Podcast: The Cost of Capable - Race, Resilience, and the Hidden Weight of High Achievement
How to recognize racial trauma, sharpen diagnosis, and apply “Cost of Capable” and “weathering” to build trust and assess suicide risk.
PSYCHED PERSPECTIVES
In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, speaks with Verena Rizg, MN, NP-PHC, founder of the first BIPOC-focused clinic in the Canadian Armed Forces and a pioneer of nurse practitioner-led care across federal prisons in Nova Scotia. The conversation centers on culturally and racially responsive care, and how clinicians can improve diagnostic accuracy by expanding their assessment vocabulary around race, culture, and migration.
Rizg describes how patterns she observed across health systems—disengagement from care, treatment nonadherence, and misdiagnosis—often reflected unrecognized race-based trauma rather than primary psychiatric pathology. She argues that clinicians frequently under-ask rather than "wrong-ask," avoiding culturally sensitive questions out of fear of using improper language, which stalls the therapeutic alliance, a known predictor of outcomes. She recommends techniques such as reflective repetition ("did I get that right?") to build trust, particularly with migrant and racialized patients.
The discussion covers physiological correlates of chronic race-based stress, such as persistent tachycardia, hypervigilance, hypertension, and eventual target-organ damage—framing racial trauma as a biopsychosocial issue, not solely psychological. Rizg also discusses incorporating "weathering" as an explicit risk factor in suicide risk assessments for patients from historically marginalized communities.
A central portion introduces Rizg's original framework, the "Cost of Capable," describing how overperformance in high-achieving individuals from marginalized or immigrant backgrounds is often rooted in survival rather than ambition, and manifests through invisibility, overexertion, and isolation. She connects this to burnout, difficulty resting, and delayed help-seeking, and discusses reframing resilience as sometimes masking unmet needs rather than something to be celebrated uncritically.
Other clinically relevant threads include: the therapeutic utility of asking patients (and clinicians) "What do you look like when you're well?" as a wellness barometer; integrating spirituality/meaning-making into treatment planning; and a candid disclosure by Rizg of her own previously undiagnosed attention-deficit/hyperactivity disorder, discussed in relation to underdiagnosis of neurodivergence in women, particularly Black women, due to high-functioning masking behaviors.
The episode closes on themes of clinician self-care, posttraumatic growth, and the idea that clinicians must "show up for themselves" before they can fully show up for patients.
Dr Clark is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association’s Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for Psychiatric Times.
Ms Rizg is the founder of the first BIPOC-dedicated clinic in the history of the Canadian Armed Forces, a nurse practitioner, and systems strategist. She is the creator of the Cost of Capable™ framework and the author of The Cost of Capable, a clinically informed, research-based guide to the hidden cost of high performance. Learn more at
