Responding to Not Knowing: Playing Big and Playing Small

April 6, 2017

(Part 1 of 3)

One of the things I love about going to a conference like Elevate is learning from some of the best and brightest people in my field. I’m not just talking about the presenters who gift us with their breadth and depth of knowledge of psychiatry. I’m also talking about my colleagues, those of us who come together from around the country to learn from each other.

Being around so many bright people certainly has its advantages when it comes to learning. But it also creates some real fears. It’s easy to imagine, when I’m struggling in a lecture with some nuanced complexity of receptor pharmacology, that the people to my left and right are understanding it handily. It can be daunting to ask a question when I assume that all the people around me comprehend the material, and so by asking a question, I’ll look dumb or maybe even frustrate the presenter. So, many of us stay quiet, hoping that maybe we can figure it out later, on our own. Or we confide in a friend, “did you get that?” Often, though, the opportunity to learn is lost to our fears.

In a field as complex as psychiatry, where no one person can know everything about every facet of the discipline, we are bound to have deficiencies in our knowledge. Every practitioner will need to contend with this reality in their professional lives, and it is to be welcomed, for if we are being challenged, we have the opportunity to grow and learn.

MORE: The Art of Sitting With and Finding Meaning in Suffering

Understandably, most of us do not enjoy the feeling of being ignorant, and have developed sophisticated ways of defending against the anxiety created when we’re afraid of being seen as inadequate. I would organize these strategies in two broad categories – playing big, characterized by arrogance and hubris; and playing small, characterized be the imposter syndrome, or the fear of your peers finding out you are an unprepared fraud. I’ll be exploring my experiences with both of these phenomenon in future blog posts.

Being  psychiatric practitioners provides us the good fortune of being lifelong learners. Each profession under the “big tent” of mental health has something to offer, if we are willing to teach and learn from one another.  But in order to learn, we have to be willing to be vulnerable in acknowledging our imperfections. Going forward in this series, I invite all of my colleagues, regardless of their specialty, to contribute to the conversation about how we can create a culture where learning from each other is paramount, and that that which is not yet known is thought of as an opportunity, rather than a vulnerability.

Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, California, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.