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The Cost of Belonging Through Achievement

Ni-Cheng Liang, MD confesses: achieving as the currency of belonging is a high price to pay and can, as she experienced, threaten your life.

“I was belonging through achievement.”

This resonated with me to my core.

It was what I had strived for my whole life.

From being a child of immigrant parents, trying to do the best we all could, resulting in the acceptance and healing from childhood emotional neglect decades later.

I recognize now that what I lacked in affirmation from my parents became channeled into academic excellence.

Straight “A”s and doing all the things from volunteering, to playing multiple instruments, and speaking multiple languages – doing more and being praised more, was the only semblance of external validation that I could muster up as a child.

And so, I became an expert at academic excellence.

 

Straight “A”s and doing all the things from volunteering, to playing multiple instruments, and speaking multiple languages - doing more and being praised more, was the only semblance of external validation that I could muster up as a… Click To Tweet

 

The drive to succeed, to aim towards perfectionism to a compulsive degree served me well through my undergraduate, medical school, and post-graduate medical education years… until it didn’t.

The awards and the accolades of “Honors” designations, merit awards and scholarships, the congratulations I witnessed bestowed upon my parents for raising such as successful child was an intoxicating drug. I was addicted and in love with external praise.

 

I recognize now that what I lacked in affirmation from my parents became channeled into academic excellence.

 

Through medical training that pattern continued but was harder to maintain despite my best efforts as an expert self-flagellator by then, because of the sheer overwork, stress, and detriment to my physical and mental health.

So much so that going 200 miles an hour in pulmonary critical care fellowship no doubt contributed to my diagnosis of breast cancer at age 31, with an 18-month-old in tow.

 

The drive to succeed, to aim towards perfectionism to a compulsive degree served me well through my undergraduate, medical school, and post-graduate medical education years… until it didn’t. Click To Tweet

 

I’ll never forget the day I received the life changing diagnosis.

It was at the American Thoracic Society meeting 2016 in Denver, CO, luckily after I had given my speech for my poster presentation session on basic science research  which I had tried really hard to love doing.

With the words “results consistent with invasive ductal carcinoma” ringing in my ears, my world shattered into a million pieces and all of that currency of achievement and doing more suddenly became worthless.

All that mattered was flying back as soon as I could do be with my family in San Diego.

In an instant, I could not care less about earning the currency and praise that I had been addicted to for so long.

 

It’s been 11 years now since that diagnosis and I’m still working on unlearning old habits that helped me succeed.

I like to say that I am a recovering perfectionist.

During Cancer Survivor Day, I met Dr. Steven Hickman, Founding Executive Director of the UCSD Center for Mindfulness, who inspired me to delve all-in to immersing myself in learning, and practicing, with the goal of teaching mindfulness.

 

It’s been 11 years now since that diagnosis and I’m still working on unlearning old habits that helped me succeed. I like to say that I am a recovering perfectionist. Click To Tweet

 

Funny to me is that I am born and raised Buddhist where mindfulness practice originates from, but it took having cancer for me to develop a contemplative practice.

I took the year off from fellowship to become one of the few East Asians in the ISPYII study (published in the NEJM, not as an author yet, but as a patient), underwent one of the toughest chemotherapy regimens known to breast cancer at that time, followed by 3 surgeries including bilateral mastectomies and reconstruction, healing my external physical wounds, and seeking psychotherapy for the first time, to put myself back together from the inside.

 

When I came back to fellowship, I finally learned to listen to myself, and to say no.

To really say, “No.” And that year off over 10 years ago was when I started to learn to be kinder to myself.

 

In an instant, I could not care less about earning the currency and praise that I had been addicted to for so long.

 

“No. I am not completing critical care fellowship.  I’ll focus on finishing pulmonary fellowship.” At that time, I had not learned to trust myself in saying no to overwork.

“No, I am not continuing deuterium exchange mass spectrometry research because it no longer interests me.” And truthfully, looking back I was lying to myself if I said I liked doing it.

 

Returning to finish fellowship after cancer treatment was quite frankly the most liberated I had felt in my entire life.

I even splurged and got the more expensive “A” parking permit thinking, “Heck I had cancer, I deserve to park closer!”

When it came down to it, the prior accolades and awards I so valued, as my own self-prescribed currency of belonging, didn’t matter anymore.

I unshackled from the belief that I only belonged because I was achieving, and I was constantly doing.

 

When it came down to it, the prior accolades and awards I so valued, as my own self-prescribed currency of belonging, didn’t matter anymore. I unshackled from the belief that I only belonged because I was achieving, and I was constantly… Click To Tweet

 

Today I’m on my own unscripted path.

I’ve continued to teach mindfulness to healthcare professionals, my patients, and the general public.

I also continue to speak internationally about it, and practice pulmonary medicine on my own terms, in a private practice group that unconditionally supports me and my innovation.

I’ll be graduating from University of Arizona’s Integrative Medicine Fellowship this fall, uncertain of what the next iteration of me will be.

While those old habits and the lure of earning my worth through the currency of external validation still sneak up as shadows, I can say, and stand steadfast, in my authentic self, “I belong here.”

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