On Burnout

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When patients tell me they feel constantly drained, unable to keep up their motivation and focus, and that they repeatedly start the week or even the day with less energy than they ended the previous one with, I sometimes will explore with them the possibility that they are heading toward or suffering from what I think of as burnout.*

What is burnout?  In my clinical practice, I define burnout as “having more going out than coming in.”  More what?  Colloquially, maybe we’d say emotional energy, but to be more precise, let’s call it self-regulation resources.  Every time you do a thing you don’t want to do or stop yourself doing a thing you want to do, that’s self-regulation.  We regulate ourselves in subtle (being polite to strangers) and not so subtle (declining your favorite dessert) ways all the time and it requires expending neurological resources, which we feel subjectively as effort.

One model/metaphor I use when talking about self-regulation is a hydroelectric dam.  You’ve got a big reservoir of water some of which flows through conduits to drive turbines, which in turn generates electricity for a town.  The reservoir behind the dam gets refilled more or less steadily from a river, so water comes in and energy goes out in a sustainable cycle.  However, if the electrical demands of the city increase or the inflow from the river decreases such that the level of the reservoir starts going down over time, that water->energy conversion can’t be sustained.  If that dynamic continues too long, eventually, there won’t be enough water behind the dam to power the turbines and there won’t be any electricity for the town.

Self-regulation works in a similar way.  Every day, our bodies produce neurotransmitters and hormones that allow us to think and feel and make decisions and take actions — that’s the river.  Those molecules then get used as we think, feel, decide, and act — that’s the water spinning the turbines — and the consequences of those thoughts, feelings, etc. manifest in our lives — that’s the town.†  Normally, there are plenty of these neurochemicals for the stuff we need to do on a daily basis, however, when the demand on us goes up or our body’s ability to make them is impaired, we run a deficit.  Like the hydroelectric dam, we can do that for a while because most of the time we have a good surplus, but if that deficit runs on long enough, our body starts sending us notices and even alarms in the form of fatigue, confusion, irritability, insomnia, and other distress symptoms.  If we don’t address the deficit, we eventually burnout — no more water behind the dam — becoming so depleted that we can’t hardly act at all and are forced to rest and recuperate, often resulting in a chaotic fallout of undesirable consequences.

I like this model because it conveys a critical point:  we are physical beings with limitations.  Yes, I believe in free will (a central component of the existentialist aspects of my orientation), but will, as in “force of will,” only gets you so far.  Just like a car can go a lot of places but run out of gas, a person has choice but can run out of self-regulation resource, no matter how willful they are.

What does this mean practically?  We avoid burnout by first recognizing it as a thing, acknowledging that we have to “feed the machine” in order for us to accomplish what we’re up to.  Second, by identifying the limits of our particular machine, we can account for them; if I want to fly to the moon, I’m going to have a much better chance of figuring out how to get there if I know that simply flapping my arms won’t work.

From here, we can start to take an inventory of credits and debits and get a sense of how to steward our self-regulation reservoir.  In terms of credits — think water coming into the reservoir — basic things like sleeping and eating habits are always worth looking at.  Also consider what you’re doing for fun — are you getting down time, both active (e.g., hobbies, sports, projects, socializing) and passive (restful behaviors like reading, watching TV, cuddling with a loved one)?  What raises the shoreline on your lake?  I think it’s important to start with what’s coming in, as we can often find small things that add up to make a big difference without even worrying about what’s going out.

That said, debits are important, too; ultimately, this model is about making sure that what’s going out covered by what’s coming in.  Once you’ve got your resources optimized, if you still find yourself at a deficit, take a look at the demands on you, what the town is expecting the turbines to power.  In the cases I’m talking about here, some of the demands — like the big project at work or the newborn that just joined your family — can’t be cut back without unacceptable consequences.  Instead, look to reduce other debits:  maybe the house doesn’t get cleaned as often as you like or that friend you were helping out has to wait a bit, things that have lower stakes that you can drop temporarily to husband your energy for the Big Demand.

There are also less obvious, but possibly more potent debits to look out for.  For example, simply resisting our circumstances costs us.  Take that big project at work:  I know I’m going to participate in it (my boss told me I will and I’m choosing to do what she says so I can keep my job), but doing so and then complaining about it only means I’m expending energy that’s counter to what’s actually happening.  I may genuinely not like the project, but that’s different from actively resisting it by complaining, wishing things were different, avoiding the tasks, etc.  In our metaphor it’s like maybe the guy who’s pushing for housing development in the town is also dumping concrete in the dam’s power ducts.  This kind of resistance is something that we all do and it can be overt, subtle, and even unconscious, but it expends effort, which drains our limited resources.

How does one avoid debits like this?  The short answer is a kind of mindful acceptance.  I’m not suggesting we roll over and resign ourselves to an unworkable happenstance, but rather to practice choosing what’s happening instead of being a victim of it.  It’s about one’s orientation to one’s situation.  It’s developing a habit of recognizing and taking ownership of what one is doing; if we make it our choice — “I was voluntold for this project, but I’m choosing it because I want to keep my job” — it helps us to let go of fighting what we’re doing anyway.  Examining one’s own behavior and attitude to identify and let go of this dynamic wherever it might show up can save precious resources and slow or stave off burnout.

A lot of deficit running can be remedied through these tools.  However, we can occasionally find ourselves in a position where we’ve maximized our input and the output can’t be cut down to a manageable level.  In those cases, the math becomes very simple and, at some point, we’re going to run out of water for the turbines.  Our common response to this awareness is to continue charging ahead and hope that our resources hold out long enough to finish the project.  In my experience, more often than not, they don’t and when that happens, our burnout results in unnecessarily messy losses.

It doesn’t have to be that way.  If we see the crash coming and are honest with ourselves that we’re going to drop some balls, we can be mindful and planful about which balls we drop and the consequences of doing so, thus limiting the cost to ourselves and to others.  For example, when I worked in a community mental health clinic, there was a period during which the demand on psychologists was unsustainably high.  I tried to keep up with it, but couldn’t and ended up getting sick a lot.  Each time I did and called out, the admin staff would have to scramble to reach my patients to let them know that I was out and then those patients who were planning to get help that day unexpectedly did not get it.  On top of that, the time off I was taking was being spent recovering from whatever nasty bug my overtaxed system had failed to protect me from, which was hardly a repleting way to spend that time and I ended up feeling even more exhausted when I returned to the clinic.  After a few months of this, I decided to adopt a new strategy:  I scheduled one extra day off per month.  I would do this well ahead of time, so my patients knew I was going to be away and we could find alternative times to meet and it didn’t burden the already busy admin staff.  On my days off, I was able to do things that replenished me, so when I came back to the office I was actually refreshed and ready for my heavy caseload.  I was still losing days at work, but being intentional about it meant it was more sustainable.

So:  if you have more going out than coming in, first look to see how you can get more coming in, then consider what demands you can reduce and how you might be resisting your situation (doing it but acting the victim of it).  If that doesn’t get you to a balance, you may have some tough decisions to make:  choosing which balls you’re going to drop.  The best way to avoid burnout it to see it coming; once you have, you can account for it.

Mindful self-awareness is the key.  Pay attention to your needs and make sure you’re getting them met in appropriate ways.  Not only will you be less distressed, but your loved ones will appreciate it.

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*This is not a technical term, nor is it a diagnosis.  I’ve met psychologists who eschew the word and I consider their arguments against it, especially that it’s not scientifically precise, as fair.  I use it here and in my practice, though, to refer to a particular dynamic that can get set up in our lives and I find that it’s a practical and effective name for it.  Additionally, I talk about burnout using the language of self-regulation resource and ego depletion theory.  This essay isn’t about the technical aspects of ego depletion nor is it a place to debate the strengths and weaknesses of the theory; rather, I use some of the ideas and terms as practical vocabulary for approaching a common subjective phenomenon and how, operationally, an individual might cope with it.

†This is oversimplifying quite a bit, but stick with me; the model works.