In honor of my upcoming interview with Joan Borysenko on Conversations with the Masters next week, I wanted to share this article, excerpted from Joan’s Inner Peace of Busy People, September, 2003.
Beating Stress and Burn Out by Joan Borysenko
“Remember-your to-do list is immortal. It will live on long after you’re dead.” -Joan Borysenko
A Stressed Society
Comedian George Carlin quipped that he went into a bookstore and asked the clerk where the self-help section was. She refused to tell him since that would defeat the purpose. He could probably have followed the scuffs on the floor. In the year 2000, Americans spent $563 million on self-help books. It’s little wonder. Approximately one in three people are sleep deprived, complaining of exhaustion and trouble holding things together. We are an anxious and worried culture. Between 1990 and 1997, the number of doctors’ office visits for anxiety increased by 31 percent. The visits for panic disorder more than doubled (ibid). Approximately 12 percent of Americans are depressed, and another 10.2 percent have chronic “low mood.” Seventy to 90 percent of visits to primary-care physicians are attributed to stress. And many more people suffer outside doctors’ offices where the statistics are gathered.
Burnout in Health and Helping Professionals
Unfortunately, many of the people who suffer in doctor’s offices are the health-care providers themselves. Some are so stressed that they have proceeded to the advanced state of exhaustion called burnout, which is a condition of mind, body and spirit that is distinctly different from stress.
Dr. Archibald Hart, writing for both clergy and other helping professionals makes some of the following distinctions. While burnout is a defense characterized by disengagement, stress is characterized by over-engagement. In burnout emotions become blunted, whereas the stress response is more likely to involve emotional over-reactivity. Whereas burnout produces helplessness and hopelessness, stress produces urgency and hyperactivity. And while both states can lead to depression, the depressions have distinct etiologies. Depression in burnout is secondary to the grief experienced over loss of one’s ideals. In stress, the depression is related to the physical need to conserve energy and protect the body. And while stress can lead to panic, phobic and anxiety-type disorders, burnout is more linked to paranoia, detachment and depersonalization.
Burnout and Loss of Relationship to Self
I think of burnout, which will be more fully defined below, as a critical and dangerous loss of relationship to self. And when the self is lost, there is no longer any possibility of having an authentic relationship with another person. The loss of empathy and the resultant perception of other people as problems to be dispatched rather than as human beings to be evoked, is one of the hallmarks of burnout.
The term burnout was coined in reference to professionals in human services-where individuals entered their work with a high degree of idealism and high expectations of helping people and doing meaningful work. Yet they encountered demand from clients that they could not meet, were frustrated by the bureaucracy, and sensed that their skill and dedication were not appreciated. As a result, they withdrew emotionally from colleagues and clients, became apathetic, thought of their work only as a means of making money, and lost interest, energy, and dedication. They became burned out. As a result, they withdrew emotionally from colleagues and clients, became apathetic, thought of their work only as a means of making money, and lost interest, energy, and dedication. They became burned out. -David E. Hartl, Ed.D.
The literature on burnout and “compassion fatigue”-the “cost of caring” for others in emotional pain- has burgeoned in recent years. Several studies have shown that the longer people work in the helping professions, the less they tend to enjoy their occupation. The result is a distancing from the patient or client, the opposite of the relationship-centered caring that we seek to provide. Doctors, lawyers and clergy are at particular risk for burnout and have the most problems with drug abuse, alcoholism and suicide, Nurses, nursing home workers, and any healthcare professional who cares for a population where there is significant pain, trauma and likelihood of deterioration and death are also at significant risk for either high stress or burnout. It’s easy to forget that life is filled with joy and blessing when your work provides a steady diet of suffering.
Dr. William Cone, a psychologist who specializes in stress management cites data (see footnote 5) showing that RN’s actually have lower rates of burnout compared to nurse’s aides and LPNs. This is attributed to the higher workload for the lesser trained healthcare providers. Burnout, at its core, has been defined as overload, having more to do than you can possibly cope with. In a society where “crazy busy” is the watchword of the day, the healthcare provider is on a particularly crazy-making treadmill. With the advent of managed care, and the need to see more patients in less time, demands on healthcare workers have increased to proportions that often become unmanageable for any sustained period.
Insurance forms, bureaucratic hassles, information overload and the need to keep up with rapid advances in one’s field is incredibly time-consuming. Add family and community responsibilities to the mix, and the strain can be overwhelming. It is all too easy to put ourselves last on our own list, taking care of everybody else’s needs without considering our own. Cone cites lack of professional recognition as another a factor in burnout. He writes, “Some companies feel that paying people for their effort is reward enough. Nevertheless, research shows that money has never been the primary motivator in work. One of my clients once told me, ‘If all I cared about was money, I’d be a hit man. The pay’s good, the hours are great, and if my clients die, I feel successful.'”
In Burnout-The Cost of Caring, author Christina Maslach defines burnout as “a state of physical, emotional and mental exhaustion marked by physical depletion and chronic fatigue, feelings of helplessness and hopelessness, and by development of a negative self-concept and negative attitudes towards work, life and other people.” She offers five cardinal signs: keeping up the usual speed becomes more and more difficult as energy gets depleted; feelings of vocational failure creep in; the work seems less and less rewarding in proportion to all the effort invested in it; a sense of helplessness to change things takes over; and finally, innocence is lost. Cynicism about one’s self, other people, society and the world holds up a pervasive negative lens to life.
How ironic that idealistic people with the highest motivation to relate in an empathetic, healing manner through their work are most at risk for loss of self, and in the process, the physical, emotional and spiritual apparatus of caring. Most helping professionals who are burned out could write a paper on how to avoid burnout. It’s not that we don’t know what to do; it’s that too many of us simply don’t do it. Another factor in self-neglect is simple denial. It’s easy to brush off exhaustion, depression, and overwork by doing what we do best-working harder and longer.
This might lead to what humorist Loretta LaRoche writes of in her book Life is Not a Stress Rehearsal -a tombstone that states, “Got everything done, dead anyway.”
Strategies for Maintaining the Relationship to Self
In response to my own encroaching sense of burnout, I did what many helping professionals are prone to do. I wrote a book to help other people with the problem I was having. It is called Inner Peace for Busy People: 52 Simple Strategies for Transforming Your Life. The book takes physical, emotional and spiritual self-care skills to a simple level that is hard to resist. Most of the strategies take very little time, other than the suggestion that every person could kick their life into a whole new orbit by taking off one day a week as a real Sabbath. By this I mean a day to drink deeply at the well of faith, family, friends, joy and rest, not a day to catch up on errands.
Every day brings a choice: to practice stress or to practice peace. The good news is that finding inner peace, and sustaining a strong relationship to self, doesn’t require hours of daily practice. You don’t have to stand on your head or stare at your navel. All it takes is a little willingness and common sense. Life is a precious gift to be savored, not an endless series of chores to complete while you complain about being “crazy busy.” Remember – your to-do list is immortal. It will live on long after you’re dead.
Relax and Be More Productive
(Excerpted from Chapter One of Inner Peace for Busy People)
When I was directing the Mind/Body Clinical Programs, a stress-disorders program at what is now the Beth Israel Deaconess Medical Center in Boston, many of the participants were high powered executives. A little brush with a heart attack or cancer had them knocking reluctantly on my door. They wanted to use the power of their mind to heal, but were afraid that learning to relax would take away their competitive edge and dull their motivation. Visions of transcendental zombiehood danced through many minds. Some feared that they would have to trade their three-piece suits for a turban, and a lifetime of navel-gazing and herbal teas. More than once I heard the sentiment that it might be better to forget the whole thing and just die in the saddle.
My department chief and mentor, cardiologist Herbert Benson, M.D., knew better. In the late 1970s, he wrote an article for the Harvard Business Review featuring an arcane, but immediately obvious, relationship called the Yerkes-Dodson Law. Don’t let the words scare you. Named after two intrepid physiologists, this handy little law looks like an upside-down letter U on a piece of graph paper. As stress increases (the x axis), so does productivity (the y axis). In other words, the more stressed you are, the better your output until you get to the top of the curve, where the upside-down U is poised to start down again. From there it’s a rapid downhill slide to poor productivity. Whereas mild to moderate stress helps us power through to-do’s, more serious stress gives rise to the un-do’s.
Let me give you a down-home case in point. If company is coming in an hour and the house is messy, I feel slightly stressed, and challenged to clean up so as to avoid looking like a slob. I get a certain look in my eye, and swoop into action like the white tornado. My husband, Kurt, calls this “getting initialized.” My output is truly unbelievable. Like a thousand-armed goddess, I vanquish the dirt and sort the piles. But suppose, on a particularly bad dirt day, I find out that company is coming in ten minutes. The stress is so great, and the job seems so big, that I’m likely to get flustered and confused. I may then be found wandering around the house, looking dazed, with the same pile in my hand for several minutes. My internal wiring is sizzling, and smoke seems to be coming from my ears, because the load on the circuits is too large.
I believe that most busy, highly productive people operate in the high-stress range, somewhere on the descending limb of the stress/productivity curve. Their output is still high, but the internal wires are starting to short-circuit and burn. If they learned to relax and shifted back to the left on the Yerkes-Dodson curve, they would find themselves nearer to the top of the inverted U. Their output would actually be greater, while the toll on their body would be lessened. If they relaxed even more-to a point where it seemed like the turban was only another breath away-they would still be able to maintain the same output they had before, when they were burning out.
The only workable strategy for maintaining productivity over the long haul is to learn how to relax. There are literally thousands of ways to do that. My hope is that this book will give you suggestions that appeal to your unique physiology and preferences. I don’t know what relaxes you, and neither does anyone else. You are the best and only judge of what it is that shuts off the internal dialogue that’s always urging you to do more, do faster, and do better. But shut off the internal dialogue we must, if the clever system of body and mind is to restore itself and be available in its full power.
This week, put aside an hour a day – yes, I really mean that – to relax in whatever way you enjoy. You will find that instead of constricting the amount of time available for you to get things done, the day will seem to unfold in a more languorous, spacious way. The to-do list will still get done, but you will live to tell about it.