Every once in a while, there's a movie that comes along that you're a bit afraid to tell your friends about. Some of them will love the movie, and others will hate it and think you're an idiot for liking it. Writer and director Stanley Tucci's "The Impostors" is like that. Some people will love it, and some will hate it, and there's no way to tell ahead of time who will fall into which camp.

The movie is a 1998 throwback to old slapstick comedies like those of Laurel and Hardy. It also has the same anachronistic sensibility as The Hudsucker Proxy. While it is ostensibly set during the Great Depression, nineties attitudes abound.

Tucci and Oliver Platt play two starving New York actors (Maurice and Arthur, respectively) who can't get themselves cast in a production to save their lives. Desperate for sustenance, they come up with a scam to trick a baker into providing them with free pastries by staging an argument in his store. Rather than pastries, however, the store owner gives them tickets to a performance of Hamlet. At the show, Maurice and Arthur upset the star, Jeremy Burtom, played by Alfred Molina, who swears to kill them. In the ruckus, Burtom is injured, and the unlucky pair are pursued by the police for attempted murder. The two flee the police, and end up as stowaways aboard a ship headed to Europe.

Upon boarding the ship, they meet up with Lili Taylor's Lili, the head stewardess, who agrees to help them avoid discovery. As they try to lay low, they discover that the rest of those aboard are rather unique, too. One of the crew members is a red revolutionary. Two of the other passengers are thieves and murderers. Another is a deposed queen, and yet another is a fabulously wealthy sheik. Rounding out the group are a lusty professional athlete, a gold-digging older woman, her depressed daughter, and Steve Buscemi as the ship's suicidal lounge singer. Just when Maurice and Arthur think things couldn't get any worse, they discover that Jeremy Burtom is also on the passenger list.

The cast of this film is simply amazing. In addition to Platt, Tucci, Buscemi, Molina and Taylor, it contains Tony Shalhoub, Woody Allen (uncredited), Allison Janney, Isabella Rossellini, Campbell Scott and Billy Connolly, among others. The two most notable performances are those of Connolly and Buscemi.

Buscemi plays the ship's entertainment, a singer, who has just been left by his wife, and has decided to kill himself. Throughout the movie we are presented with his bungled attempts at suicide, which echo Maurice and Arthur's obsession with performing the perfect death scene. Just as they always screw up death scenes, he cannot succesfully off himself. He also has the movie's best line. At one point, Buscemi's character (ironically named Happy Franks), is asked why he is so sad. He replies that his wife left him for his agent. When someone disparages the agent, he leaps to his defense, saying, "He was a great agent! I loved him like a brother. I loved my wife like a mother and a hooker, and look where it's got me!"

Connolly, as Sparks, a tennis pro, is also excellent. Sparks has a thing for young Grecian men, and develops a liking for Maurice, who is half Greek. For the rest of the movie, he pursues Maurice, who does not appear to return his desires. His pursuit continues even when, later in the film, Maurice is disguised as a woman - although when he finds out about the ruse, he is even more excited. In addition to being rather humorous, Sparks also highlights the fact that Maurice and Arthur are (as a review at IMDB points out) somewhat ambiguous in their sexuality - they are never presented as a heterosexual threat, and sleep in the same room. Whether Maurice's discomfort at Sparks' advances is due to his sexuality or merely the fact that he is already spoken for is left open to interpretation.

Finally, of course, the heroes save the day in slapstick fashion. How do they do it? By relying, of course, on over-the-top acting. After the denouement, however, Tucci takes a big risk, ending the movie with a dance number that includes the whole cast dancing off the set and allowing the cameras to pan to show that the ship is, of course, a soundstage. By breaking the fourth wall, Tucci makes the audience question whether the film is merely a fiction, or a fiction within a fiction.

It's tough to explain the appeal of this film verbally. The funniest bits are really the physical comedy of both Platt and Tucci, which has to be seen to be appreciated.

Author's note: This is a piece I wrote with the intention of publishing in a medical journal. It was rejected twice, so in my frustration I have given up, and I am putting it here for anyone who might be interested.

Balaji Varatharaju entered medical school at Adelaide University as a model student, known for his generosity and altruism. He studied, he volunteered at the Red Cross, and helped in aged care, despite suffering from depression and back pain. He wanted to help the most disadvantaged people of Australia, and he took up as an intern in Alice Springs Hospital in 2009.

Quite soon his colleagues noticed his severe lack of clinical knowledge, and his ineptitude in basic tasks like IV cannulation. After he had spent ten months treating hundreds of patients, these concerns were finally raised with the Medical Board, who discovered that he had been expelled from Adelaide University for forging a lecturer’s signature. His certificates were also fakes. He was arrested and charged with forgery, criminal deception, and aggravated assault. He pleaded guilty and received 14 months in gaol.1

The Medical Board of Australia now routinely cross-checks all qualifications with their issuing institutions, as a matter of course.

Balaji is just one fraud among many. At one end of the spectrum are trained professionals who step beyond their scope of practice or make falsely optimistic claims; at the other end are career fraudsters who skip from one high-profile job to another. These cases are interesting to read about, but they also cast an oblique light upon a fear that quietly nags at many of us in the health professions: that we too might be fakes, pretenders, impostors.

The impostor syndrome was first described by Clance and Imes, of Georgia State University, in 1978.2 It is characterised by an inability to internalise success, and the tendency to attribute success to external causes such as luck, error, or knowing the right people. This leads to an inner sense of fraudulence, sometimes called impostorism.

Though not a recognised psychiatric diagnosis, the impostor syndrome is much talked-about in the press. If you read the news or follow the journals, you will have seen headlines about this modern epidemic of self-doubt. You can listen to podcasts about it,3 watch Michelle Obama talk about it on YouTube,4 and do the online quiz to find out how badly you suffer from it yourself.5 The impostor syndrome is said to be at almost epidemic levels in our society.6

Is this true? Probably. The syndrome is estimated to affect 30% to 60% of medical students, residents, and physicians, with a particular prevalence amongst women and people of colour.7 It is strongly linked with emotional exhaustion, work-family conflict, job dissatisfaction, poorer organisational citizenship, and the twin curses of burnout & depression.8

But what can we do about it? To this author’s knowledge, there are no published studies that assess any intervention’s efficacy in reducing impostorism. Instead you might ask a colleague, and they might say that you should work harder, so you won’t have time for such futile fretting. Or you might ask a large group of people who rate highly on clinical scales of impostorism, so they can tell you what works for them. The strategies these people have described in the literature are quite reasonable: education and self-improvement, external validation of successes, creating supportive work cultures that don’t punish errors, sharing experiences of living with the syndrome, positive mentorship, and setting clear expectations within professional roles.9,10

All this sounds like excellent advice. However, one question lingers: If we are looking for strategies to reduce impostorism, should we really be asking the people who suffer from it the most? Aren’t they, almost by definition, the very people who are using the wrong strategies? When managing my social anxiety, should I ask a patient in the mental health clinic what strategies they have been using, so I can do the same?

Instead, I would like to propose a different way of looking at the problem. It starts with a question: What if we really are fake?

We are trained since childhood to respect rules we don’t necessarily believe in. To say ‘please’ and ‘thank you’. Not to take what isn’t ours. Not to speak ill of others, even when they aren’t around. Society puts a high price on politeness, which is simply a set of practiced behaviours that we agree are important and good. Politeness is a performance that files away the rough edges of our authentic personalities. Even the word ‘personality’, something supposedly innate to each of us, actually comes from the Latin persona, referring to the role an actor plays on the stage; more literally, it refers to a mask. Our personality is the mask we wear in polite company.

In a way, this relates to Freud’s structural model of the mind, which still still looms large in how we think and talk about our internal conflicts, despite being ill-favoured by modern psychological science. Of relevance to the impostor syndrome is the Super-ego: the internalised aspects of our society, the sense of right and wrong we have been taught, the rules laid down by our parents and by unspoken customs. It is something that is nurtured and developed over many years, and if it fails to develop fully then we are left stunted and psychopathic for the remainder of our lives. This part of ourselves, which we usually think of as being the best, most admirable, most noble aspect of our humanity, is the part that is imprinted upon us by others, thus being explicitly inauthentic to our underlying self. And this is the part where we are meant to incorporate and embody all the virtues of a good doctor.

Similarly, in our work we will present ourselves under the cover of a persona that has been cultivated over time. It comes from our education, both formal and informal. In lectures we learn codes of ethics and methods of resolving moral dilemmas. In the wards and clinics we find role models and gauge the prevailing standards of our time and place. We gain a sense of what role we ought to be playing, and mostly we try to inhabit the role. This is why actors can perform so well as doctors on TV: because we all have a feeling for what a good (or bad) doctor is like. Whether on a stage or at the bedside, a kind of performance is taking place.

Ellen Aronofsky Cole is an American poet and actor, who has written about the experience of being a pretend patient in medical school simulations:11

‘Of course, some students resist the whole idea of role playing. I like to remind them that as doctors, they, too, are playing a role. The doctor must appear professional, competent, and empathetic, even if the patient is difficult, argumentative, noncompliant, or physically repulsive. Physicians who've just argued with their spouse, stubbed their toe, or crashed their car still owe it to their patients to provide the needed attention and care.’

When I first read this, I was taken aback by having my fakeness acknowledged so bluntly. I was taken back to my first year of medical school, when I first sat down with an actor in a room with a one-way mirror, to learn how to interview a patient. As a student I was scared and didn’t know what to say, but I pretended. Now I am a registrar who usually knows what to say, but I am still scared, and still pretending. Every day I pretend, and as I do, I get better at pretending. I watch my seniors, my juniors, my fellow trainees, and I take the elements of them that I admire. I try out a phrase, an emotional manoeuvre, a new way of explaining something, and I watch how my patient reacts. If my tactic works, I incorporate it into my ever-changing ‘doctor’ persona.

This is where Balaji and all the other impostors shed light on us: we all are pretenders. We act out the role society gives us. We might think our noble motives are what separates us from the impostors, but perhaps not. The commentary made by Justice Jenny Blokland on Balaji’s case was revealing: she said that he was ‘motivated in his fraudulent activity to help people in the community rather than hurt anyone’. Balaji was doing what he could to overcome the barriers that kept him from helping the sick people in an underserved part of the country. It is unfortunate that the main barrier was a lack of qualifications and skill. Unlike Balaji, I have the qualifications. I am not always so sure about the skill, but each day I just do the same thing he did. I pretend.

1 - Statham L. Fake Doctor Jailed for 14 Months [Internet]. Sydney NSW: Sydney Morning Herald; 2010 [updated 2021 Jun 16; cited 2021 Apr 17]. Available from: https://www.smh.com.au/national/fake-doctor-jailed-for-14-months-20100616-yfxa.html
2 - Clance PR, Imes SA. The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice. 1978; 15(3), 241–247.
3 - NPR. Impostor Syndrome: How to Overcome Feeling Like A Fraud: Life Kit: NPR [Internet]. Washington DC: NPR; 2021 [updated 2021 Feb 01, cited 2021 Apr 17]. Available from: https://www.npr.org/transcripts/959656202
4 - The Star. Michelle Obama explains impostor syndrome – YouTube [Internet]. Sun Bruno CA: Youtube; 2019 [updated 2019 Dec 13, cited 2021 Apr 17]. Available from: https://www.youtube.com/watch?v=dumm_XfHkmY
5 - Means N. Clance Impostor Phenomenon Score [Internet]. Austin TX: NICHOL.AS; 2014 [cited 2021 May 17]. Available from: http://impostortest.nickol.as/
6 - Martin C. Why impostor syndrome has become epidemic [Internet]. Sydney NSW: The Australian Financial Review; 2020 [updated 2020 Feb 11, cited 2021 May 17]. Available from: https://www.afr.com/work-and-careers/workplace/why-imposter-syndrome-has-become-epidemic-20200205-p53xxp
7 - Bravata D, Watts S, Keefer A, Madhusudhan D, Taylor K, Clark D, et al. Prevalence, Predictors, and Treatment of Impostor Syndrome: a Systematic Review. J Gen Intern Med. 2020 Apr; 35(4):1252–75.
8 - Gottlieb M, Chung A, Battaglioli N, Sebok-Syer S, Kalantari A. Impostor syndrome among physicians and physicians in training: A scoping review. Med Educ. 2020 Feb; 54(2):116–124.
9 - Ibid.
10 - Barr-Walker J, Werner DA, Kellermeyer L, Bass MB. Coping with Impostor Feelings: Evidence Based Recommendations from a Mixed Methods Study. Evidence Based Library and Information Practice. 2020 Jun; 15(2), 24–41.
11 - Cole EA. My Life as a (Fake) Patient. N Engl J Med. 2015 Dec; 373:2302-2303.

Log in or register to write something here or to contact authors.