The Tribe in Our Heads
The most powerful form of control isn't external. It's the voice we eventually learn to use on ourselves.
Most surgeons can remember a moment when they wanted to say something and didn't. It could have been on rounds as a medical student. It could have been in the operating room as a resident. Maybe they wanted to challenge a decision. Maybe they wanted to admit they were struggling. Maybe they simply wanted to say no.
And before anyone else had the chance to respond, a thought appeared:
"Everyone will think that’s stupid." “Just deal with it." "Don't make waves." "Don't be that person."
The remarkable thing about tribal shame is that eventually the tribe doesn't have to enforce its rules anymore. We do it for them.
The need to belong
Clinical neuropsychologist Dr. Mario Martinez describes tribal shame as the distress of believing we have become unworthy of love or belonging within our group.
Most of us think shame is about feeling bad. It's not. Shame is about the fear of separation: the fear that if people knew the truth about us (what we need, want, think, and where we struggle), we would no longer belong.
And belonging matters more than almost anything. Belonging is warmth, safety, and identity. Belonging answers the question: Who am I? When the tribe approves of us, we feel solid. When it withdraws approval, we doubt ourselves. The tribe is not necessarily right. But because we evolved to survive inside groups, our nervous system still treats exclusion as danger.
Why growth feels dangerous
Martinez points out something fascinating: the tribe will almost always welcome us back when we fail. Failure reinforces the existing order. The struggling surgeon doesn't threaten anyone's worldview. Neither does the exhausted surgeon, or the surgeon who tolerates mistreatment.
But growth is different. Growth changes the rules.
When we establish boundaries, we force other people to notice they don't have any. When we stop apologizing for our needs and wants and simply express them, we expose how many people are still apologizing for—or ignoring—their own. When we question a dysfunctional norm, we reveal that those who went along with it may have been wrong.
And that makes people uncomfortable. Because our behavior challenges the story other surgeons have been living inside.
How surgeons keep themselves small
Most surgeons aren't being held back by a lack of ability. They're being held back by a fear of what success, visibility, authenticity, or honesty might cost them socially.
We stay silent in meetings. We overextend ourselves because that's what the colleagues before us did. We volunteer for things we don't want to do. We tolerate behavior we know is unacceptable. We say yes when we mean no.
No one is explicitly forcing us to override ourselves. We simply want to remain in good standing with the tribe. We want the warmth, belonging, and safety. So slowly, over time, we trade pieces of ourselves for membership in the tribe of surgery. A boundary here, a preference there, a truth we keep to ourselves. Until one day we look around and realize we've become extraordinarily good at fitting in…and we have no idea who we really are.
The solution
Just as the problem starts inside of us, so does the solution.
The first step is awareness. The moment we hear ourselves think, "I can't do that," pause. Is that true? Or am I afraid of the social consequences? Those are very different things. One is inability. The other is tribal shame.
The goal is not to leave the tribe. The goal is to stop abandoning ourselves in order to remain inside it. We are allowed to belong, to contribute, and to care deeply about our colleagues and our profession. And we are allowed to honor our own truth.
The healthiest tribes do not require self-erasure as the price of admission. And the healthiest team members are not the ones who blindly follow the group. They are the ones whose belonging no longer depends on pretending to be someone they are not.
