As I turn 40, I’ll rededicate myself to my identity formation and continue to reflect frequently and periodically about what it means to be a 40-year-old rheumatologist in the year 2025. But to do so, I’ll have to engage in the process of rediscovering who I am.
Identity & Self-Concept
Identity formation is deeply and intimately intertwined with self-concept. Although the term professional identity formation is relatively new, there’s an older theory that helps describe the creation of self-concept. In 1902, the sociologist Charles Horton Cooley proposed the theory of the “looking glass self.”3 According to Dr. Cooley’s theory, we see ourselves as we imagine others see us. That may sound abstract and self-referential, but it has very practical ramifications on identity formation. In the context of professional identity formation, the looking glass self suggests our identity as rheumatologists is deeply influenced by how others, including patients, peers and mentors, perceive us.
This is why it’s crucial to surround ourselves with people who see the inalienable good in us. According to the proponents of the looking glass self, love, respect and esteem flow like currents through social groups. The more we share these authentically positive self-images of one another and the more we open ourselves to seeing the good in one another, the more our self-concept and our identity evolve toward goodness itself. At its best, identity formation can be thought of as a kaleidoscopic, multidirectional and relational process of affirmation and aspiration.
Even if the looking glass self and professional identity formation seem unfamiliar to you, I am sure you have experienced this throughout your career. Mentorship, sponsorship, coaching and role modeling are all practical manifestations of this mutualistic relationship between self-concept and identify formation. When a trainee sees their mentor listening deeply, demonstrating humility or admitting uncertainty, they internalize those behaviors as part of their own professional identity. Likewise, when a mentor sees their mentee receptive to growth, it fosters a sense of reciprocation within the mentor to become humble and listen deeply, ultimately nurturing the affinity of the relationship between both the mentor and the mentee.2
Terror Management Theory
Of course, the looking glass self is only one theory that helps us contextualize the formation of our identity. Another, very different, theory that seems to go against the looking glass self is terror management theory (TMT).4 Unlike the theory of the looking glass self, TMT is a psychological framework that suggests much of human behavior is driven by a desire to buffer ourselves against the fear of death. We manage this existential terror by aligning with cultural worldviews and striving for symbolic immortality, like legacies, reputations and contributions that endure after we’re gone. Unlike the looking glass self, the audience that sees us in TMT is situated in the future, coolly and inertly judging us, rather than interacting with us in the present.
