we can show it in appropriate contexts—like not toward someone who’s showing you a bunch of contempt, necessarily—but when we can model vulnerability, it creates safety for other people. When we share our challenges and mistakes with our colleagues, it helps normalize imperfection. And it can reduce shame in team dynamics and, in turn, help create more openness and honesty.
Address contempt when you see it. You know, it’s easy to say, and it’s also easy to get grandiose in addressing contempt—like Amanda did earlier, saying, *She’s so judgy,* right? So, if we notice a colleague speaking dismissively to a nurse or patient, if we feel like it’s appropriate, gently call it out. One way to do that would be to say, *Hey, you know, I respect you so much, and I know you don’t know how you’re coming across.* That is coming to someone in the same way, not coming in as *I know how much I know how to treat nurses, and you don’t.* It’s more like, *I know who you are, and you want to be caring. This is what I’m seeing, if you would like to know.*
Or it might just be offering a different perspective, like *Maybe there’s more to the situation. Let’s get curious and take a closer look.*
Prioritizing psychological safety. The concept of psychological safety is one that, I know, there was probably a time in my life I would have poo-pooed this and been like, *Oh gosh, you’re just soft. You’re just, like, you know, suck it up, buttercup,* or whatever. But psychological safety really is key for any system to function well. Otherwise, people are not going to be showing up in a true, honest, open, authentic way. And there’ll be secrets; there will be hiding of things—and you don’t want that.
So, to create psychological safety, we try to make spaces where team members feel like they can speak up without fear of judgment. This is tough in medicine. We see the needle moving a little bit. Things are shifting a little bit over time. Hopefully, this will become more common, but it’s important for people to be able to speak up. Otherwise, bad stuff happens—especially if you’re running a code and one of your people on your team sees something that you’re missing or, you know, something that could be addressed. You want them to feel safe where they can talk to you and say, *Hey, what about this?*
If they don’t, this happens. I think in the OR a lot, where if a young trainee sees something their attending does and they don’t speak up, it can cause major problems. So make it safe for people to speak up without fear of judgment, and that can reduce shame and foster collaboration and make for better outcomes for our patients as well.
Yeah, I think that’s key because you also want to create that sense of psychological safety so they don’t fear retaliation. I know some people have tried to take a step in this direction, and there’s been a retaliatory effort on the other party, and that didn’t go so well. And so that’s definitely another part to this—is having that integrity and creating that space, and then also speaking up if it seems to be that there’s momentum toward retaliation.
So, contempt is more subtle, I think, than we realize. It shows up in ways that can be a little bit hard to swallow. But once you become aware, just small steps really help in moving the needle in the other direction. Because contempt, like Brené says when she talks about this in *Atlas of the Heart,* she refers to John Gottman and his work with relationships and says, *This is probably the single most important horseman to be aware of. And if it’s showing up in the relationship, it’s the single most predictor of a poor outcome.* Basically.
So, it’s pretty important. It is a defense mechanism with two extremes—shame and grandiosity, like we talked about. So, recognizing these helps us move to that healthier middle ground, where you’re just living wholeheartedly or living in that health where you’re right in the middle. And small daily practices like self-compassion and humility really can break the cycle. And what better way for someone, especially when you work with a team like we do in the emergency department, than when they start seeing the decisions you make and how you’re treating yourself?
People really are moved by how they see you live your life, not just by what you’re telling them. And so, if they’re seeing you take the deep breath and being like, *I’m doing the best I can,* or saying something under your breath, or whatever it may be, that’s huge. That’s really huge to just model that behavior.
And I think that inasmuch goes just as far, if not farther. Where you notice shame or grandiosity showing up in your life, think about small steps that you can take today just to move more toward that self-compassion. And then connection—connection with colleagues, patients, friends, you know, spouse, kids, whatever it is. And wellness starts with self-awareness and self-kindness.
Let’s keep showing up for ourselves, our colleagues, and our patients—just one step at a time. We hope that you don’t take this entire podcast and try to adopt it in one fell swoop because it will be too much. You will feel overwhelmed. Small steps make all the difference. And if this helped you today, please give us a review. Give us five stars; leave a review. Once again, it makes our ripple that much bigger and helps other doctors find us.
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