Merriam-Webster defines stigma as “a set of negative and unfair beliefs that a society or group of people have about something.” In medicine, stigma often shows up in subtle ways: the raised eyebrow when someone takes a sick day for mental health reasons, the whispered conversations about the resident who “needed time off,” the unspoken belief that needing support is a sign of weakness rather than a marker of humanity. For many clinicians, stigma becomes an ambient background noise that may not be explicit, but is always felt.

Shame, on the other hand, is defined as “a painful emotion caused by consciousness of guilt, shortcoming, or impropriety.” Dr. Brené Brown expands this further, describing shame as “the intensely painful feeling or experience of believing we are flawed and therefore unworthy of love and belonging.”

In other words:

• Stigma is the negativity that comes from the outside (from institutions, culture, or colleagues).

• Shame occurs when we internalize that negativity and begin to police ourselves with it.

This means that even if you are in a program or healthcare system that openly endorses mental health care, you may still feel shame simply because the need for support feels incompatible with the internal standards you hold for yourself. Shame is a quiet narrator, telling clinicians that their needs are inconvenient, excessive, or unacceptable. This can occur even when their environment is, on the surface, supportive.

Addressing stigma requires collective action: awareness, policy changes, advocacy, and courageous leadership. Healthcare institutions can and should play a role in dismantling external stigma.

But addressing shame is different. Shame lives within us, and addressing it requires self-reflection, internal permission, and often guidance from supportive peers or professionals.

There is an unfortunate paradox here: psychotherapy can be extraordinarily effective in working through shame, particularly for healthcare professionals who have been trained to compartmentalize. But shame itself can become the very barrier that prevents clinicians from seeking care. It whispers that we “should” be able to manage distress independently, that we “should” be more self-sufficient, or that asking for help signals a failure of competence or character.

Once we start telling ourselves what emotions we should be allowed to have, or what emotions are acceptable for someone in our role, we move away from authenticity. We begin responding not to our actual emotional experience, but to our judgments about which emotions are “permissible” within the culture of medicine. This distortion can be subtle, but its impact is profound.

And it is important to remember that the opposite of “ashamed” is not “shameless.”

It is unashamed.

Becoming unashamed does not mean ignoring errors or bypassing accountability. You don’t need shame to reflect honestly, to repair what needs repairing, or to acknowledge when you need support. In fact, excessive shame often interferes with growth by narrowing our attention, increasing defensiveness, and undermining learning.

Becoming unashamed means holding your humanity with compassion: recognizing that you can strive for excellence without demanding perfection, that you can own your mistakes without defining yourself by them, and that you can care for others without abandoning your own emotional well-being.

Name it to Tame It

One of the most powerful first steps in working with shame is simply naming it.

Shame says: “You feel bad because you are bad.”
We can counter that with: “I feel bad because I’m feeling shame.”

Naming shame shifts it from being an identity (“I am the problem”) to being an emotion (“I am experiencing a feeling”). It creates just enough psychological distance to engage with the emotion rather than being overtaken by it.

And it helps to remember: feelings are real, but they are not facts.

If you read a heartbreaking novel and cry, your sadness is genuine, even though the events never occurred. The same is true for shame. Feeling ashamed does not make you inadequate any more than crying over a fictional character makes that character real.

You may truly have made an error. You may have fallen short of your own expectations or the expectations of others. Clinical work is complex and imperfect. But your feeling of shame is not what determines the reality of your actions or your worth. Shame is a response, not a verdict.

The Value of Storytelling

“It’s okay to not be okay.”
“You are enough.”
“Don’t compare your insides to other people’s outsides.”

Many healthcare professionals have encountered one or all of these well-intentioned phrases, whether on wellness posters in the hospital, in presentations about burnout, or shared among colleagues trying to support one another. Some of these statements may land with you more than others. And for many clinicians, none of them feel quite strong or specific enough to pierce the layers of shame, self-criticism, and high internal standards that are woven into medical training and culture.

One of the most meaningful tools in that regard is storytelling. Humans are wired for connection, and clinicians, who spend their days immersed in the stories of others, often forget the healing potential of their own. Listening to TED Talks, podcasts, or memoirs by respected professionals who openly acknowledge their vulnerabilities can normalize your own experience. When leaders, educators, and colleagues speak honestly about uncertainty, mistakes, or the weight of responsibility, it invites compassion rather than self-judgment. It reminds you that even the most competent, dedicated clinicians struggle at times. You are not alone.

You may discover that sharing pieces of your own story (when it feels safe and appropriate) is healing not only for you, but also for peers who are quietly carrying similar burdens. Vulnerability, when chosen and paced thoughtfully, can be a profound antidote to professional isolation.

Using Reframing Techniques Effectively

Another strategy is reframing. In the clinical environment, where the stakes are high and outcomes matter, it’s easy to default to a deficit-based internal narrative. Reframing is not about sugar-coating or telling yourself that “everything is fine.” It is about intentionally choosing a perspective that remains honest but also acknowledges what is working, what is valuable, or what is growing beneath the surface.

This kind of reframing must feel authentic to be effective. It must be something you choose for yourself, not something imposed from external sources. When practiced consistently, reframing can shift the emotional impact of difficult situations, allowing you to access gratitude, meaning, or compassion even in moments of distress.

You might consider the possibility that the very experiences you view as shameful, flawed, or inadequate are also what deepen your empathy. Your struggles may be shaping you into someone who understands the vulnerability of patients, families, and colleagues more fully.

Is it possible that these moments of self-doubt make you more patient with patients?
More understanding with peers?
More courageous in naming suffering, your own and that of others?

Thoughtful Use of Positive Affirmations

Alongside reframing, positive affirmations can support self-worth and healing. Affirmations only work when they feel grounded, believable, and connected to your lived reality. Forced positivity often backfires, feeling hollow or self-invalidating. But carefully chosen affirmations, ones that genuinely resonate with your values and professional identity, can slowly recalibrate the way you speak to yourself.

Examples such as:
• I am committed to improving physical and mental health in my community.
• My work brings value to the lives of others.
• I am proud of my contribution to healthcare.
• My presence brings peace of mind to those in distress.
• I am a source of hope and healing for those facing health challenges.

(Source: https://thegoodpositive.com/positive-affirmations-for-doctors/)

Even a few sentences like these, repeated consistently, can shift long-standing patterns of harsh self-evaluation.

When These Tools Don’t Resonate

Still, for many healthcare professionals, shame can be deeply ingrained and continuously reinforced by environments that reward stoicism, perfectionism, and self-sacrifice. You may feel such a strong expectation to be “the one who holds it all together” that you deny yourself even the possibility of healing. If that strikes a chord with you, it may be worth asking:

What is shame trying to do for me?
How does maintaining the status quo protect me?
What might feel unfamiliar, risky, or new if I loosen my grip on shame?
And what might open up, professionally and personally, if I didn’t have to carry this alone?

I invite you to consider caring for yourself as you care for others.

Resources:

The American Psychiatric Association Foundation’s Center for Workplace Health has an arm specifically dedicated to workplace health in medical settings, with emphasis areas in fear and shame, peer support, clinician cultural competency training, and suicide prevention, among others.

Clinician Burnout Foundation combats clinician burnout by offering innovative, foundation-funded support and solutions directly to healthcare professionals.

Debriefing the Front Lines provides structured debriefing for single incident and cumulative trauma. The organization also provides emotional wellness programs, sobriety support, and CE workshops.

Don’t Clock Out offers peer support services and a self-care podcast for nurses, along with an online resource page.

Emotional PPE Project offers a directory of volunteer therapists providing psychotherapy to healthcare workers across disciplines. There is also an advocacy arm dedicated to reducing barriers to appropriate mental healthcare.

Operation Happy Nurse is an online community that works to improve the mental and physical well-being of nurses who are dealing with stress, anxiety, or depression.

Physicians Anonymous is a resource for physicians, residents, and medical students. It also offers 1:1 coaching and free anonymous support groups. Finally, Physicians Anonymous maintains a blog that includes firsthand stories intended to reduce shame and stigma.

Physician Support Line (1-888-409-0141) is a free and confidential support line run by volunteer psychiatrists. It is open Mon-Fri (except federal holidays) 8:00 AM-12:00 AM EST. In addition to working with physicians, it also serves medical students. https://www.physiciansupportline.com/

Togather is a collective care membership-based platform built by and for healthcare providers to reduce burnout and amplify the impact of those pursuing health justice. Some peer support opportunities, some work on addressing moral injury.

988 is the National Suicide and Crisis Lifeline.