The Golden Larva syndrome: Is it real?

Bhagwan Satiani
Failure is part of the process that leads to success. Occasional failures may sting but we must recognize the adage that failure is a “bruise, not a tattoo.”

I knew a mid-career faculty member some years ago who was rapidly progressing up the leadership ladder until they were not. There were no apparent personal or health issues, or any other roadblocks, but gradually, over a period of six to 12 months, the brakes went on. There were some inexplicable decisions, beyond just humility or caution, which made me wonder if professional advancement was even a priority. 

My experience with a few underachieving physicians has been more in the academic sphere than the private-practice world. Although there were some private practitioners who wished to climb the administrative ladder, most were focused on patient care, some academic work, and activities outside work. 

Academic physicians have specific targets, such as promotion, climbing the administrative ladder, and moving up the national and international specialty society hierarchy. These steps are linked with financial rewards and professional recognition. The behavior of underachieving, resulting in a failure to advance, is seen in many professions, including sports and business, and is said to be part of the “Golden Larva syndrome.” 

Robert F. Kennedy is supposed to have said, “Only those who dare to fail greatly can ever achieve greatly.” In a business, entrepreneurial and leadership context, failing is part of the process that leads to success. Famous founders of companies like Google and Apple are cited. New, successful writers are a good example. They ask themselves, “Can I succeed again?” And fear failure. 

Similarly, the fearful leader may freeze and be unable to make any decisions. Carried to an extreme, an irrational fear of failure or atychiphobia occurs often in perfectionists. Fear of failure can sometimes be crippling. Paulo Coelho, the writer, is reputed to have said: “There is only one thing that makes a dream impossible to achieve: the fear of failure.” If enough self-doubt creeps in, most will either not attempt a “stretch” goal, or, if they do, they make it known that their expectations are low. 

Self-doubt is common before we develop enough self-awareness and discover our own capabilities. However, achievements are not always under our control. In my case, I know that there were some events beyond my control, such as timing, bias, or cultural upbringing, where boasting about accomplishments was considered gauche. My deliberate choice of family time versus work and travel was also a factor. It was never a fear of failure. Later, there were health issues that would have prevented me from being competitive and successful, but I wonder if there was, at times, a touch of the Golden Larva syndrome. 

The behavioral hodgepodge of underachievement, negative thinking, sometimes self-sabotage, fear of failing, or even fear of success, falls under the Golden Larva syndrome. Educator and psychoanalyst Manfred Kets de Vries describes one extreme when there is self-sabotage as being akin to a caterpillar that does not fulfill its potential, and therefore fails to flourish into a butterfly.1 People possess the promise of a bright future, but get in their own way and hinder their ability to thrive. Hence, the term Golden Larva syndrome. This includes manifestations such as imposter syndrome and Peter Pan syndrome. 

Imposter syndrome is the most well-known and was first described in 1978 by psychologists Pauline Rose Clance and Suzanne Imes in professional women.2 They initially described women as feeling like frauds and lacking confidence, but later determined that the syndrome occurred in both sexes equally. People with imposter syndrome doubt their abilities, don’t like attention, feel unworthy or less deserving of any success, and give credit to factors other than themselves. Success may also be avoided because one feels unfit or fearful of being under the spotlight in society and taking the place of more deserving people. Some consider this is “success phobia,” part of an ever-increasing number of phobias. There is no joy if and when success does come. Psychologists say that the syndrome is not a medical diagnosis but viewed as “cognitive distortions,” or biased on irrational thoughts and beliefs that we choose to self-reinforce over time.2 

There are some who think that imposter syndrome is an excuse to cover up systemic failures. Ruchika Tulshiyan and Jodi-Ann Burey believe it is a result of bias and exclusion, and that women especially are made to feel that it is a lack of self-confidence that causes them to fail rather than system or organizational issues.3 

Another reason why some may self-sabotage is a reluctance to grow up and take on responsibilities, otherwise known as Peter Pan syndrome. Dan Kiley described this phenomenon in his book, The Peter Pan Syndrome: Men Who Have Never Grown Up. This is also not a medical diagnosis, but a term psychologists use to describe adults, most often males, who decline to shoulder responsibilities and are unable to have healthy personal relationships. In another book, Men Who Never Grow Up, Dan Kiley describes these men as unable to “grow up.” Other traits include a fear of loneliness, a tendency of being self-centered or narcissistic, and impulsive behavior. 

As surgeons, we sometime fail even after performing a “perfect” operation, and although cumulatively these failures take a toll, few of us feel like failures ourselves and stop helping our patients.4 In a clinical context, I know I have had, at one time or another, a fear of failing but in the context of causing harm to patients. We fight through this. We have faith in our training and experience. But the most valuable asset we have are the people around us who believe in us and our abilities, at home and work. 

Given a difficult surgical problem, we have the luxury of leaning on colleagues and members of our society to seek other opinions. I have never had anyone refuse to assist me or decline a call for help when I needed another opinion. Nor have I ever declined to help, including desperate calls from the operating room. This is another reason why we can reach out to members of our society, as extended family, to give our patients the very best care that they deserve. 

Occasional failures do sting, but family, faith, friends, work-related teams and, yes, our colleagues are powerful antidotes. As the poet and writer John Sinclair said: “Failure is a bruise, not a tattoo.” Healers need other healers to take care of each other. We should try this more often. 


  1. De Vries KMFR. Breaking the Cycle of Self-Sabotage: How to Overcome the “Golden Larva Syndrome.” 
  2. Saymeh A. What is imposter syndrome? Learn what it is and 10 ways to cope. is%20the%20condition,phony%22%20and%20doubting%20 their%20abilities 
  3. Tulshyan R, Burey JA. Stop Telling Women They Have Imposter Syndrome. 

Bhagwan Satiani, MD, is a Vascular Specialist associate medical editor. 


  1. Sir,
    You can’t possibly write about racial/gender bias in other articles, and not realize that sometimes, just sometimes, the amount of bias one faces becomes insurmountable. That opportunities are taken away, that unfairness happens daily, and there is nothing one can do about it. Therefore, one loses interest/respect for the field, and focuses on other stuff. Are you sure it has anything to do with fear of failure? We’re already surgeons – as long as no crime is committed or no licensure revoked, is there really failure? Failure in progress up the society ladder – you meant failure to make small talks over the free bar at conferences or promoting a twitter page to get oneself the illusion of academic success? That has nothing to do with clinical ability or quality of scientific research. That is, however, essential for advancement isn’t it? But this type of “professional advancement” is wrought with possibility of bias, since it depends on social networking. Not everyone knowing what this type of success entails still holds it with the same respect. Some just want to be good surgeons/researchers and work on retirement. Consider an athlete, would there still be the same motivation, if the game is obviously rigged?


Please enter your comment!
Please enter your name here